Nausea / Vomiting Flashcards
metocloprimide (Maxeran)
Nausea/Vomiting
Class
Antiemetic
EMS Indications
Nausea and vomiting as a result of a suspected migraine
Adult Dosage
Metoclopramide 10 mg IV dilute in 50 mL normal saline bag and infuse over 5 minutes
Or
Metoclopramide 10 mg IM
Do not repeat dose
EMS Contraindications Hypersensitivity Bowel obstruction or perforation Seizure disorders Extrapyramidal reaction Monoamine oxidase inhibitor therapy within last 14 days Parkinson Disease
Notes
More effective in central nervous system based problems
Monitor patient carefully – goal is to provide symptom management without over medicating
Metoclopramide can cause extrapyramidal symptoms (incidence is higher with rapid administration); these include:
Dyskinesias – any number of repetitive, involuntary, and purposeless body or facial movements (e.g. tongue movements, lip smacking, eye blinking, finger movements)
Akathisia – an extreme form of restlessness (e.g. inability to sit still with an undeniable urge to be moving constantly, feeling of jitteriness or shakiness)
Dystonia – a muscle tension disorder involving very strong muscle contractions which can cause unusual twisting of parts of the body
If extrapyramidal symptoms appear, stop the administration of metoclopramide and consider diphenhyDRAMINE
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dimenhydrinate (Gravol)
Nausea/Vomiting
Class
Antiemetic
EMS Indications
Nausea and vomiting as a result of vertigo, motion sickness, and narcotic administration
Adult Dosage
50 mg SIVP/IM
Patients 65 years of age or older 25 mg SIVP/IM q 15 minutes to a total maximum of 50 mg
EMS Contraindications
Hypersensitivity to dimenhyDRINATE, diphenhydrAMINE, or propylene glycol
Narrow angle glaucoma
Patients who have ingested large quantities of depressants (including alcohol)
Notes
Preferred anti emetic in treatment of nausea and vomiting associated with vertigo or motion sickness
Preferred medication to accompany narcotics since supine ambulance transport may induce motion sickness
Monitor patient carefully – goal is to provide symptom management without overmedicating
Administer IM injections in the lateral quad (vastus lateralis) muscle
morphine
Pain
Class
Narcotic analgesic
EMS Indications
Pain
Adult Loading Dosage
0.1 mg/kg SIVP/IM/IO to a single maximum dose of 5 mg q 5 minutes prn to a total maximum of 20 mg
Maintenance Dosage
10 mg/hr SIVP/IM/IO in 2.5 mg increments prn
Maintenance dose time starts after loading dose administered
EMS Contraindications
Hypersensitivity
Systolic BP 90 mmHg or less
Notes
Analgesic of choice
Use cautiously if evidence of ETOH or drug intoxication
May cause respiratory depression and hypotension; monitor vital signs closely post administration
Use with caution with other drugs that are sedatives / depressants
ondansetron (Zofran)
Patient Safety Considerations Rapid infusion (less than 15 minutes) of ondansetron, especially in patients over 65 years of age, can lead to QT interval prolongation Caution should be used when administrating ondansetron to patients who are at risk of QT interval prolongation or cardiac arrhythmias
Class
Antiemetic
EMS Indications
Nausea and vomiting as a result of chemotherapy, head injury, gastroenteritis, of undetermined origin, or for continued nausea and vomiting refractory to the EMS administration of metoclopramide or dimenhyDRINATE
Adult Dosage ondansetron 8 mg IV, dilute in 50 mL normal saline bag and infuse over 15 minutes Or ondansetron 8 mg IM Do not repeat dose
EMS Contraindications
Hypersensitivity
Notes
Rapid infusion (less than 15 minutes) of ondansetron, especially in patients over 65 years of age, can lead to QT interval prolongation
Caution should be used when administrating ondansetron to patients who are at risk of QT interval prolongation or cardiac arrhythmias
More effective in nausea due to medical reasons or medication-induced
Monitor patient carefully – goal is to provide symptom management without overmedicating
Administer IM injections in the lateral quad (vastus lateralis) muscle
