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Nausea and emesis are different. If any of us have had nausea, we can
all attest to the fact that ondansetron is highly effective at
reducing this symptom, so studies evaluating emesis may not be the
whole story.

Over all, I think this is a risk/benefit personal style question.  I
went into medicine to reduce suffering, and don't have the personal
PTSD of being sued to temper that. To me, the benefit of reducing the
suffering of nausea is every bit as big a gift as the opportunity to
give someone a pain medication to relieve that symptom. Bigger,
actually-there are several studies showing that patients may prefer to
have pain to the nausea caused by some medications.  I created and
validated a scale to evaluate pediatric nausea -
http://www.ncbi.nlm.nih.gov/pubmed/21624874  In the discussion I cite
the literature highlighting the fact that one can have nausea for days
without ever having emesis, and nausea is its own health risk, that
many patients rank nausea as worse than pain, and argue that nausea is
worth treating and thus measuring.

I think the benefit of being able to decrease nausea with the
mid-to-late gastroenteritis is its own benefit.  Frankly, I don't care
if they share one of the three doses I prescribe with another family
member.  It may keep the family member out of the ED where they'll
catch something worse, or at least make them more comfortable than
coming into the ED would be.

Amy Baxter MD
CEO MMJLabs
buzzyhelps.com


> On Dec 20, 2015, at 11:38, stephen freedman <[log in to unmask]> wrote:
>
> A bit more of a realistic review of the evidence cited in the article that Michael refers to has also been provided in a letter to the editor (attached).  This summary really highlights the lack of any evidence to support significant reduction in vomiting, revisits or other beneficial effects while simultaneously having a fairly consistent trend towards increased number of diarrheal stools.  While more research into this field would be great, at present I think the evidence shows that while we would like to think we are benefiting the child by sending them home with extra doses of ondansetron, we should ask ourselves who are we really treating?
> Stephen
>
>    On Sunday, December 20, 2015 9:21 AM, Brian Sanders <[log in to unmask]> wrote:
>
>
>
> I routinely send home with zofran. Never have seen missed serious diagnosis with zofran rx. There are a couple of studies to this point. Here is one..
> Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses?
> Sturm JJ, et al. Ann Emerg Med. 2010.
> Show full citation
>
> Brian Sanders, MD
> Medical Director
> Pediatric Emergency Medicine
> Lowell General Hospital
>
>> On Dec 20, 2015, at 2:40 AM, Eugene Izsak <[log in to unmask]> wrote:
>>
>> I will send the home on with a max of 2-4 doses if it works in the ED.
>>
>> 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
>>>>>
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>>>>
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>>>
>>>
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>>
>>
>>
>> --
>> *"I would rather be the kind of person who makes molehills out of
>> mountains, then mountains out of molehills." *
>> *"I dream of a better world, where chickens can cross the road and not have
>> their motives questioned." Anon.*
>> *"The art of medicine consists in amusing the patient while nature cures
>> the disease." Voltaire*
>> *"I may not have gone where I intended to go, but I think I have ended up
>> where I needed to be."  Douglas Adams*
>>
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>
> 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:
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>
>
>
> 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:
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> <Letter to Editor_Multiple Dose Ondansetron.pdf>

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