The latest placebo-controlled trial showed that a sniff of alcohol actually worked better than the antiemetic ondansetron Annals of Emergency Medicine , online, Feb. According to the authors, inhaled isopropyl alcohol works better than either inhaled saline placebo or an ondansetron pill. The benefits last at least 30 minutes. They note:. We believe the existing studies of isopropyl alcohol support an excellent safety profile and that repeated dosing for recurrent symptoms is likely to be safe, with minimal risk of adverse events related to overdose, provided the route of administration is nasal inhalation alone.
The investigators cannot explain how breathing a little alcohol from a gauze pad would relieve nausea. They conclude, however:.
Do not inhale huge amounts of alcohol for this approach. A whiff or a sniff of alcohol is all that is necessary. Remember, the researchers used disposable gauze pads with just a little isopropyl alcohol. Do not overdose! Too much alcohol can be irritating to the nose and throat.
Some susceptible people may develop difficulty breathing. Be very cautious about this approach and if nausea and vomiting persist, check with a physician promptly! After all, nausea is a symptom that something is not quite right.
Treating a symptom without looking for the cause could be problematic. Take muscle cramps, for example. For decades, people have been using pickle juice or yellow mustard to ease their charley horse cramps. Football coaches would keep jars of pickle juice on hand during practice. Ethical approval for this study was obtained from the regional ethics committee METC Noord-Holland , and our institutional review board approved the protocol.
Our ED nurses screened all patients visiting the ED during the study period for inclusion and exclusion criteria. Exclusion criteria included a known allergy to IPA or conventional anti-emetics, pregnancy, inability to inhale through the nose, a reduced level of consciousness, and any other medical condition hindering following study instructions. In case a patient was identified as eligible for inclusion, written informed consent was obtained. Nausea severity was evaluated using a visual analog score VAS.
VAS-scores are a validated tool for acute and chronic pain, but can also be used for determining nausea severity [ 9 ]. Furthermore, we registered patient characteristics, the presumed cause of nausea upon ED entry, a VAS for pain, the time of inclusion, the time of initiation of symptomatic treatment IPA or conventional anti-emetic , the total amount of used anti-emetics, the use of IPA swabs, and the definitive diagnosis as made by the treating physicians at the end of the ED visit.
In the baseline phase of the study, nauseous patients were symptomatically treated according to daily practice, and no specific treatment protocol was used. In case a patient was identified as nauseous, the nurse discussed with the treating physician if symptomatic treatment for nausea was indicated, and if so, which anti-emetic to administer. During the implementation phase, primarily the nurse decided whether symptomatic treatment for nausea was desirable, and if so, he or she provided the patient with three IPA swabs.
The patients were instructed to open an IPA swab and hold it 2 cm in front of their nose while taking a number of deep nasal inhalations. Afterwards, patients could decide for themselves how frequently they used an IPA swab, with a maximum of 3 swabs every 15 min. A high level of inhalation compliance can be assumed, as the nurse was always present during the first and usually present during subsequent inhalations.
Additionally, even though the instruction and practical execution of a correct application of IPA inhalation is very simple, an information sheet with inhalation instructions was present at the bedside. Fifteen minutes after the first inhalation, a new VAS for nausea was obtained. In case of a decrease in nausea, IPA therapy was continued if needed.
If nausea had not changed or even increased, the nurse would discuss with the treating physician if conventional anti-emetics would be administered Fig. The primary outcome was the number of patients that received symptomatic treatment for their nausea in the ED. Secondary outcomes were the time from inclusion to symptomatic treatment, the number of administrations of a conventional anti-emetic per patient during their stay in the ED, the estimated cost of symptomatic nausea treatment per patient, and the experiences of nurses with the use of IPA.
To calculate the cost of symptomatic treatment, we used drug prices as provided by a governmental institution [ 10 ] and calculated the average cost per administered dose of conventional anti-emetic, amounting to 2.
As all patients received 3 swabs, and no patient used more than 3 swabs, the cost of treatment with IPA was determined at 0. All questions were asked using a five-point Likert-scale.
We used Gpower 3. We determined that we would need 93 patients in each study phase. For both continuous and ordinal variables, we used the Mann-Whitney U test. The chi-square test was used to compare percentages.
Regression analysis was used to control for confounding factors. The variables from Table 1 age, sex, initial nausea score, initial pain score, and presumed nausea cause were used one by one for this analysis. For the survey, we calculated an average score per question and per implementation outcome measure based on the 5-point Likert scale. Due to the limited number of surveys completed by the ED nurses, we report averages but do not make any statistical inferences based on this survey.
A total of patients were included in the study: in the baseline phase and in the implementation phase. There were no significant differences between the two groups with regard to age, sex, initial nausea score, pain score, and presumed cause of nausea upon presentation in the ED Table 1. Additionally, there were no significant differences between the two groups with regard to the definitive diagnosis as made by the treating physician during the ED visit see Additional files, table A1.
The percentage of nauseous patients that received nausea treatment was Additionally, the time between an entry in the ED and nausea treatment initiation fell significantly after the implementation of IPA inhalation.
The mean number of administered conventional anti-emetics decreased from 0. Comparison of the cost of nausea treatment between the two phases showed a reduction from 1. Regression analysis showed that none of the included variables age, sex, VAS pain, VAS nausea, and presumed cause of nausea influenced our primary and secondary outcomes. Therefore, we performed a subgroup analysis for the group of patients that had not received prehospital anti-emetics. Results of this subgroup analysis were consistent with the results presented in Table 2 : all significant differences in primary outcomes were also found in this separate subgroup see Additional files, Table A2.
A total of 8 patients that received IPA inhalation reported mild side effects. Three patients noted a headache, 1 patient reported dizziness, and 1 patient experienced a chemical taste. In 3 cases, nausea increased after IPA inhalation. No side effects were reported in the baseline phase.
Regarding the 8 implementation outcome measures, feasibility and sustainability received the highest average scores 4. Specifically, within the feasibility aspect, nurses indicated that the most important advantage of IPA inhalation was that it is easy to use 4. Additionally, they experienced that giving inhalation instructions was easy 4.
Even though the sustainability aspect consisted of only one question, nurses strongly agreed they would be glad to continue to use IPA inhalation treatment after the termination of the study 4. Moreover, the implementation outcome measures adoption, appropriateness, and fidelity were also scored more positively than negatively 3. Full survey data on individual questions as well as on the 8 implementation outcome measures are provided in the Additional files see Tables A3 and A4.
In this study, we evaluated the practical implications of the implementation of IPA as a first-line nausea treatment in the ED. Both objective and subjective measures suggest that definitive implementation and permanent use of IPA as a first-line treatment in the ED is both viable and practically feasible. Firstly, after IPA was introduced, the number of patients receiving anti-emetic treatment rose significantly.
This is most likely explained by several factors: IPA has a high user-friendliness for both the nurse and patient involved, IPA can be initiated by the nurse independently without prior permission of the treating physician, and IPA can be applied more rapidly and easily as no intravenous access is required and providing usage instructions does not require much time or effort. Secondly, the time patients had to wait for nausea treatment to be initiated was significantly reduced. Thirdly, when IPA inhalation was used, less conventional anti-emetics Ondansetron and Metoclopramide were prescribed and therefore the cost for symptomatic treatment of nausea in the ED dropped notably.
There is lots of potential bias in there. There is also the question of Ondansetron, which in this study really does not seem to work at all. Well, we have two recent RCTs that suggest sniffing alcohol swabs works. They both have similar flaws, but they are consistent. Until we know better it seems like a reasonable tool for the ED clinician who wants to reduce nausea quickly. A second question would be whether this study is robust enough to suggest that we should swap Ondansetron for alcohol swabs.
In that regard my answer is no. Get sniffing. He is co-founder of BestBets, St. He is verified on twitter as EMManchester. The satisfaction score for the alcohol patients was double the satisfaction score for the saline solution patients. That said, the available evidence suggests these alcohol wipes may be a potent tool for relieving nausea and improving satisfaction among our emergency patients.
Materials provided by American College of Emergency Physicians. Note: Content may be edited for style and length. Science News.
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