Zofran and ACS

[vquintessence]

When you all out there bust into the narcs regarding ACS, what is the general consensus on preventively administering Zofran "to stay ahead of the game"? I mean, N/V can be a manifestation of ACS in and of itself... but now we've throw analgesics into the situation? Anyways, aside from the answer "every situation is unique", can anybody give a general yes or no opinion on the matter? I know, I know, this is medicine and there are never "yes" or "no" answers... but for selfish and debating purposes, could we try it.

Personally I'm extremely sensitive to analgesics; even low doses PO will make me nauseous... I've opted for pain, simply to avoid the nausea. That said, it's safe to say I'm biased toward a more pro-active prevention of N/V, especially when analgesics enter the game.

Typically the decision will boil down to: if there's NKA and no serious hepatic compromise... the pt gets it. Recently my thinking has been audited, and I'm curious about any positions for or against. This is no attempt to vent or cry about the audit, I'd just would like to walk away wiser to differing opinions.
Thanks as always!

[marineman]

When I was doing clinicals in the ER it was standard that any patient that was getting analgesics would get 4mg Zofran first.

On the street it's medics choice, in our protocols it's listed as a special note "consider Zofran prior to morphine" as a reminder that it's an option but not required. I usually will give it but it really does come down to patient presentation and if there are more pressing things that I need to get done the Zofran takes a back seat unless patient already has N&V.

[medic417]

If you eliminate the stress of N&V you lesson demand on heart lessoning the damage that is occurring. So yes use Zofran or other to help N&V.

[OklaEMT]

I will usually ask the patient if they get nauseated easily or have had N/V with other pain medications.... if there is a 'yes' then you definitely get Zofran. Otherwise, I'm afraid I have to go with 'depends on the situation'

[Linuss]

If you have Phenergan, obviously use that first so that you don't potentiate the morphine too much.


I, myself, would give Zofran or phenergan proactively, as feeling N/V is never fun.

[Ridryder911]

Actually, newer studies are revealing Phenergan does not potentiate as much as once was thought. As well, Zofran is a great anti-emetic as long as they are not currently nauseated. In other words great for prophylactic use. The reason is used with great use in Chemotherapy patients (why it was developed).

Personally, I have seen Zofran work very few times, after the patient had became nauseated or have vomited in comparison to other anti emetics.

R/r 911

[triemal04]

Originally Posted by medic417

If you eliminate the stress of N&V you lesson demand on heart lessoning the damage that is occurring. So yes use Zofran or other to help N&V.

Kind of like using analgesics other than morphine for cardiac chest pain. I don't see how this could be a problem, especially if you are using morphine to manage their pain. There is a good, valid reason to give it so...vquintessence, did you actually get in trouble over this, or just called on to defend your thinking?

[ResTech]

If I understand correctly, anti-emetics aren't a "one size fits all". Depending on the cause of the nausea and which neurotransmitters are involved will likely determine how well a particular patient responds to a given anti-emetic. This is largely due to anti-emetics targeting and inhibiting the binding of the different neurotransmitters at different receptor sites which turns off the "nausea & vomiting" signal to the CTZ and vomiting center in the brain.

Nausea from motion responds well to anti-emetics that block histamine and acetylcholine. Chemotherapy patients respond better with anti-emetics that block serotonin such as Zofran.

One doc in the hospital I do clinicals always order Droperidol for nausea while the other docs mostly order either Zofran or phenergan... mostly Zofran.

Phenergan has dropped out of favor in many hospitals and pre-hospital given the high profile cases of its damaging effects with extravasation. It is highly vesicant and can be very damaging if not administered properly.

[Smash]

Only about 5% of patients receiving IV morphine will develop nausea from the morphine.

If they have nausea, I treat it. I don't prophylactically give more drugs unless I have a reasonable expectation that they will develop nausea.

[OklaEMT]

Originally Posted by Ridryder911

Actually, newer studies are revealing Phenergan does not potentiate as much as once was thought. As well, Zofran is a great anti-emetic as long as they are not currently nauseated. In other words great for prophylactic use. The reason is used with great use in Chemotherapy patients (why it was developed).

Personally, I have seen Zofran work very few times, after the patient had became nauseated or have vomited in comparison to other anti emetics.

R/r 911

I will definitely second that..... once they start vomiting, it is hard to catch up with Zofran. Unfortunately, that is the only anti-emetic that we carry (unless you count Benadryl). Which I will say, I worked at a service once that only used Benadryl, they didn't carry any other anti-emetics. It works surprisingly well.