Ondansetron Is Safe and Effective for Prehospital Treatment of Nausea and Vomiting by Paramedics

Abstract Obective. The objectives were to evaluate the safety and efficacy of ondansetron in the out-of-hospital treatment of undifferentiated nausea or vomiting. Methods. Patients with severe nausea or intractable vomiting who were transported by paramedic-staffed ambulances in eight California cou...

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Published in:	Prehospital emergency care Vol. 15; no. 1; pp. 34 - 38
Main Authors:	Salvucci, Angelo A., Squire, Benjamin, Burdick, Marc, Luoto, Mark, Brazzel, David, Vaezazizi, Reza
Format:	Journal Article
Language:	English
Published:	England Informa Healthcare 01-01-2011 Taylor & Francis
Subjects:	Adolescent Adult Aged Aged, 80 and over Allied Health Personnel - statistics & numerical data antiemetic Antiemetics - administration & dosage Antiemetics - adverse effects Antiemetics - therapeutic use California Child Child, Preschool Confidence Intervals Databases, Factual Emergency Medical Services - methods Emergency Medical Services - statistics & numerical data Female Health Status Indicators Humans Infant Infant, Newborn Infusions, Intravenous Injections, Intramuscular Male Middle Aged nausea Nausea - drug therapy ondansetron Ondansetron - administration & dosage Ondansetron - adverse effects Ondansetron - therapeutic use Pain Measurement paramedic Prospective Studies Statistics, Nonparametric Tablets vomiting Vomiting - drug therapy Young Adult California
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Summary:	Abstract Obective. The objectives were to evaluate the safety and efficacy of ondansetron in the out-of-hospital treatment of undifferentiated nausea or vomiting. Methods. Patients with severe nausea or intractable vomiting who were transported by paramedic-staffed ambulances in eight California counties were treated with intravenous (IV), intramuscular (IM), or oral dissolving tablet (ODT) administration of ondansetron. Data were collected prospectively for a six-month period using an online database. Prospectively defined outcome measures were 1) efficacy as measured by a quantitative visual analog nausea scale and 2) incidence of adverse effects. There were no control or placebo groups. Results. Data was collected for 2072 patients, but one patient did not receive the medication. Therefore, Ondansetron was administered to 2,071 patients (3.7%% of transported patients). Most patients were adult, with only 66 patients less than 18 years old. Of the 2,071 patients, 1,320 (64%%) received IV administration, 77 (4%%) received IM administration, and 674 (33%%) received ODT administration of ondansetron. Intravenous administration resulted in the largest improvements in nausea scores (mean 4.4; 95%% confidence interval [[CI]] 4.2, 4.5), followed by IM (mean 3.6; 95%% CI 3.0, 4.3) and ODT (mean 3.3; 95%% CI 3.1, 3.5). Overall, the mean decrease in nausea score was 4.0 (95%% CI 3.9, 4.1; p < 0.001) on a 10-point scale. After medication administration, four patients had mild hypotension, one had hypertension, two had itching or rash, and one had a brief episode of supraventricular tachycardia that resolved spontaneously. Conclusions. Ondansetron is safe and effective for out-of-hospital treatment of nausea and vomiting when administered by paramedics via the IV, IM, or oral route. When available to paramedics, ondansetron is used frequently.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1090-3127 1545-0066
DOI:	10.3109/10903127.2010.519822