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

 

• • See Medical Hypotension Protocol

 

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 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.