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Managing Nausea in the Emergency Department

Managing Nausea in the Emergency Department
Author Information (click to view)

Antonia R. Helbling, MD

Department of Emergency Medicine

San Antonio Uniformed Services Health Education Consortium

San Antonio Military Medical Center

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Antonia R. Helbling, MD (click to view)

Antonia R. Helbling, MD

Department of Emergency Medicine

San Antonio Uniformed Services Health Education Consortium

San Antonio Military Medical Center

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Considering the broad impact that nausea can have on ED patients, researchers are continuing to explore new strategies—beyond antiemetic medications—as treatment options.

According to published studies and anecdotal evidence, nausea is among the leading complaints for the millions of patients who visit EDs each year in the United States. Symptoms can result from a variety of different causes and are oftentimes distressing to patients. In some cases, nausea may lead to other health issues, such as dehydration.

Testing an Alternative Approach

For a study published in Annals of Emergency Medicine, Antonia R. Helbling, MD, and colleagues at the San Antonio Uniformed Services Health Education Consortium had a study published to compare the safety and efficacy of using a nasal inhalation form of isopropyl alcohol with placebo in treating nausea among ED patients. “This treatment is relatively inexpensive and widely available,” says Dr. Helbling.

Patients involved in the study were instructed to inhale deeply through their noses for 60 seconds every 2 minutes, with the research team setting a maximum of three total inhalation periods. Nausea and pain were then measured 10 minutes after the start of treatment using an 11-point verbal numeric response scale, which had been previously validated, and patient satisfaction was measured using a 5-point Likert scale. The study had 37 patients receive nasally inhaled isopropyl alcohol while the remaining 43 were given nasally-inhaled saline solution.


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Within 10 minutes of the intervention, nausea scores among patients treated with isopropyl alcohol were about half that of the group receiving the saline solution. “The nasal inhalation form of isopropyl alcohol was effective for about 75% of patients who received it,” Dr. Helbling says. When assessing patient satisfaction scores, recipients of the isopropyl alcohol were twice as satisfied as those receiving saline solution.

“The nasal inhalation form is another tool in our arsenal to manage nausea,” says Dr. Helbling. “It can also be used as a bridge to prescription drugs for nausea. An added benefit is that the wipes are relatively inexpensive and can be used quickly and easily to provide relief to patients.”

The authors of the study noted that the alcohol wipes used in the analysis were safe, and no adverse effects were observed in the analysis. Furthermore, no significant differences were seen between arms with regard to the median pain verbal numeric response scale scores or subsequent receipt of rescue antiemetic therapies.

More Research Needed

While results of the study are encouraging, more investigations may be needed to test the duration of effect and performance as compared with traditional pharmaceutical antiemetic drugs. Despite requiring further validation, the available evidence suggests that nasal inhalation isopropyl alcohol wipes may be an effective tool for relieving nausea and improving satisfaction among ED patients.

Antonia R. Helbling, MD, has indicated to Physician’s Weekly that she has no financial disclosures to report. She notes that the opinions expressed here are solely those of the authors and do not represent an endorsement by or the views of the United States Air Force, the United States Army, the Department of Defense, or the United States Government.

Readings & Resources (click to view)

Beadle KL, Helbling AR, Love SL, April MD, Hunter CJ. Isopropyl alcohol nasal inhalation for nausea in the emergency department: a randomized controlled trial. Ann Emerg Med. 2015 Dec 8 [Epub ahead of print[. Available at: http://www.annemergmed.com/article/S0196-0644(15)01361-X/fulltext.

Egerton-Warburton D, Meek R, Mee MJ, et al. Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo. Ann Emerg Med. 2014;64:526-532.

Radford KD, Fuller TN, Bushey B, et al. Prophylactic isopropyl alcohol inhalation and intravenous ondansetron versus ondansetron alone in the prevention of postoperative nausea and vomiting in high-risk patients. AANA J. 2011;79:S69-S74.

Barrett TW, DiPersio DM, Jenkins CA, et al. A randomized, placebo-controlled trial of ondansetron, metoclopramide, and promethazine in adults. Am J Emerg Med. 2011;29:247-255.

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