Zofran (ondansetron)

[rescuebill]

For all of those who would suggest to just "let them puke, it's just a little clean up, so be a man and clean it up" I submit for your consideration that it's not just about clean up.

It is also about possible exposure, and lenght of clean up. While I am cleaning up, I am not available for another call, one which may very well be a legitimate emergency, and one in which my timely interventions can make a difference, but remember I'm stuck at the ER mopping up puke.

And what if I get hit by flying puke, now in addition to cleaning up my truck, I have to change my uniform ( at a minimum ) and possible take a shower, so now I'm out of service even longer, all because I wanted a drunk to learn a lesson which is not my job to teach !

Here's a thought, how's about we treat our PT's, according to our respective protocols and leave our thoughts and feelings about every thing else in the locker before getting on the ambulance

 

[alphatrauma]

1. Alcohol gets absorbed almost instantly upon entering the stomach.

2. Letting the patient vomit all over the place will unlikely effect the level of alcohol in the body.

You are incorrect on both accounts. Alcohol absorption is dependent on how quickly the stomach empties into the small intestine. Many factors can influence this, food being a major one. The presence of food will cause the pyloric sphincter to close, to allow for the proper breakdown of food, thus delaying intestinal absorption. Vomiting can facilitate the emptying of the stomach (read: alcohol), and prevent the absorption of the expelled contents. So what if you have to clean up the back of the truck... big deal if you need to change clothes or stay "out of service" a little longer.

A strategically placed emesis receptacle IS your friend.

Wait a minute, what am I thinking... if it's in the protocol to use, I'll just give it.

 

[18G]

Actually, alcohol absorption begins as soon as it enters a persons mouth. The mucosa absorbs alcohol and it rapidly transfers across the stomach and small intestine.

Yes, food effects absorption rate. But if your being called for an "alcohol overdose" (common dispatch around here) and the patient already has a level of alcohol sufficient to cause significant N/V and obtundation, letting them vomit is probably not gonna effect their recovery time.

Protecting the obtunded patients airway and limiting exposure to the patients emesis is more wise in my opinion.

Perhaps neither train of thought is actually wrong. It does make sense about eliminating some of the contents of alcohol in the stomach through vomiting, but the patient has already absorbed a lot of the alcohol and having them vomit will not change their condition during the time EMS has the patient. But will make it worse for them and the EMS providers.

I think its more of the mentality surrounding letting the patient be nauseous, vomit, and punish the patient for their action that is bothersome.

 

[mycrofft]

Well, we've been using IM and PO Zofran for a little while now.

Not better than Tigan, much more expensive. Jury is still out about drug interactions, side effects, etc.

 

[Alaska Dustoff]

Zofran

My flight service uses both Zofran & Phenergan. We got a good read from the pharmacy on uses:

1. If they aren't puking yet, Zofran has its greatest effect.
2. Already puking, Phenergan is better. Drug rep for Zofran even says it's less effective once puking starts.

So that's how we use it. All the way up 12mg total PRN. Especially useful for the head-bonk types who start puking as reflex anyway.

If there's a lot of anxiety or agitation along the need for an antiemetic, we like phenergan better, with the sedation effect it provides. A lot of time if I can wipe out the anxiety, the puking center in the brain becomes happier (and my partner is much happier!).

 

[javajunkie]

Zofran "Undesired Effects"

I know for most people Zofran's a godsend, but keep in mind it's still a drug that can have side effects.

I was given IV Zofran after surgery with morphine, and immediately started vomiting. After 24 hours on Zofran (and nothing else for 12 hours), my mother (RN) finally figured out the Zofran was the problem. Sure enough -- no Zofran, no emesis! The morphine never did make me queasy... I now keep Zofran on my "please don't give me" list and put up with phenergan's drowsiness.

 

[TransportJockey]

We use Zofran in the ER more than any other anti-emetic. Great drug. And if we're transferring a pt a long distance, we tend to give them benadryl to help with the motion sickness. Seems to work well. The local services carry phenergan only.

 

[Alaska Dustoff]

Individual Drug Reactions

For Java Junkie: As with any medication there can be sensitivities. You may have found yours. You also may have had nausea already, which is a point for phenergan rather than zofran. It's still a great drug for the pre-nausea, pre-vomiting patient. At least folks don't mix atarax with phenergan anymore...

 

[alphatrauma]

Actually, alcohol absorption begins as soon as it enters a persons mouth. The mucosa absorbs alcohol and it rapidly transfers across the stomach and small intestine.

The amount of alcohol absorbed through the oral mucosa is infinitesimal, compared to the rate of absorption through the small intestine. Roughly 20% is absorbed in the stomach, with a contrasting 80% at the small intestine.

Yes, food effects absorption rate. But if your being called for an "alcohol overdose" (common dispatch around here) and the patient already has a level of alcohol sufficient to cause significant N/V and obtundation, letting them vomit is probably not gonna effect their recovery time.

Suppressing vomiting with pharmaceuticals (or anything for that matter) is not indicated here. And vomiting WILL affect the recovery time/overall long-term outcome. Why continue to allow alcohol to be introduced into the small intestine, when the body is NATURALLY attempting to get rid of it... other than fulfilling one's own sense of self-importance or getting one's protocol gun off?

Protecting the obtunded patients airway and limiting exposure to the patients emesis is more wise in my opinion.

Protecting an airway is very important!

Dodging emesis... not so much

Perhaps neither train of thought is actually wrong. It does make sense about eliminating some of the contents of alcohol in the stomach through vomiting, but the patient has already absorbed a lot of the alcohol and having them vomit will not change their condition during the time EMS has the patient. But will make it worse for them and the EMS providers.

Just because the patient has absorbed a lot, does not mean that we should allow it to continue by suppressing vomiting. Of course there are some who are only concerned about the time they spend with the patient, and could care less about what happens after they clear and return to service. But there are consequences to everything we do, whether some want to acknowledge it or not.

I think its more of the mentality surrounding letting the patient be nauseous, vomit, and punish the patient for their action that is bothersome.

Punishing a patient is never justified, but ignoring the body's
natural/therapeutic processes isn't either.

 

[Aidey]

Suppressing vomiting with pharmaceuticals (or anything for that matter) is not indicated here. And vomiting WILL affect the recovery time/overall long-term outcome. Why continue to allow alcohol to be introduced into the small intestine, when the body is NATURALLY attempting to get rid of it... other than fulfilling one's own sense of self-importance or getting one's protocol gun off?

I had a discussion with a doc the other day about this and giving pill OD patients Zofran along with their charcoal. He said if we are giving charcoal, he would rather the patient get an anti-emetic and keep the charcoal down than puke it all back up, even if throwing up will remove some of the pills.

Punishing a patient is never justified, but ignoring the body's
natural/therapeutic processes isn't either.

I agree with the body's natural process thing. Some people want to give every single person who has nausea Zofran, and I don't understand why. Sometimes in life a person is going to be sick and nauseous, and they may even throw up. It's a natural reaction. The issue is when a person can't stop throwing up, or you need them to keep something down (like charcoal, or the GI cocktail).

 

[Aidey]

Double post, oops.

 

[PrincessAnika]

from a pt standpoint....during PG i was on phenergan for N/V....worked for a couple months, then no more. got zofran in the ER....once PO, once SIVP - both times worked better than any cocktail i could come up with of phenergan/reglan at home....unfortunately couldn't afford to get a script of zofran, and melting stuff under my tongue usually induces vomiting for me anyway. but as a pt it worked great!