Antiemetic article

[spenac]

I use IV Zofran quite a bit (much to the chagrin of admin as it is the most expensive despite now being the most expensive). It works great, even for those who are actively vomiting. I don't use it very often for migraines. I also use reglan, phenergan and compazine quite a bit. They all seem to be equally effective. I'm a big proponent of EMS anti-emetics. I would much rather have them vomiting on the floor of your ambulance than on the floor of my ER

We gave zofran to a patient on a transfer. No vomitting for the hour plus trip. Got to the hospital. Nurse got rude with us and said wait. Patient said they needed to puke. So I told nurse she said she would get with us when she got good and ready. Well patient said I can't stop I have to puke. Told him use that nice patch of hospital floor as the nurse was walking past. Was a wonderful sight. He got placed in his room real quick then.

[EMS49393]

One of the hospitals in our metro area has stopped the use of promethazine except in patients with a central line. Apparently the drug has a black box warning (nothing new) and has caught the attention of the lawyers. Our EMS medical director happens to be on staff at this hospital, and as a result of this has removed promethazine from our units and replaced it with the ondansetron. This generic alternative anti-emetic is not as expensive as one might believe. If cost were any sort of an issue, my EMS organization would scrap the anti-emetic altogether because we have short transports and limited resources. Two years ago this generic zofran was issued and cost me around $4 for a 4 mg vial. Its not as cheap as lidocaine, but it's not as expensive as amiodarone.

We still want to be able to provide this comfort measure for our patients. As a pretty regular GI patient myself, I am a big fan of anti-emetics and have had every one of them at one point and time. I have a pretty vested interest in helping patients not vomit. Phenergan works, no doubt about it. When I give it, I dilute it in AT LEAST 30 ml of saline and I give it slow with fluids running. Unfortunately, few providers take that sort of care with this drug. I've had Phenergan diluted and I've had menopausal nurses push that stuff full strength in less than 5 seconds on me. Aside from from the feeling that my arm was going to fall off, I now have absolutely NO venous access and require a PICC or central line every time I need a transfusion. I could blame Phenergan as a lot of people now do, but I won't because it's not the drugs fault, it is the fault of the person administering the drug. However, the lawyers don't buy that and in their endeavor to bring about yet another class action lawsuit against a drug manufacturer they have set out fliers asking that if anyone has had ANY adverse reaction to this medication they may be entitled to damages.

Now that I think of it, the fault is two-fold. Poor administration of the drug from equally crappy providers and lawyers.