Inter-facility Considerations Nausea and Vomiting

[18G]

This is a pretty good article from medic1pharmacology.com on, "Inter-facility Considerations for Management of Nausea and Vomiting".

I am always proactive in assessing my patients for nausea as an IFT Paramedic. Many times a patient doesn't always report their nausea and suffer unnecessarily. So, the article is pretty right on with all of its points and goes over the physiology of nausea which is a good review.

http://www.medic1pharmacology.com/2014/12/inter-facility-considerations-for.html

 

[gonefishing]

This is a pretty good article from medic1pharmacology.com on, "Inter-facility Considerations for Management of Nausea and Vomiting".

I am always proactive in assessing my patients for nausea as an IFT Paramedic. Many times a patient doesn't always report their nausea and suffer unnecessarily. So, the article is pretty right on with all of its points and goes over the physiology of nausea which is a good review.

http://www.medic1pharmacology.com/2014/12/inter-facility-considerations-for.html

I always throw em on 02 and presto! No more nausea. It's amazingly hard to explain to a newbie or a nurse.

 

[TransportJockey]

I just give out zofran like candy lol. But good page. I have never seen that one before

 

[NomadicMedic]

"Do you ever get sick to your stomach when you take pain medicine or ride in the car?"

Yes? Blam! ZOFRAN!

I believe in heading puke off at the pass.

 

[MonkeyArrow]

In hospital here, no provider will order any pain med without Zofran. They go hand in hand nicely; haven't yet seen someone puke from being given narcotics.

 

[NomadicMedic]

I still pine for the days of phenergan and morphine together. That was the best pain management combo I'd seen.

 

[Carlos Danger]

In hospital here, no provider will order any pain med without Zofran. They go hand in hand nicely; haven't yet seen someone puke from being given narcotics.

it happens. Ondansetron is only about 20% effective by itself in high risk populations.

OTOH, N&V risk is low in non-high risk populations. It's overkill to give it to everyone who gets narcs.

 

[Tigger]

"Do you ever get sick to your stomach when you take pain medicine or ride in the car?"

Yes? Blam! ZOFRAN!

I believe in heading puke off at the pass.

Amen. It's a very windy road between us and the hospital. Here you go maam, put this little guy on your tongue. It amazes me that more places do not allow EMTs to provide Zofran ODT.

 

[gonefishing]

Amen. It's a very windy road between us and the hospital. Here you go maam, put this little guy on your tongue. It amazes me that more places do not allow EMTs to provide Zofran ODT.

ARE YOU INSANE!?!?! THAT WOULD GO AGAINST EVERY RULE! (Sarcasm)

 

[Brandon O]

Any of you guys doing benadryl alongside opiates?

 

[DesertMedic66]

In my county (as of right now) we can not give Zofran until the patient complains of nausea or vomits. Even if we give pain meds we have to wait for the patient to have that complaint.

Now that we are using Fent instead of morphine it seems like a lot less of our patients experience nausea.

 

[DesertMedic66]

Any of you guys doing benadryl alongside opiates?

Base contact order. If we are lucky they will give it to us.

 

[H33]

We can, Sometimes we even do. Oddly this year they put benadryl in our nausea vomiting protocol as in with, our instead of zofran. I have actually tried it a few times and had good results.

 

[Carlos Danger]

Any of you guys doing benadryl alongside opiates?

Generally only with morphine....and only if I want them to sleep for a long time. +/- promethazine.

 

[MonkeyArrow]

Any of you guys doing benadryl alongside opiates?

We do not. Anecdotally in the ED, we do not give Benadryl as a general rule. Our providers would rather not treat if its minor (a small, isolated rash), give Decadron and put on a Medrol dose pack, or give IM/IV epi for something acute/semi-acute.
EDIT: And as stated in a previous post, Zofran with any sort of analgesia.

 

[johnrsemt]

"patient complained of nausea {10 years ago} so I gave him Zofran" Depends how you write the run report. (don't put in what was in the brackets). LOL
I ask patients if they get nauseated in mountain passes (and we have one between us and the ED) if they say sometimes they do; I give them Zofran as a preventative. If they sometimes get car sick riding facing forward, they will almost always do it riding backwards, even laying down. Never had a problem and the ED doctors seem to agree that it is better to stop it before it happens than wait, and the driver does too, since they have to clean up after runs

 

[18G]

We do not. Anecdotally in the ED, we do not give Benadryl as a general rule. Our providers would rather not treat if its minor (a small, isolated rash), give Decadron and put on a Medrol dose pack, or give IM/IV epi for something acute/semi-acute.
EDIT: And as stated in a previous post, Zofran with any sort of analgesia.

Benadryl is also an antiemetic. So instead of giving Zofran with the morphine to head off any N&V you could also give Benadryl. I think Benadryl is underused for its antiemetic property. Antiemetics are not a one size fits all so seeing how Benadryl is on every ALS ambulance why not use it?

 

[zzyzx]

Benadryl also appears to potentiate the high that drug seekers get from the opiates that they get in the ER. Or at least that is my anecdotal evidence based on the zillion times that I've been asked for it by an obvious drug seeker.

 

[18G]

Rule#101. it is not a Paramedics job to screen drug seekers from non-drug seekers.

 

[zzyzx]

Drugs are illegal. Im not going to facilitate someone obtaining a narcotic so they can get high.