Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial Kenneth Lee Beadle, DSc, MPAS, Antonia R. Helbling,

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Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial Kenneth Lee Beadle, DSc, MPAS, Antonia R. Helbling, MD, Sue L. Love, DSc, EMPA-C, Michael D. April, MD, DPhil, Curtis J. Hunter, MD Annals of Emergency Medicine Volume 68, Issue 1, Pages 1-9.e1 (July 2016) DOI: 10.1016/j.annemergmed.2015.09.031 Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 1 CONSORT diagram of patient enrollment, allocation, follow-up, and analysis. Annals of Emergency Medicine 2016 68, 1-9.e1DOI: (10.1016/j.annemergmed.2015.09.031) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 2 Image of study pads both unblinded (A) and blinded (B). Annals of Emergency Medicine 2016 68, 1-9.e1DOI: (10.1016/j.annemergmed.2015.09.031) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 3 Patient nausea verbal numeric rating scale (VNRS) scores from 0 to 10 minutes after intervention for each study arm. The horizontal axis separates data for each patient, with the central line demarcating data for patients receiving placebo (left) versus isopropyl alcohol (right). The vertical axis represents the patient-reported nausea VNRS score (0 to 10). Each circle represents the initial nausea VNRS score for each patient. Associated vertical lines represent changes in nausea from study start (0 minutes) to time of final outcome measure (10 minutes). Circles without lines represent patients reporting no changes in nausea VNRS. The box plots on the figure margins represent summary statistics, with the central lines representing medians, boxes representing interquartile ranges, and outermost plots representing maximum and minimum nausea VNRS values for the samples composing each study arm. Median nausea VNRS scores at 10 minutes postintervention were lower by 3 (Hodges-Lehmann estimator 95% confidence interval 2 to 4) in the isopropyl alcohol arm compared with the placebo arm (P<.001 by Wilcoxon rank sum test). Annals of Emergency Medicine 2016 68, 1-9.e1DOI: (10.1016/j.annemergmed.2015.09.031) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 4 Patient pain verbal numeric rating scale (VNRS) scores from 0 to 10 minutes after intervention for each study arm. The horizontal axis separates data for each patient, with the central line demarcating data for patients receiving placebo (left) versus patients receiving isopropyl alcohol (right). The vertical axis represents the patient-reported pain VNRS score (0 to 10). Each circle represents the initial pain VNRS score for each patient. Associated vertical lines represent changes in pain from study start (0 minutes) to time of final outcome measure (10 minutes). Circles without lines represent patients reporting no changes in pain VNRS. The box plots on the figure margins represent summary statistics, with the central lines representing medians, boxes representing interquartile ranges, and outermost plots representing maximum and minimum pain VNRS values for the samples composing each study arm. Median pain VNRS scores at 10 minutes postintervention were comparable in the two arms with a difference of 0 (Hodges-Lehmann estimator 95% confidence interval -1 to 2). Annals of Emergency Medicine 2016 68, 1-9.e1DOI: (10.1016/j.annemergmed.2015.09.031) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure E1 Box plot of patient nausea verbal numeric rating scale scores from 0 to 10 minutes after intervention for each study arm. Patients receiving isopropyl alcohol had significantly lower nausea score distributions at every interval after study start. Annals of Emergency Medicine 2016 68, 1-9.e1DOI: (10.1016/j.annemergmed.2015.09.031) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure E2 Box plot of patient pain verbal numeric rating scale scores from 0 to 10 minutes after intervention for each study arm. There were no significant differences in scores at any interval after study start. Annals of Emergency Medicine 2016 68, 1-9.e1DOI: (10.1016/j.annemergmed.2015.09.031) Copyright © 2015 American College of Emergency Physicians Terms and Conditions