Paper Chase 3 - Antiemetic Cage Match!

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Brian T. -

?Fluids and time? Are you saying that all 'nauseated' patients in the study were given IV therapy? What about the additive effect of zofran with reglan PO (as we have heard from the ob literature for hyperemesis) and then PO trial, avoiding the IV expense and the placebo effect of the IV?
Thank you for reviewing an important daily malady in every ED...

Sean G., M.D. -

This is one of those cases where the "evidence"I believe is actually misleading. Can't say I can put my finger on how this research failed, but 19 years in the ED tells me anti emetics work. I know we are not supposed to do that but I believe in reality Medicine is both an art and a science and there are times when the clinician must rely more on his/her art then on science. im still giving that next person puking their guts up an anti emetic. And they will be glad I did. When I listen to this type of thing I picture myself w a lab coat on and a pencil protector....my glasses instead of contacts and a poor wretched pt puking violently in front of me, shaking drool running down their chins(yes I said chins this is America baby) and I am saying in my best nerdy voice..."I am sorry sir but the studies show none of these medicines work...."....ahhhh. No.

Paul J. V., D.O. -

This studied the effects of antiemetics on the symptom of nausea. I don't use antiemetics for nausea. I use antiemetics to treat emesis. Though I do care about the patient's comfort and their symptoms of nausea, my main concern is can I stop them from vomiting and allow them to take PO fluids/medications without vomiting. This study did not address this issue.

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