Nausea & Vomiting

Question 1

Nausea and Vomiting - Definition

Answer 1

Unpleasant, painless sensation of potentially vomiting

Question 2

Goal of Care

Answer 2

Symptom management. Improve comfort. Transport for definitive diagnosis and treatment

Question 3

Overview

Answer 3

The list of potential etiologies for nausea is extensive

There are two main principles to managing nausea:

• Identify the underlying cause to provide specific therapies if appropriate
• Treat symptoms empirically for comfort

Question 4

Guiding Principles

Answer 4

Common presentations are - infectious, medication-related or vertigo

Potentially life-threatening conditions - stroke, meningitis, GI bleeding, ischemic bowel, DKA, myocardial infarction and sepsis

Emergent diagnoses - electrolyte disturbance, overdose, drug toxicity, carbon monoxide poisoning, pregnancy, intra-abdo infection, biliary disease and bowel obstruction

Question 5

Guiding Principles - Dimenhydrinate

Answer 5

• is a medication that maybe admin’d empirically for symptom relief.
• Use only if symptoms are present and not for prophylaxis

Caution - increased intraocular pressure/ glaucoma, prostatic hyperplasia and urinary obstruction, cardiovascular disease. asthma/COPD, elderly (due to anticholinergic effects)

• IV fluids may be given to those who are severely dehydrated due to poor oral intake or persistent vomiting

Question 6

Intervention Guidelines - EMR/PCP/ACP

Answer 6

EMR
Keep pt at rest
Position of comfort
Initiate transport in position that pt can maintain their own airway
Be prepared and ready to manage the vomiting pt

PCP/ACP
All above, plus;

Anti-emetic for symptom relief
- Dimenhydrinate IM/IV 25-50mg IM/IV

NS IV fluids for dehydration as appropriate

Question 7

Further Care

Answer 7

Other medications (Ondansetron, Metoclopramide)
Rehydration
Investigations to address and treat underlying etiology