I am quite surprised to see so much variation in style in prescribing Ondansetron from the ED. However, it gives me a pleasure to see a cohort of mine with whom I had the opportunity to work in the past still haven't changed their practice and prescribing a medication that worked in ED, considered to be relatively safe, and considered to be equally effective for a short term. Yes, if after repeated exam in ED and the time I spent to rule out a potential surgical belly, I have used a medicine that worked and made me comfortable to discharge the patient and and then patient returns with a potential acute abdomen can I really blame that on a tiny little pill that melts away under the tongue?
This discussion reminds me of our discussion with our surgical colleagues regarding the usage of IV narcotics in acute appendicitis, which used to be a hot topic during the last decade. I agree, at the end of the day style does prevail and we all adopt to the style which we are most comfortable with. I would be curious how many of these patients actually end up calling or seeing their PCPs for a prescription of zofran after getting discharge, or how many of these parents miss work because of the duration of symptoms are just prolonged. I believe as emergency physicians we do carry some social responsibility outside of our comfort zone which we call the ER.
Subhankar Bandyopadhyay, MD, MBA
Penn State Hershey Medical Center.
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