Quality Checklist for Randomized Clinical Trials:
Secondary: Change in pain VAS 30 minutes post intervention, nausea scores until emergency department disposition, pain score at emergency department disposition, and satisfaction VAS scoresĪuthors’ Conclusions: “ Among ED patients with acute nausea and not requiring immediate intravenous access, aromatherapy with or without oral ondansetron provides greater nausea relief than oral ondansetron alone.”.Primary: Change in nausea from baseline to 30 minutes post-intervention as measured on a 0- to 100-mm VAS.Comparison: There was no dual placebo arm due to concerns that would discourage patient participation.Inhaled saline placebo with 4 mg oral ondansetron.Inhaled isopropyl alcohol and oral placebo.Inhaled isopropyl alcohol and 4 mg oral ondansetron.Intervention: There were three treatment arms in this study.Allergy to isopropyl alcohol or ondansetron inability to inhale through the nares recent intake of medications contraindicating alcohol administration altered mental status a known history of QT-segment prolongation clinical suspicion for serotonin syndrome suspected or know pregnancy or treating provider discretion. Exclusion Criteria: Notably they excluded patients who had already had an intravenous catheter placed or who had received antiemetic therapy prior to enrollment.Population: Patients greater than 17-years-old presenting to the emergency department with a chief complaint of nausea, with self-reported nausea severity of three or greater on a numeric response scale (range 0 to 10).The SGEM bottom line from that critical review was that for patients presenting to the emergency department with complaints of nausea and vomiting, a nasal inhalation of isopropyl alcohol is a quick, inexpensive way that may transiently improve symptoms without evidence of harm.Ĭlinical Question:Does nasally inhaled isopropyl alcohol reduce nausea in adult emergency department patients with or without oral ondansetron? We covered that paper on the SGEM in Episode #144. There’s some data supporting the use of an inhalation of isopropyl alcohol in emergency department patients (Beadle, et al Ann Emerg Med 2015). They concluded that aromatherapy may have similar effectiveness to placebo based on low-quality evidence.
The most commonly utilized antiemetic in US emergency departments is ondansetron, a 5-HT 3 antagonist.ĭespite its widespread use, a dose of intravenous ondansetron takes about 30 minutes to take effect, which has led to an interest in more rapidly acting interventions for actively nauseous patients on the verge of vomiting.Ī new Cochrane Review by Hines et al published in 2018 looked at aromatherapy for post-operative nausea and vomiting. She’s hemodynamically stable and looks a bit queasy but isn’t actively retching when you see her.īackground: Nausea and vomiting are frequent complaints of patients presenting to the emergency department, accounting for just under five million visits per year.Ī number of prescription medications are available to treat these symptoms, including ondansetron, droperidol, metoclopramide, promethazine, and prochlorperazine. She’s been a contributor for the Academic Life in Emergency Medicine and Emergency Medicine PharmD blogs and is a member of the ALiEMU Capsules team.Ĭase: A 32-year-old woman presents to your emergency department with complaints of nausea (nausea VAS is about a 5 on a scale of 0 to 10) and states she’s worried she’s coming down with some sort of stomach flu. She’s recently transitioned into industry, taking on a position as a medical science liaison in New England. Guest Skeptic: Meghan Groth is a pharmacist who has been practicing in emergency medicine for the past six years. Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial.
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