North Country EMS Protocol Option
July 2010
Brand versus Generic
 Brand- Zofran
 Cost- ~$66.00 for 4 mg
 Generic – Ondansetron Hydrochloride
 Cost- ~ $5.00 for 4mg
Zofran (ondansetron hydrochloride)
can be used instead of Reglan
(metoclopramide)as an antiemetic.
 North Country EMS 2007 Protocols
Acute Coronary Syndrome (page 18)
 Nausea/Vomiting (page 35)
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Zofran (ondansetron hydrochloride)
 This is approved for use in adult protocols.
 Not approved for use in pediatric protocols.
 Medical control order would be needed for Pediatric
patient and dose is 0.1 mg/kg for children 2-12 y/o, if
under 40 kg (88lbs)
 Optional for agencies to carry.
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OLD
CARDIAC – ACUTE CORONARY
SYNDROME (ACS)
(Suspected Cardiac Chest Pain)
Routine Medical Care
Chewable Aspirin 162 mg total
EMT-CC / EMT-P
If SBP >100 Nitroglycerine 0.4 mg SL*
May repeat every 3-5 min. x 2
Transport patient as soon as feasible. Obtain 12
Lead ECG (if available)
Do not delay transport
Nausea/Vomiting present - Metoclopramide
(Reglan) 10 mg IV/IM
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If chest pain persists and SBP >100
Morphine 2 mg IV
May repeat every 5 min. up to 20 mg
If heart rate >75 and SBP >100
Metoprolol (Lopressor) 5 mg IV slow
May repeat X 2 every 5 min.
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Complete fibrinolytic checklist (Pg. 81, if
transport time allows)
Do not delay initial Nitroglycerin therapy
to establish IV access.
Nitroglycerine is contraindicated in
patients who have taken
Erectile Dysfunction medication within 24
hours.
If SBP <100 without Altered Mental Status;
consider Medical Control consultation for
Nitroglycerine administration.
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NEW
 CARDIAC – ACUTE CORONARY
SYNDROME (ACS)
 (Suspected Cardiac Chest Pain)
 Routine Medical Care
 Chewable Aspirin 162 mg total
 EMT-CC / EMT-P
 If SBP >100 Nitroglycerine 0.4 mg SL*
 May repeat every 3-5 min. x 2
 Transport patient as soon as feasible. Obtain 12
Lead ECG (if available)

Do not delay transport
 Nausea/Vomiting present –
Metoclopramide (Reglan) 10 mg IV/IM
or
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Ondansetron (Zofran) 4 mg IV/IM
(may repeat X 1 after 5 minutes if no relief)
 If chest pain persists and SBP >100
 Morphine 2 mg IV
 May repeat every 5 min. up to 20 mg
 If heart rate >75 and SBP >100
 Metoprolol (Lopressor) 5 mg IV slow
May repeat X 2 every 5 min.
Complete fibrinolytic checklist (Pg. 81, if
transport time allows)
 Do not delay initial Nitroglycerin therapy
to establish IV access.
 Nitroglycerine is contraindicated in
patients who have taken
 Erectile Dysfunction medication within 24
hours.
 If SBP <100 without Altered Mental Status;
Control consultation for Nitroglycerine
NAUSEA / VOMITING
Indicated for patients experiencing nausea and/or
vomiting as a result
of disease, medications or acute motion sickness.
EMT-CC / EMT-P
Routine Medical Care
Consider Fluid Challenge
(Pg. 26)
Metoclopramide (Reglan) 10 mg IV/IM
Or
Ondansetron (Zofran) 4 mg IV/ IM
(Slow IV Push 2-5 minutes)
(May repeat x 1 if no relief after 5 minutes)
Zofran (Ondansetron Hydrochloride)
 Class- Antiemetic
 Description –Serotonin (5-HT₃) receptor antagonist-Blocking
action may take place in CNS at area postema (chemoreceptor
trigger zone) and in peripheral nervous system on terminals of vagus
nerve
 Indications- nausea and vomiting
 Contra Indications – Hypersensitive to drug
 Precautions-In pregnant and breast-feeding women use
cautiously, may be excreted in breast milk, may cause syncope if
pushed to fast
 Dosage- 4 mg slow IV push (over 2-5 minutes) or 4 mg IM
Zofran (ondansetron Hydrochloride)
Pharmacokinetics
 Absorption: Variable; bioavailability is 50% to 60%
 Distribution: 70% to 76% is protein bound
 Metabolism: Extensively metabolized.
 Excretion: Primarily excreted in urine, can be excreted
in feces or breast milk.
 Half-life : 4 hours
Zofran (ondansetron Hydrochloride)
Adverse Reactions
 CNS: - Headache
 GI: Diarrhea, Constipation
 Skin: Rash
Side effects may include: constipation, diarrhea,
drowsiness, dizziness, fatigue, headache, impaired
wound healing, itch, decreased heart rate, fever,
anxiety/agitation
 Any questions please contact North Country EMS at
315-379-3977.
 You must complete training program and quiz prior to
using medication.
 Agencies must keep copy of providers completed quiz
on file, provider must obtain 80% or better on quiz.
 Documented remediation from training officer or
medical director required if score is 80% or less
Works Sited
 Springhouse Nurses Drug Guide 2005, pg 942.
 North Country EMS 2007 Protocol Book
 Physician Desk Reference Health (pdrhealth.com)