Nausea - Vomiting

 

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
    • Ovarian cyst
    • PID
  • Infections
  • Electrolyte abnormalities
  • Pregnancy
  • Psychological

 

Treatment:

 

  • Oxygen
  • Obtain BGL
  • 12 Lead EKG
  • Initiate IV

 

Signs of hypotension ?

 

  • Yes

 

 

8-15 kg ?

 

  • Yes

 

    • Zofran 2 mg slow IV/IM over 2 min

 

≥ 15 kg

 

  • Yes

 

    • 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 Broselow tape 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.