History:
- Age
- Time of last meal
- Last bowel movement/emesis
- Improvement or worsening with food or activity
- Duration of problem
- Other sick contacts
Significant Findings:
- Pain
- Character of pain
- Constant
- Intermittent
- Sharp
- dull
- Distention
- Constipation
- Diarrhea
- Anorexia
- Radiation
Associated symptoms (helpful to localize source)
- Fever
- Headache
- Blurred Vision
- Weakness
- Malaise
- Mental status changes
- Myalgia
- Cough
- Dysuria
- Rash
Differential:
-
CNS
- Increased pressure
- Headache
- Stroke
- CNS lesions
- Trauma/hemorrhage
- Vestibular
- Myocardial infarction
- Drugs
- GI/Renal disorders
- Diabetic Ketoacidosis
-
Gynecologic disease
- Infections
- Electrolyte abnormalities
- Pregnancy
- Psychological
Treatment:
Signs of hypotension ?
8-15 kg ?
-
- Zofran 2 mg slow IV/IM over 2 min
≥ 15 kg
-
- Zofran 4 mg slow IV/IM; may be repeated in 10 mins; 4 mg ODT can be substituted
- Notify receiving facility or contact Medical Control
PEARLS:
- ODT Zofran (Ondansetron) 4 mg can be given to a previously healthy child > 6 months of age.
- Use Handtevy for pediatric drug dosages.
- Zofran (Ondansetron) can cause QT widening.
- Use ODT (orally disintegrating tablets) with caution in adult patients complaining of abdominal pain.
- For ODT, place one tablet on top of patient's tongue.
- Beware of vomiting in children. Pyloric stenosis, bowel obstruction, and central nervous system processes (bleeding tumors, or increased cerebral spinal fluid pressure) all often present with vomiting.
- Document the mental status and vital signs prior to administration of antiemetic medications.