Ondansetron contraindicated for subdural and epidural hemorrhage?

[smuin538, ADN, RN]

Hello!

I had an ED rotation this morning and during morning huddle the attending was discussing the differences in treatment of subdural versus epidural hemorrhages. He mentioned in passing that ondansetron is contraindicated for patients with either type of hemorrhage. The nurse I was following nodded knowingly--I meant to ask her before I left why ondansetron can't be used in these patients, but we were dismissed early due to the snow in our area and I didn't get a chance to ask her. Now I am trying to figure it out on my own, but I can't find anything in my drug guide or any articles online that would explain why ondansetron wouldn't be used to manage nausea/vomiting that might be present in these patients. Is someone able to explain this to me? I would very much appreciate it!

[NICU Guy, BSN, RN]

"Ondansetron use during an initial emergency department visit for head trauma in children not requiring neuroimaging is associated with a higher likelihood of return within 72 hours and subsequent admission."

Nausea and vomiting could indicate that a head injury is getting worse. If the patient is sent home on Zofran, it might mask a worsening condition.

[chare]

I believe this is the article NICU Guy referenced.

Use of Ondansetron for Vomiting After Head Trauma: Does It Mask Clinically Significant Traumatic Brain Injury?

[smuin538, ADN, RN]

Thank you for the responses!

On 1/29/2019 at 9:45 PM, NICU Guy said:

"Ondansetron use during an initial emergency department visit for head trauma in children not requiring neuroimaging is associated with a higher likelihood of return within 72 hours and subsequent admission."

Nausea and vomiting could indicate that a head injury is getting worse. If the patient is sent home on Zofran, it might mask a worsening condition.

So in the case of a head injury is it considered best practice to simply not treat nausea/vomiting pharmacologically?

[murseman24, MSN, CRNA]

I don't know either. I know zofran can cause headaches, that's about the only neuro symptom I can think of. It's not you being a student, that's a good question.