In part one of this podcast, we covered a popery of analgesics and analgesic adjuncts for all kinds of

common painful conditions that we see in the ED. We're going to switch gears now from pain

and talk about nausea and vomiting. Now, there are few things that catch our attention more when we're

cruising down the hallways of our ED than the patient who's

incessantly vomiting. So I'd like to cover first what works for nausea and vomiting,

and second, whether adding antimetics to morphine to prevent nausea and vomiting is of any

benefit. Now, there are many choices here. There's metaclopramide. There's on dancetron. There's diamond hydronate,

which we all know is gravel in Canada. There's prochlorparazine. There's haloperidol. There's

even inhaled isopropal alcohol from an alcohol swab. And the list goes on from there.

Dr. Lexchin, what are the best ED medications for nausea and vomiting, generally speaking? You know, I think this is an issue

where if you ask 10 different emerge docs, you'll get 10 different answers. I used to use Graval, then I switch to

metaclopromide. Now I usually go to Andansetron, and from the literature that I've read,

it doesn't seem to matter what you use. There's nothing better than any of the other ones.

All you're doing is giving your patients different sets of side effects. So I don't think that there's

a real good answer to what to use. Now, maybe when we get to the isopropyl alcohol, we'll get a bit of a different answer.

But all these other drugs, I really don't think that there's anything in terms of benefits to

choose from. It's the side effects that you should be using to make your choice.

And you said, you know, they don't seem to be any different from each other. But the fascinating

thing about this literature to me is that actually, in almost all the trials that are done,

they aren't any different from placebo either. And that's a bit of a problem. I'm not sure it

fits with what we see clinically, but that's why we run trials, right? And those are really strong. And

I don't think it's possible that these drugs could have no benefit, because I think if you

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