GI/Nausea Administrative Guideline

Question 1

History

Answer 1

• Age
• Time of last meal
• Last bowel movement/emesis
• Improvement or worsening with food
  or activity
• Duration of problem
• Other sick contacts
• Past medical history
• Past surgical history/Medications
• Menstrual history (pregnancy)
• Travel history
• Bloody emesis / diarrhea

Question 2

Signs and symptoms

Answer 2

• Pain
• Character of pain (constant, intermittent,
  sharp, dull, etc.)
• Distention, Constipation
• Diarrhea
• Anorexia
• Radiation
• Associated symptoms: Fever, headache,
  blurred vision, weakness, malaise,
  myalgias, cough, headache, dysuria,
  mental status changes, rash

Question 3

Differential

Answer 3

- CNS (stroke, CNS lesions, trauma or 
hemorrhage, vertigo, migraine)
- Myocardial Infarction
- Drugs (NSAID's, chemo, antibiotics)
- Chronic GI or renal disorders
- Diabetic ketoacidosis
- OB-Gyn disease (ovarian cyst, PID, 
Pregnancy)
- Infections (pneumonia, influenza)
- Food or toxin induced

Question 4

GI complaint
Nausea/Vomiting
Abdominal Pain

Answer 4

Vital sign assessment, including temperature if available, FSBG analysis
IV/IO access (two 18-20 gauge if signs or symptoms of shock)
O 2, consider cardiac monitor/12 lead ECG

Question 5

What else do you do?

Answer 5

Administer ondansetron 0.15 mg/kg IV (max 4mg)
Do not give if age <3mos
May repeat x 1 in 15 min
Administer 20 mL/kg NS/LR fluid bolus (max 1 L)
May repeat fluid bolus
Consider Pain Management AG if indicated

Monitor and reassess vitals

Question 6

What should you know about heart rate and dehydration?

Answer 6

Increased heart rate is one of the first clinical signs of dehydration or infection, and may
represent a reduction in volume status. Tachycardia usually increases as dehydration becomes more
severe. Patients with normal heart rate are very unlikely to be significantly dehydrated.

Question 7

What should you know about vomiting and pediatrics?

Answer 7

Beware of isolated vomiting in children. Isolated vomiting may represent pyloric stenosis, bowel
obstruction, and CNS processes (bleeding, tumors, or increased CSF pressures), as well as a response to
fever or infection.