EMS is called to the house of a 24 yo female who is 8 weeks pregnant. She has had countless episodes of nausea and vomiting over the last 4 days. She has been unable to take anything by mouth over this period and has not urinated in the last day. Heart rate is 115, blood pressure 101/60. The crew starts an IV and begins administration of IV fluids. The patient asks if they can give her anything for the nausea on the way to the hospital. The current protocol for nausea and vomiting recommends administration of 4 mg of IV ondansetron. Given recent controversy about zofran and birth defects, and the recommendation by American College of Obstetricians and Gynecologist that vitamin B6 plus doxylamine be the first line treatment for hyperemesis, what do your protocols currently recommend for nausea and vomiting in pregnancy? Do you or do you not give zofran and why? What are the alternatives?
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