Short Attention Span Summary
Pass the alcohol
Sniffing an alcohol pad relieves nausea. Yes, you heard that correctly. This came out last December and was officially published in Annals of EM in July, so I thought we would revisit this.
This was a well done RCT with 80 patients. Patients who sniffed an alcohol vs. saline pad had a marked and clinically significant reduction in nausea at 10 minutes and a marked improvement in patient satisfaction. This is really handy for motion-sick patients on a helicopter! Our LifeFlight medics have been using this trick for years.
This was a convenience sample and not consecutive recruitment, and though it was double-blinded, it’s hard to see how you wouldn’t know you didn’t get an alcohol vs. a saline pad, unless you could make the study double-anosmic.
When you need a quick fix for nausea, before you have time to get an IV or meds, try having your patient whiff an alcohol pad. It works! ALiEM has a great Tricks of the Trade about this. SGEM has a podcast if you prefer audio.
Ann Emerg Med. 2016 Jul;68(1):1-9.e1. doi: 10.1016/j.annemergmed.2015.09.031. Epub 2015 Dec 8.
1Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.
2Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX. Electronic address: Michael.D.April@post.harvard.edu.
We compare nasal inhalation of isopropyl alcohol versus placebo in treating nausea among emergency department (ED) patients.
A convenience sample of adults with chief complaints of nausea or vomiting was enrolled in a randomized, double-blind, placebo-controlled trial conducted in an urban tertiary care ED. Patients were randomized to nasally inhaled isopropyl alcohol versus nasally inhaled normal saline solution. Patient nausea and pain were measured with previously published 11-point verbal numeric response scale scores; patient satisfaction was measured by a 5-point Likert scale. The primary outcome was reduction in nausea 10 minutes poststart. Secondary outcomes included patient satisfaction and pain reduction measured at 10 minutes poststart.
Of 84 recruited patients, 80 (95.2%) completed the study. Thirty-seven (46.3%) received nasally inhaled isopropyl alcohol and 43 (53.8%) received nasally inhaled normal saline solution. At 10 minutes postintervention, median nausea verbal numeric response scale score was 3 in the isopropyl alcohol arm versus 6 in the placebo arm, for an effect size of 3 (95% confidence interval 2 to 4). Median satisfaction score was 4 in the isopropyl alcohol arm versus 2 in the placebo arm, for an effect size of 2 (95% confidence interval 2 to 2). There were no significant differences between the 2 arms in median pain verbal numeric response scale scores or subsequent receipt of rescue antiemetics.
We found that nasally inhaled isopropyl alcohol achieves increased nausea relief compared with placebo during a 10-minute period.
Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
PMID: 26679977 [PubMed – in process]