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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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> 
> 
> -- 
> *"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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