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By The Hippo EM Team on October 05, 2023

A World Without Ondansetron

 Andy Little, DO and Zack Repanshek, MD

Ondansetron is a great antiemetic that we use for all types of vomiting. But not all emesis is the same. Andy Little hosts Zack Repanshek, who delves into the details of how we can tailor our treatment of vomiting by choosing antiemetics that are targeted toward the underlying cause. Read on for a few pearls.

Anticipate Medication Shortages

Medication shortages have become frequent in hospitals around the world. Relying on a single agent can leave you unprepared should a shortage suddenly occur.

Understand the Root Cause

Nausea and vomiting mostly fall into four categories: gastrointestinal, vestibular, brainstem, and brain-gut axis. Understanding the cause will help guide you when determining which medication to give as first-line treatment. 

Check for Risk of QT Prolongation

Routine EKGs prior to administration are not indicated in patients at low risk for QT prolongation. 

Patients at risk for QT prolongation include those on high-risk medications (antipsychotics, antiarrhythmics, macrolides, fluoroquinolones, antidepressants, methadone, other antiemetics) or those with high-risk conditions (long QT syndrome, hypocalcemia, hypokalemia, hypomagnesemia, hypothyroidism, hypothermia).

For a deeper dive on proper targeting and use of antiemetics, listen to this episode on the ERcast podcast.

Published by The Hippo EM Team October 5, 2023