Print

Print


I actually do not see a big deal on this, one way or the other, and at
times prescribe a couple of doses for the few hours after discharge. It is
not a routine practice, but a select practice.

While the "literature" does not "support" this, I would argue that the
literature provides direct guidance for about 10% of what we do. The rest
is extrapolated.

The literature suggests zofran is safe and effect. I do not believe that it
masks serious disease, such as intussusception or surgical pathology, and
this should have been addressed on the primary visit. Certainly not in the
limited doses prescribed.

I personally don't think it sends ANY message other than the one I intend:
here are a couple of doses of the next few hours. Again, I am select in who
I provide this (and every) medication for and specific in my purpose.

Why do I do this?

Once resistant, a colleague reminded me that nausea can be construed as a
source of pain. We prescribe NSAIDS for comfort in the context of fever and
we prescribe NSAIDS for MSK trauma. Why not zofran for nausea (which many
of our very young children experience, but do not articulate well.)

In my personal life, I generally eschew most of what I do clinically (as I
can choose the risk benefit and do not need to offer/choose the most
conservative choice for myself and my family). However, I have found that
ibuprofen and ondansetron are the most useful agents available and I find
each of them to be "miracle" drugs from time to time.

Rick Place
Inova Fairfax

On Sat, Dec 19, 2015 at 10:00 PM, Gill Winnik <[log in to unmask]>
wrote:

> While I routinely use Zofran for my nausea/vomiting patients, I do not
> discharge pediatric patients with a prescription for Zofran. I'm not sure
> what the rationale for that is perhaps the idea is that if there is a
> serious cause for the nausea/vomiting the patient should come back and it
> should not be masked by Zofran but the same can be said for Tylenol or
> Motrin.
> So my question to the group is does anyone routinely prescribe Zofran to
> discharged children who presented with nausea forward/vomiting?
> Did anyone have a bad experience doing this?
> Thank you
>
> Gill (Giora) Winnik
>
> > On Dec 17, 2015, at 6:59 PM, Aaron Wiener <[log in to unmask]>
> wrote:
> >
> > We use zosyn for all appy's.
> > None perf and pre-operatively, ancef/mefoxitin.  If perforated or chance,
> > Zosyn.
> > Mike Falk.
> >
> > On Thu, Dec 17, 2015 at 1:42 PM, Todd Zimmerman <
> > [log in to unmask]> wrote:
> >
> >> For appe, what abx are you using.
> >> For those using Rocephin and Flagyl, what dose of Flagyl are you using
> in
> >> the er, 10 per kg or 30 per kg?
> >> And Rocpehin?
> >>
> >> This is a bit more generalized, as there are obviously many different
> >> practice styles that remain within safety...For your DKA, what volume of
> >> fluids and over how long are you giving the first amount.I give between
> 10
> >> and 20 ml per kg over 60 minutes.
> >> And finally, who thinks Michigan State will win CFB? Hoops?
> >> Thanks,Todd Z(Please don't quote up to date, I read it)
> >>
> >>
> >> Sent from my Verizon Wireless 4G LTE smartphone
> >>
> >> For more information, send mail to [log in to unmask] with the
> >> message: info PED-EM-L
> >> The URL for the PED-EM-L Web Page is:
> >>                 http://listserv.brown.edu/ped-em-l.html
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >                 http://listserv.brown.edu/ped-em-l.html
> >
> > For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >                 http://listserv.brown.edu/ped-em-l.html
>
>
>
> ______________________________________________________________________
> This e-mail has been scanned by McAfee Managed Email Content Service.  To
> report
> any issues regarding e-mail SPAM ONLY, please call the Helpdesk at
> 718-283-MIS1________________________________________________
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
>

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html