Zofran and our n/v protocol. Can someone explain?

[AnthonyM83]

Yeah...nothing wrong with letting someone vomit into a bag for 10 minutes or so...not like we should bother to try and take care of that or anything...after all, the patient doesn't care.

I have no problem with anyone treating it. It's great you guys have meds for it. It's just that I don't really see it as an emergency or requiring an emergency treatment (except for the the examples given above about morphine or MI's which was a good enough reason for me).

But I thought that in fire based systems everything except full arrests and really kewl traumas were BLS. After all, you don't want to keep the firefighters from missing the latest episode of Saved.

Good point...though N/V by itself is an approved BLS transport, not one of the many cases where they pawn off ALS calls to BLS crews.

[triemal04]

I have no problem with anyone treating it. It's great you guys have meds for it. It's just that I don't really see it as an emergency or requiring an emergency treatment (except for the the examples given above about morphine or MI's which was a good enough reason for me).

It's not an emergency in and of itself. (though we'll still be responding code 3 to it due to the wonderful dispatch system...) Giving Zofran, or phenergan or any other anti-emetic isn't an emergency treatment either. It's just doing what is appropriate for your pt. And if you don't it's the same thing that's going to happen after they insist on being taken to the ER. So why not treat them appropriately? Just because you don't see N/V as a big deal does not mean that the pt see's it that way either; I wasn't kidding about someone vomiting for 10 straight minutes with little to no let up. Treat your patient appropriately.

Now, an emergency treatment would be RSI'ing them...gotta prevent aspiration don'tcha know. (and listening to someone gagging is really annoying)

[Connie31079]

only have Gravol for "active vomiting" here, nothing else. No Reglan, no Zofran, no Maxaran, no Stemetil......and I can only give Gravol for active vomiting. That's right folks, if they're nauseated, and haven't puked yet, I can't give them anything. Pretty bad, huh?

[Dustdevil]

It boggles my mind that you guys actually have meds for nausea / vomiting. That's a BLS transport for us....

There's the problem right there. You have basics in your system to dump vomiting patients on. In a real EMS system, where medics have to clean up the ambulance and smell it all the way to the hospital, we make sure to actually treat the patient's nausea instead. :wink:

[buckeyedoc]

I think that something that needs to be looked at is the untoward side effects of phenergan. I've seen WAY too many medics and nurses giving 25mg of phenergan fast IVP. That is not the proper route. Phenergan can cause necrosis and nerve damage. I know. We had a guy in our ER that was given 12.5 phenergan IVP into an infiltrated IV. He lost 4 fingers on one hand. Yep, he's a bit richer now. If I have to give phenergan, I dilute it w/ NaCl and slowly push it over 1-2 minutes. We're replacing phenergan w/ Zofran in our 2008 protocols.

[JakeEMTP]

We had our Medical Director update on Wed. He was discussing the pain control protocol which has 50-100mcg Fentanyl and 12.5mg of Phenergan. I asked the question as to why Phenergan? It was explained to me that back in the day, we had Demerol for pain control on the ambulance which as you are aware causes N/V. That is where the Phenergan came from. Phenergan is still on the ambulance, but is a second choice.

Because of the analgesic effect of Phenergan the primary medication of choice for N/V is now Zofran. Apparently, it has a much better chance of being tolerated by the pt. The MD mentioned that in his 19+ years in Emergency Medicine, he has only seen 5 people have an allergic reaction to Zofran.

[canuckEMT]

only have Gravol for "active vomiting" here, nothing else. No Reglan, no Zofran, no Maxaran, no Stemetil......and I can only give Gravol for active vomiting. That's right folks, if they're nauseated, and haven't puked yet, I can't give them anything. Pretty bad, huh?

Sorry to tell you Connie, I have both Gravol and Maxeran in my kit. I can also give it for nausea and not just active emesis.

Also included in ACS and Analgesia guidelines as well.