How liberal are you with antiemetics?

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Fox800

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A while back we had a thread with several medics advocated withholding antiemetics from drunk patients to "teach them a lesson". I figured we could expand that conversation a little. How liberal or conservative are you when it comes to antiemetics? Do you give them preemptively (pt. hasn't vomited yet but feeling queasy)? Do you give them before backboarding patients that are intoxicated and queasy (think airway compromise once you've got them strapped to your cot and alone in the back). What does your service carry?

Personally, I give Zofran out very frequently. If someone is nauseated, they're getting Zofran (usually). I give it preemptively to make my patients more comfortable, prevent airway issues, and make life easier for my partner who would have to clean up the vomit in the truck. Keeps my uniform clean, too. Our protocol is ondanestron 4mg IV/IM.
 
TransportJockey

TransportJockey

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When I've worked under a scope I can give them, I was pretty liberal with them. I don't wanna have to clean up the mess, plus it keeps my patients a little more comfortable
 
reaper

reaper

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If they need it, they get it.
 
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dmiracco

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Fox800

I agree with all your reasoning of why to give it and how often. We can give zofran or phenergan its the medics preference.
ME personally if you havent yacked but fell like it Ill probably give zofran but if you are currently yacking Ill probably give you phenergan.
 
Shishkabob

Shishkabob

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We used to have Phenergan that we could give IV/IM. New protocols came out and now we replaced Phenergan with Zofran IV.


Sad thing is, according to our protocols, Zofran is "Not indicated" for pedis... just adults. Now I don't have an anti-emetic for kids. Guess I'll have to call med control if I get a pedi who's nauseated and see if they'll clear pedi Zofran.

One part of our protocols says 2-4mg IV, and 4mg deep IM, but every other part states only IV Zofran, so I'll have to clear that up with a supervisor...




I'd MUCH rather have PO Zofran.
 
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dmiracco

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Ya that sucks and you can give zofran to peds typically its weight based until you reach 4mg the adult dose.
We also carry zofran ODT and we give 8mg for adult because typically the range is 4-8mg. Typically for peds its 8-30kg you can give up to 4mg.
 
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Fox800

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Linuss said:
We used to have Phenergan that we could give IV/IM. New protocols came out and now we replaced Phenergan with Zofran IV.


Sad thing is, according to our protocols, Zofran is "Not indicated" for pedis... just adults. Now I don't have an anti-emetic for kids. Guess I'll have to call med control if I get a pedi who's nauseated and see if they'll clear pedi Zofran.

One part of our protocols says 2-4mg IV, and 4mg deep IM, but every other part states only IV Zofran, so I'll have to clear that up with a supervisor...




I'd MUCH rather have PO Zofran.
Click to expand...


I hope that was a mistake/oversight by your medical director(s), and if not then that's a huge FAIL. :excl:
 
Sandog

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A while back we had a thread with several medics advocated withholding antiemetics from drunk patients to "teach them a lesson".
Click to expand...

This thinking seems rather unethical to me. Considering that the AMA has recognized Drug dependency and alcoholism as a disease.

"The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice."
Click to expand...
http://en.wikipedia.org/wiki/Disease_theory_of_alcoholism

If one considers that the Disease theory of alcoholism to be real, then would not this person deserve the same considerations and care that would be shown to a patient with cancer?
 
NomadicMedic

NomadicMedic

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I'm in the same boat, pretty liberal with antiemetics. Even a hint of "quease" gets a dose. The last place I at used 12.5mg of Anzemet as the front line antiemetic. I hadn't heard if it 'til i got there.

Worked great.

(I also had phenergan in my box, but only used it when I wanted to potentiate a little Morphine for a fracture PT.)
 
8jimi8

8jimi8

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Linuss said:
We used to have Phenergan that we could give IV/IM. New protocols came out and now we replaced Phenergan with Zofran IV.


Sad thing is, according to our protocols, Zofran is "Not indicated" for pedis... just adults. Now I don't have an anti-emetic for kids. Guess I'll have to call med control if I get a pedi who's nauseated and see if they'll clear pedi Zofran.

One part of our protocols says 2-4mg IV, and 4mg deep IM, but every other part states only IV Zofran, so I'll have to clear that up with a supervisor...


I'd MUCH rather have PO Zofran.
Click to expand...

Why would you give a PO anti-emetic? That doesn't make any sense to me whatsoever, bro!
 
Shishkabob

Shishkabob

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Lets see,

Don't need an IV
Don't need to stick a patient with a needle
It works.
I can load it on any patient that complains of nausea at anytime.
 
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Fox800

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8jimi8 said:
Why would you give a PO anti-emetic? That doesn't make any sense to me whatsoever, bro!
Click to expand...

I know they make a fast-dissolving Zofran, it melts in your mouth. At least that's what one service I used to work for uses.
 
8jimi8

8jimi8

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Linuss said:
Lets see,

Don't need an IV
Don't need to stick a patient with a needle
It works.
I can load it on any patient that complains of nausea at anytime.
Click to expand...

sublingual makes sense, but I never undrstood giving enteral medications to people who were about to throw up. See what I'm getting at?
 
BLSBoy

BLSBoy

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You say you feel queezy, I am on the line for orders for Zofran (thank you NJ MICU protocol.....<_<)
 
8jimi8

8jimi8

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