Phenergan....good or bad?

[Ridryder 911]

I personally like administration of Phenergran, in fact I have not found anything much more effective antiemetic except good old Compazine. The problem is newbie Doc's have been burned by poorly trained staff in and how they administer it and to whom they administer to.

Zofram is only effective when administered prior to onset of nausea it was never designed as antiemetic, rather for chemotherapy treatments side effects when taken prior to onset of nausea, and it is very expensive !

Phenergran when diluted down, and administered s-l-o-w, can be effective and one has to be extremely cautious on giving to anyone over 65 years old. In fact, I will only give 6.5mg for people over that age, I have fought off delirium side effects too many times in ICU, until it wore off.

Other antiemetics should be explored such as Reglan (which it too has hostile s/e) an Benadryl.

R/r 911

[ERDoc]

In my experience Zofran is a little better at controlling nausea than phenergan. The problem is that Zofran (especially IV) is much more expensive. Whenver I order Zofran (IV or ODT) in the ER I can hear the beancounters cringing upstairs. It has gotten to the point where we get occasional nastygrams reminding us how much zofran costs. I like phenergan because of the sedative side effects. It works great on drug seekers, they are usually so out of it that they don't ask for more meds . Just to take the topic off track again, where I am currently at, if you come in and c/o pain most docs give you 2mg dialudid and 12.5 of phenergan. No wonder we have such a large drug seeking population ( :evil: ARGH!!). Nothing like being the candyman. Needless to say that I am not well liked among our seekers. I never give out dilaidid, unless there is true pathology.

[Spock]

I use zofran to prevent post op nausea and vomiting (PONV) but has already stated it must be given before the patient vomits. I give it routinely for certain cases such as any laparoscopy procedure. It does not work very well after the fact. Promethazine is effective but causes significant tissue damage if the IV infiltrates. The University of Pittsburgh published a report in a pharmacy journal reporting several cases of over sedation in patients who had received opioids and then promethazine for nausea. Promethazine is a potent antihistamine and they had a significant percentage of patients found unresponsive and nearly apneic after receiving both. The were using promethazine because there was a shortage of compazine.

Other drugs that work for PONV are dexamethazone, benadryl, anzemet, compazine, scopolamine patch, reglan, ephedrine and fluids. All have pros and cons. Many cases of PONV are related to volume depletion or hypotension. Granted this does not help in the prehospital arena but as Dust stated vomiting is seldom an emergency although the patient may argue otherwise.

Patients at high risk for PONV are young females and nonsmokers. For some reason smokers have a very low incidence of PONV. A dubious recommendation for smoking to be sure.

The last cost I saw for zofran was $16 for a 4mg vial. I think the nausea issue is a good reason to use fentanyl instead of morphine.

Live long and prosper.

Spock

[PRPGfirerescuetech]

Just got a memo that phenergan was removed from the squad trucks because of recent issues with tissue necrosis at the IV site.

Thoughts?

[Ridryder 911]

Just like any other potential necrotic medication a good IV should be in place, as well I always dilute it before administering. I have seen bicarb and D50w cause problems as well. I believe Valium as well is supposed to be administer above the hand due to potential damage, (not sure if it necrotic or circulatory)

R/r 911

[mediccjh]

Just like any other potential necrotic medication a good IV should be in place, as well I always dilute it before administering. I have seen bicarb and D50w cause problems as well. I believe Valium as well is supposed to be administer above the hand due to potential damage, (not sure if it necrotic or circulatory)

R/r 911

You beat me to it bro!

[Asysin2leads]

WARNING WARNING ---EMT CURRICULUM BASHING ABOUT TO OCCUR (NOT EMTs, BUT THE CURRICULUM

I didn't think EMTs in class these days even knew what a nasal cannula was, much less of whether or not you have a choice.

High flow O2 Non rebreather for everything, right? Cause too much O2 never hurt anyone and it doesnt matter what the problem is, everyone gets it!!

WE NOW RETURN TO OUR REGULARLY SCHEDULED DEBATE ON PROMETHAZINE

Nasal cannulas, the things that go flying through the air while I say loudly "Why the f--- do w have so many nasal cannulas in the cabinet?"

[Dustdevil]

Nasal cannulas, the things that go flying through the air while I say loudly "Why the f--- do w have so many nasal cannulas in the cabinet?"

That happens because the EMT in supply doesn't know the difference between a nasal cannula and oxygen tubing, so everytime you order oxygen tubing, they send you more nasal cannulas.

[1EMT-P]

I have used IM/IV Phenergan in the field since the mid 90's & I have never had a problem with it. I usually give adults 12.5 to 25 mgs IM/IV, unless they are older then I give 6.25 mgs slowly. I usually dilute the phenergan with normal saline before

administration.

Other Alternatives: Benadryl, Compazine, Droperidol, Reglan, Tigan & Vistaril.

[windsong]

Zofram is only effective when administered prior to onset of nausea it was never designed as antiemetic, rather for chemotherapy treatments side effects when taken prior to onset of nausea, and it is very expensive !

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Metoclopramide HCL as I was told was also used for chemo patients when taken prior to onset of nausea, as for the expense of it, I dont recall how expensive it is but it isnt reccomended as much as bendryl or gravol is, but a really good friend of mine who is on morphine and has been for a very long time, I told her about HCL and she spoke to her doctor about getting it.

Her case history and why she is on morphine this long, also 2 doctor's who wont touch her said she is a difficult patient to treat, she vomits almost everyday, she cannot lead a normal life because of these 2 doctors who wont help her get better. She's not abusing the drugs, she cant eat 3 meals a day of solid food like you and I can, she has been on liquid for the last 2 yrs. She is bloated because of the vomiting, swelling of the tissues and the posion that evades her body, what does this spell to you about the healthcare system, they hope she dies, that she is not a compromised issue in the system.

Her own Doctor says she's over weight and I'm like saying to him, well let's see how long did you goto medical school to make that assumption, the overweight appearance is not from over eating, it is from the fact of the poisons in her body from the break down of the acid and toxins building up in her, so he says yes you are correct, let's do a double take on that one.

I told him, you dont live with her to know what she is going through, or when she has to go out to shop for house hold items, laundry soap etc...and she maybe having a good day not a great one, then the vomiting comes out of no where,it's in public she vomits and the public doesnt want to be around someone like that, I hear about the nastiness from village idiots how disgusted they are, why she didnt stay home, does this mean she has to literally be confined to her home because nobody wants to help her. People dont understand,what a pathetic world we live in.

So whether you look at the drug it's self, whether you look at it if the side efects are to great. One way or another will it be the best solution for your patient's best welfare?

I need feed back, if you have some to give me to help her, because I'm in a corner. TY