Isopropyl Alcohol
Isopropyl Alcohol
Inhaled anti-emetic effects
January 6, 2023
Dear Colleagues,
Welcome to the first week of UH EMS Institute’s Pharmacy Phriday in 2023! Happy New Year!! As we begin our review for this year, the first few installments will focus on changes in the 2023 protocols that are related to medications and dosing. Although these have been addressed in the 2023 Protocol rollout CE, these will serve as additional reminders of the changes. In this first week, we will focus on the use of Isopropyl Alcohol (IPA) prep pads for nausea and vomiting.
Nausea and vomiting (N&V) remain common complaints in emergency medicine. In reviewing a recent spreadsheet documenting the total medications administered in the prehospital setting within the UH system, Zofran is one of the top five medications given. To provide quicker care for N&V, several studies have investigated the use of IPA prep pads with these complaints. Though the mechanism of how IPA works is unclear, some articles suspect it may be due to an olfactory distraction like scented oils.
The use of IPA has been studied in the anesthesia literature and shown positive results in decreasing nausea severity by more than 50% in a much faster time than ondansetron, promethazine, and placebo. In a study looking at IPA’s use in the emergency setting, the results surprisingly showed greater improvement in a nausea score using IPA as compared to that of oral Zofran. Another study reported a practical benefit of the use of IPA in the nauseated patient as a first-line treatment with minimal side effects. Minor side effects reported in that study included headache, dizziness, or chemical taste.
The use of the IPA prep pads for nausea and vomiting has been included in the UH EMS Protocols as a consideration for all levels of providers, including the EMT Basic. Advanced providers can consider its use as they prepare for other pharmacological treatments as an IV is established or a drug box is obtained and opened. It was interesting to find that some studies noted a reduction in the need for conventional antiemetics following the use of IPA.(https://intjem.biomedcentral.com/articles/10.1186/s12245-021-00334-z)
To use the IPA pads, tear open the package and either hold or have the patient hold the pad under their nose (about ½ inch) and have them take deep breaths through their nose. The peak effect of the IPA should occur within 4 minutes. Multiple pads can be used for continued short-lasting nausea relief. For longer relief from N&V, the provider should still consider the use of a conventional antiemetic.
In a December 2015 EMS1 article, the following was cited: "Alcohol wipes are safe, and there were no adverse effects," Beadle said. "Further research is warranted to test the duration of the effect and performance in comparison to traditional pharmaceutical antiemetics. That said, the available evidence suggests these alcohol wipes may be a potent tool for relieving nausea and improving satisfaction among our emergency patients."
It will be interesting to see the effectiveness of this new intervention in our area. Your feedback is welcomed regarding this new tool.
In closing, we also would like to remind providers of the free safety stickers available for the Power Pro ambulance cots. The stickers are designed to remind the crew to lower the cot from a loading height while moving a patient. The stickers are not visible when the cot is at a lower height. Stickers are available from your local EMS coordinators.
Till next week, stay safe!
Sincerely,
The UH EMS-I Team
University Hospitals