Phenergan....good or bad?

[ERDoc]

Sorry to hijack this thread again. There is actually a good entry in Wiki on EBM. NREMT-Basic, read the last paragraph under the OVERVIEW about the value of expert opinions. Again, if you want to have an educated discussion or have any questions, I will be more than happy to talk. Again, back to your regularly scheduled discussion on phenergan.

[medic001918]

Sorry about hijacking the thread, I just wanted to correct your inaccuracies (it is nothing personal). If anyone else has a problem with me trying to correct errors and do a little educating in the mean time, please let me know publicly or via PM and I will not do so again.

Absolutely continue to post and educate doc. Your threads are often insightful and accurate. We can all learn something from each other.

Shane

NREMT-P

[NREMT-Basic]

Doc-

continue to educate at will. If you will notice, I also cited a source from a monograph on Phenergan in my post. Are those considered valued sources of information?

[BushyFromOz]

Read carefully and you will see that I was contributing to the conversation about Phenergan and other CNS depressants with the information readily at hand. You and I have always gotten on well, so this little attack coming from you is quite a surprise, especially since you have been known to whine from time to time yourself.

It was nothing more than you deserved for your post, however I missed this little gem of a backhanded compliment - though it is a funny little thing...thanks for the laugh, i needed that.

I am however confused at the the citation in your example? is it the website you are referring to? The problem with web based data is verifying its validity is and can be tough. Try to draw information from reputable e-journals that are peer reviewed and have specific referencing on its content. Using web sites often give highly inaccurate information (duh) or accurate information that has no supporting evidence/documentation to qualify its validity such as sources that reference other texts. Anything less is highly unreliable and does not stand up well in academia.

One thing i have learned is that citing an e-journal as a web reference seems ro carry less weight than citing the same article as a periodical when they are in fact the same document....go figure :shock:

-EDITED-

spelling error thoughtfully pointed out by NREMT-Basic as a petty little attack in a PM...Good on ya mate!

[OzMedic]

I was just reading through this post and it seems that most people are referring to the use of promethazine as an antiemetic. While I do use it for this in some circumstances, the major reason that I utilise the drug are for it's anti-histamine effects during severe allergy. I have found it to be very effective in this area and when co-administered with hydrocortisone it will arrest and reverse a developing reaction avoiding the need the resort to the administration of adrenaline and it's undesirable side effects. My service also utilises it for co-administration with agents that have a high incidence of allergic reactions such as antivenoms. While I utilise metaclopramide as my primary antiemetic agent it is my understanding that promethazine is more effective for nausea due to disruptions within the middle ear such as motion sickness vertigo and labyrinthitis. I believe this is due to the inhibition of of signals from the vestibular apparatus to the emetic centre in the medulla. While it will potentiate the sedative effects of narcotics the belief that it enhances the analgesic effect has been refuted by some studies proposing that this practice actually results in sub-standard analgesia. Anyway, as I was initially saying I find promethazine an excellent tool for moderate to severe allergies that have not quite developed to the point of anaphylaxis negating the need to pull out the big guns. While I am well aware that there are a myriad of mediators of allergy/anaphylaxis besides histamine, I have not yet encountered a reaction that did not respond positively to promethazine.

[1EMT-P]

According to the FDA there has been cases of Severe Tissue Injury with the administration of IV Promethazine ( Phenergan ). Please see the FDA's website for additional details.

[Ridryder 911]

Again, due to improper administration . Will this thread ever die?

R/r 911

[FL_Medic]

At my service, we have some very liberal and aggressive practice parameters to include valium up to 30mg, Morphine up to 10mg Versed and Etomdateall without orders to name a few. My question herein lies, we must do a physcian consult if we want or need to give Phenergan and then the dose is only 12.5mgIV/IM. I know that Phenergan has some dystonic effects on a few patients, I guess I'm wondering if there is something i'm missing. that would make it more controlled than our narcs. I am trying to get a meeting with our medical director this week for an answer. What do you guys think?

Take care;

Todd

This may be due to the sometimes too liberal use of Phenergan. It is a good drug when needed, but does cause damage when given IV to the Tunica Intima of the vein. And it isn't fun to recieve as a patient, it burns!. If you were to give it IV leave your line running and don't pinch it off. I kind of agree with the low dose IM administration.

[Code 8 Paramedic]

We have phenergan on standing orders for any kind of nausea, or vomiting. But a few miles south of me where the protocols change, they have to give phenergan with benadryl just incase the patient might have a dystonic reaction... talk about a sedated patient!

[fireflymedic]

I love phenergan, especially with the transport times we have and the curvy roads it helps patients that are puking nicely, plus puts then slightly sedated and they don't care as much. I've found it to be a very effective med. I'm not fond of zofran - they used it when I worked in ER quite a bit and unless given prior to onset of nausea as previously stated it didn't seem to have any effect. Ativan actually is a decent anti emetic in truth, and yes there are indications for it as that. Puking though inconvenient can actually be a good thing though and you need to watch when giving a drug to retard it as it is the body trying to rid itself of something. If you are bothered by puking, forget the basins best thing to do is get a bio bag, and one of those embroidery hoops that is large. Put the bio bag in the hoop and go from there. Catches almost everything and is easy to get rid of the puke, also don't splash out like it does in the basins.