Would it be silly of me to observe that giving oral meds for vomiting might just be an exercise in futility....



Just sayin'.......

+1,000,000,000
LowKey - you are my favourite person on this forum at the moment.

I was just going to say exactly the same thing!

Threads like this worry me. V&D serve a purpose and fluids and electrolytes all that is usually required. I would only take Loperamide if i HAD to (go to work, out camping, on holiday) not just because I had diarrhoea. I survived campylobacter with no drugs!

That's why phenergan is usually an injection or a SUPPOSITORY.

I'll tell you why suppositories are great: they're the only legitimate way you can respond to a patient's complaints by telling them to stick it up their ass.

I've been on phenergan many times, and never once was it an injection or suppository.



Man, I miss out on all the fun.

It's okay. I took it for awhile with both of my pregnancies because I had monster morning sickness. It DOES knock you out (well, it did me anyway). I've never seen it in anything other than a suppository form. That's good if you're vomiting. I assume less so if you've got diarrhea (to be honest in pregnancy I had the opposite problem).

I wouldn't want to take it in a dangerous situation, because of the KO factor but...I guess if I was uncontrollably purging out of one or both ends I'd be a sitting duck anyway.

I've only had it as a suppository, maybe I should treat my Doctor better.

Maybe not.
Maybe he likes you too much already

Well because Phenergan actually works WAY better than Pepto or Maalox, because it takes up way less room in your bag and it weighs WAY less. You can't really do the same thing with Pepto/Maalox that you can with Phenergan. If the person is continuously throwing up how are you going to get that stuff into them anyway? With Phenergan there's also suppositories and you can administer it IV/IM (probably NOT going to be able to get it in that form from your Dr.) so you don't have to drink it and then hope that you're able to hold it down.

BTW - Phenergan doesn't do a damn thing for diarrhea. Give the pepto to them AFTER they stop throwing up.

Then again I'm real familar with Phenergan from having to give it to pts at work (EMS) and from having to take it occasionally (I get migraines from a fractured skull a few times a year from when I was jumped by 8-9 guys when I was 18/I tend to barf all over the place when this happens. I've tried taking Pepto and Maalox during them before, it doesn't work and there's nothing worse than throwing up Pepto. Well except maybe spagettiO's and vodka).

Your buddy may or may not have told you you need it because it's in the TC3 Protocols now. It's one of those magic drugs every medic should carry.

The primary reason is as a morphine compliment.
Sans the morphine, it's awesome for hives and making people go to sleep.

The tummy badness prevention is an off label use. That is becoming more of a label use.

Phenergan is an anti-histimine I do believe. It's like benedryl with more side effecs.

I have it in my drug box. Usually I push it with toradol. People in pain like sleeping.

I push it IM the slow push IV supposedly causes necrosis in the veins, some docs say yay most are saying no.

Phenergan is known as a vesicant: it's caustic to veins. We give it IV push all the time in the hospital, but it must be diluted and must be given slowly. I give it the same way I give all IV push meds: dilute it with saline in a 10cc syringe, then push it over 1-2 minutes (hint: 6 to 12 seconds per cc when using a 10cc syringe). Hasn't been a problem yet. If they say it stings, slow it down. It's even better if they already have fluids running, since they dilute it further. You don't want to give it IV push in somebody with poor circulation. There may very well come a day soon when it'll be required to give it IV piggyback after diluting it in a 50cc or 100cc bag.

Well, who doesn't like to nitpick?

Use as an anti-emetic or anti-motion sickness medication are no longer off-label for promethazine (phenergan). On label uses also include for sedation and relief of apprehension, and as an adjunct to analgesics, pre-, post-, and obstetric sedation.

Reference: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=2643



As far as localized tissue irritation, it's well established that subcutaneous injection can result in some pretty serious side effects, including erythema, burning, spasm of distal vessels, localized edema, tissue necrosis, etc. BUT, so long as the concentration is maintained at 25 mg/ml in a reliable intravenous route, it's been shown to be safe and reliable. Agreed, however, that dilution beyond this will reduce the amount of discomfort experienced.

G-

Edit: I didn't mean to come off poorly, sorry if I did. Everything you listed is good practice, IMO, and I can't argue with that. Patient comfort is always important. Just wanted to add a few bits. Also, promethazine is an Rx medication for a reason, it is not without side effects and contraindications. Nobody needs this medication in their PAW medical kit for all the reasons discussed.

Ahem.

Nit-picking implies you are attacking comments for the sake of attacking them.

You sir are educating.

I practice medicine like I practiced hockey.

I get checked frequently.



I didn't mean to imply it was needed just giving the reasons I carry it and how I use it.
Benedryl and epi Jr are needed, this one is nice to have.

Thank you. My post was intended as just that, education, not an attack. The portion of my post regarding needing it was directed at the OP. I believe that promethazine is an excellent medication when appropriately used by trained medical professionals in the right setting, just not something that should be in every prospective "PAW-Doc"'s medical bag, "just in case" or because the TCCC says it should be in a medic's bag. As far as getting checked, that's why it's called practicing and the day you stop learning is the day you should get your license punched and go home.

G-

I didn't take it that way. No worries. When I read this edit portion, I had to look back to see why I may have been offended. Still, always good to cover your bases.

Everything on this page is about the use of this drug in (or en route to) a hospital setting, in a modern care facility, under doctor supervision. Nobody is arguing whether or not phenergan is a good drug.

What we are talking about is the need for it in a FAK. So far I see no reason for someone to have this in their FAK. Can somebody pose a PAW/disaster scenario where this would be appropriate for the OP? Are we all going to seriously argue whether or not benadryl is better than phenergan for an allergic reaction? Or whether or not it is better to give phenergan than fluids and electrolytes, and maybe Maalox or Pepto? (Btw, both of which come in pills, and the difference in weight/size is so negligible that the argument against carrying them in favor of phenergan to save weight/space is absolutely ridiculous)

I didn't think we were talking about homebrew medical care, I thought this was about disaster/PAW survival. I just don't see a scenario where this is a better approach. I see it's use in a hospital, by trained medical staff, but I don't think the OP is a trained medical provider, because he did not appear to even know what phenergan is.

My PAW theory on medicine must be different. I tend to think that the average person does not need prescription meds to treat most ailments. There are some pretty good OTC meds that can do the same thing, and have less of a probability of further complicating the situation.

Agreed, I was just putting out a theory on where the need for Phenergan came from.
a lot of people try to use military packing list. The reasons given were why we use it in the field military wise.

Yeah, that's easy.

Someone is throwing up continuously after becoming sick from Cholera because their drinking water has been contaminated by human waste improperly disposed of, they're becoming severely dehydrated (not to mention the fact that throwing up over and over again isn't exactly very comfortable) and you can't get it to stop any other way. Other than the Cholera part that's the same scenario that I've ever given it to a patient and it's the same exact scenario that I've ever used it myself in.

PAW or not, becoming sick is a fact of life. In fact it would be reasonable to guess that becoming extremely ill and throwing up over and over again in the PAW is even more likely to happen in the PAW than during normal times (dirty water, flu, migraines, pandemics etc etc).



You don't have to be a medically trained professional to use a Phenergan pill or suppository.

The person using it can just follow the directions on the bottle or the packet and they can just give it to themselves or the other person orally or by inserting the suppository into their rectum or their vagina (depending on the sex of the person throwing up continuously and depending on what kind of suppository it is). How do you think most people take meds that they've been perscribed? They read the instructions. They don't need to have a medical professional holding their hand to follow instructions do they? If that were the case every person on earth who had to take daily medication would be clogging the hospitals day and night.

People outside of the medical community don't really have access to injectable Phenergan and no doctor that I know of is going to perscribe it that way so discussing injectable Phenergan by untrained care givers is really kind of a moot point.

OTC meds DO NOT do the same thing that Phenergan can and they don't have anywhere near the same effect. Maybe you just haven't ever continuously vomited the way that I'm talking about or ever seen anyone else do so over and over and over again. It really sucks to be that person. In these cases Pepto or some other OTC meds just ain't gonna cut it.

It's just not. :shrug:

Veritas,

I believe that we've all come to the same conclusion as you in regards to the inclusion of this drug in a PAW FAK. As I mentioned a few posts back, I see no real need for it. We just happened to get into a tangential discussion of its use in the medical setting. I don't see the harm in that since the OP's original question was apparently answered in the first few posts. As far as the use of Maalox and Pepto, I presume that people were simply posing those as safer OTC alternatives to promethazine if the OP chose to include some form of medication to address his/her concerns. Further, I think it is wholly appropriate to discuss the limitations of those medications as well as promethazine so that the OP can have a reason to include or not to include them beyond just "I said so" or the dreaded "Scope of practice" reasons. If our posts were construed as a hijack of the thread, my apologies.

G-

A short clarification:

I don't see the need for (most) prescription drugs in a FAK.

However, in a BOL or long-term PAW scenario, sure, I can see where you are coming from.

But in a disaster scenario, a la Katrina, tsunami, earthquake, I don't see the need for a prescription strength antihistamine. It seems overkill and a little contra-indicated, especially due to the sedation/CNS effects.

jakewcu: My bad, sorry if I came across like an ass. Please proceed with tangent.

Browning: I had a long response, but I decided to just agree to disagree. I agree that it would be more appropriate to use in a pregnant woman or someone with chronic debilitating migraines, but not in someone with an infectious disease, especially not cholera. Once again though, I think those are long-term PAW scenarios, not disaster/survival scenarios.

That's cool, not everyone on these boards has to agree on everything and even when we do disagree it doesn't have to degenerate into some huge fight.

There really isn't a right or a wrong answer to this, it's just whatever your personal experience tells you.

Just going to throw this out there...

I agree with the guys that are saying unless you are already prescribed promethazine as an anti-emetic, you probably won't want to use it in your FAK. It's got some nasty side effects not due to its anti-histamine action, but its anticholinergic effects. (It's action on acetylcholine receptors is what makes it sedating and what makes people go "bat shit crazy", not its anti-histamine action. Histamine is not a neurotransmitter. ACh is. Also, delerium due to acute anticholinergic syndrome really only occurs when too much is administered.)

Diphenhydramine (benadryl) is a pretty great antihistamine indicated for allergies, although it doesn't posess the anti-emetic properties of promethazine. It's a pretty remarkable drug despite being OTC.

Just an opinion with some fact thrown in. Of course if a doc prescribed you promethazine in the past for things like morning sickness, migraines, etc, go right ahead and keep it in your kit. Just use it for what the doctor indicated its for, not for when you're feeling a little nauseous.

Aww shucks...
I'm no more than an unlettered layman....how could I possibly contribute to a medical discussion?

I am pretty sure there are histamine receptors in the cortex. Doesn't the medial forebrain bundle have histamine neurons in it? I know that it carries norepinephrine tracts, and the whole "hedonic highway" thing with dopamine, but I thought there was some histamine in there also. Going to try and find a literature reference.

As far as the anti-cholinergic effects, of that I was not aware. Thanks for the info there. Maybe promethazine does not block the H1/H2/H3 (whatever they are) receptors in the cortex?

Ok, this is what I found, for your discussion:


ref: Brown RE, Stevens DR, Haas HL. The physiology of brain histamine. Prog Neurobiol. 2001 Apr;63(6):637-72. http://www.ncbi.nlm.nih.gov/pubmed/11164999

I will be honest, I only read the abstract. I could link the full article on Elsevier if anyone cared, but I didn't think they would. There are a few more articles, but I did not have full article access in case somebody called BS...

One more, same info w/ full text, just the link to abstract: http://www.ncbi.nlm.nih.gov/pubmed/1862 ... dinalpos=6