To Spew or not to Spew is the Question

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.

~ Leo Buscaglia                      

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia
Read more at: https://www.brainyquote.com/quotes/keywords/caring.html

  Imagine with me for a moment you are in the back of the ambulance taking a patient to the hospital. This patient you are transporting should be an easy transport. However, as the transport continues they become nauseous. To be placed in the semi-fowlers position and ride backwards is not a normal position that your patient travels when going down the road. To make things worse, you’re traveling down a rough, dirt road.  You start watching the time, trying to mentally calculate how long it will be till you arrive at the hospital. You then realize that your patient is getting worse and is on the brink of retching their guts out.  So you grab out your emesis basin and place Kleenexes in it, or your fancy emesis bag with hoop. The patient grabs it out of your hands and everything but the kitchen sink presents itself into your gray bucket. The patient feels better some, but now the smell reeks all over the back of your unit. With the exhaust fan running, it still does not take care of half of the foul stench of bile that has been created in your truck. What if I told you that there might be a solution for BLS providers when it comes to dealing with vomit. Not only will it help basic providers but ALS providers can utilize this technique while they are still fumbling around with the IV to administer Zofran. 

   When we deal with patients who are sick one of the most common sign and symptom that presents itself to us is nausea and vomiting. It has been documented that Zofran is one of the most common drugs given to patients. Now is this because we as providers are concerned for the patient and their comfort level as we are taking care of them. For some I believe this is the case. More so I believe that we give Zofran due we don’t want to deal with smell, or for some even to look at the disturbing liquid that has been produced by your patient.  This is fine though, because if we are sick , we can't take care of subjects who are under the weather.

     So what’s this tip that will reduce our patient’s nausea and possibly reduce us giving Zofran, well I will tell you. It called Isopropyl Alcohol Vapor Inhalation. In a paper that was written by the Academic Life in Emergency Medicine in 2015, they talk about a South American folk remedy for nausea, the use of isopropyl alcohol.

They have found that there are great results, so much so that by inhaling the alcohol it reduces nausea severity by more than 50%. This reduction is also faster than Zofran taking effect for the nausea. They also found in what they call “Transporters” which I believe is EMS providers that during their transports they provided relief in 84% of the patients that experienced the retching sensation while they were moving. How it works at this time inside the body is not well understood, but it seems to trigger something inside the brain through the smell receptors.

 Below are the suggested technique and a drug formulary example. Use at your own risk, this technique is not FDA approved but it does show very good outcomes in patients that it is used on. This technique is considered an off label use of alcohol prep pads. It’s interesting though to see that there are some techniques we could use to improve our patients nausea. Whether it works all the time or some of the time it’s another useful tool for the tool box. Remember to always keep advancing your knowledge. We are in the best career for new advances we just have to take advantage of opportunities and education that comes our way. Always keep learning guys, don’t every stop. Take care and be safe out there.

Technique:

So when providing this treatment, this is how it is supposed to be done to see the effects of nausea relief.

    1.  Have patient hold emesis basin or bag just in case they still need to vomit.

    2.   Grab three, 70% ISO-propyl alcohol prep pad for IV’s.

    3.    These will be administered three times via the inhalation route every 15min.

    4.      It can be done twice.

    5.      Instruct the patient to inhale through the nose and exhale out through the mouth.

Drug Information:70% ISO-propyl Alcohol pads

Class: Alcohol (ISO-propyl, meaning mixed with water)

Action: Mechanism of Action not certain, theorized influences neurotransmitters at several sites, activates chemo-receptors in the nares.

Indication: Prepping any injection site, i.e.… (IM, IV, IO), and using for nausea/vomiting

Contraindication: Hypersensitivity to smells, allergic to alcohol or any concentration.

Caution: Giving to patients who have frequent epistaxis or bleed easily from the nose

Dose: 3 (70% ISO-propyl Alcohol pads) repeat every 15min; can repeat a total of 2 times.

Adverse reactions: Unknown at this time

Drug Interaction: Unknown at this time

ATTENTION: This Technique has not been approved by the FDA; this is just a technique that has shown improvement in some patients, it has not shown any problems in any patients at this current time. This is an opinion article, use technique at your own risk.

Bibliography

Culver, Mark, PharmD,BCPS. "Trick of the Trade: Isopropyl Alcohol Vapor Inhalation for Nausea and Vomiting." Academic Life in Emergency Medicine. N.p., 21 Dec. 2015. Web. 30 Apr. 2017. <https://www.aliem.com/2015/12/trick-trade-isopropyl-alcohol-vapor-inhalation-nausea-vomiting/>.