The evidence base supporting the prehospital use of prophylactic anti-emetics is limited. Some jurisdictions administer at least one anti-emetic to trauma patients in an effort to prevent nausea and vomiting in this setting. Whilst there is no good evidence to support the routine administration of metoclopramide when morphine is administered in the acute care setting ( Simpson et al. Emerg Med Australas 2011 23(4): 452-7) there are logical reasons why prophylactic antiemetics are given for patients with trauma. Patients with traumatic injuries typically experience pain and are commonly administered opiate / opioid analgesics both of which are associated with increased rates of nausea and vomiting. Additionally many trauma patients have their spine immobilised for the transport to hospital which typically includes the fitting of a semi-rigid cervical collar and being secured to a spine board or stretcher. Additionally these patients may have impaired airway reflexes, delayed gastric emptying and motion sickness all contributing to an increased risk of aspiration.
A recent epidemiological study by Easton et al. (Journal of Trauma and Acute Care Surgery 2012, 72(5): 1249-1254) has described the prevalence and risk factors for prehospital nausea and vomiting after trauma….read more