Nausea/Vomiting Medical Directive

Question 1

What are the indications for the Nausea/Vomiting MD?

Answer 1

Nausea or vomiting.

Question 2

What are the conditions for Ondansetron administration?

Answer 2

Weight ≥25 kg
LOA - Unaltered

Question 3

What are the conditions for dimenhyrinate?

Answer 3

Age <65 years
Weight ≥25 kg
LOA - Unaltered

Question 4

What are the contraindications for ondansetron administration?

Answer 4

• Allergy to ondansetron
• Prolonged QT syndrome (known to the patient)
• Apomorphine use

Question 5

What are the contraindications to dimenhydrinate administration?

Answer 5

• Allergy or sensitivity to dimenhydrinate or other antihistamines
• OD on antihistamines or anticholinergics or tricyclic antidepressants
• Co-administration of diphenhydramine

Question 6

What is the dosage for ondansetron administration?

Answer 6

PO
4 mg, max 1 dose.

Question 7

What is the dose of dimenhydrinate for patients ≥25 kg to <50 kg?

Answer 7

IV/IM
25 mg, max 1 dose.

Question 8

What is the dose of dimenhydrinate for patients ≥50 kg?

Answer 8

IV/IM
50 mg, max 1 dose.

Question 9

What is the preferred tx?

Answer 9

Ondansetron

Question 10

How should dimenhydrinate be diluted prior to IV administration?

Answer 10

1:9 with normal saline or D5W.

Question 11

Is dimenhydrinate diluted IM?

Answer 11

No.

Question 12

If a pt has been given ondansetron with no relief of symptoms, can they be given dimenhydrinate?

Answer 12

Yes. If no relief of their nausea & vomiting symptoms after 30 minutes, dimenhydrinate may be considered.

Question 13

What’s the first clinical consideration?

Answer 13

IV administration of dimenhydrinate applies only to PCPs authorized for PCP autonomous IV.