Nausea/ Vomiting Medical Directive

Question 1

What are the indications?

Answer 1

• Nausea or vomiting

Question 2

What are the two medications that we can give?

Answer 2

• Ondansetron & dimenhydrinate

Question 3

What are the conditions of ondansetron?

Answer 3

• Age= n/a
• Weight= >25 kg
• LOA= unaltered
• HR= n/a
• RR= n/a
• SBP= n/a
• Other= n/a

Question 4

What are the conditions of dimenhydrinate?

Answer 4

• Age= <65 yrs
• Weight= >25 kg
• LOA= unaltered

Question 5

What are the contraindications for ondansetron?

Answer 5

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

Question 6

What are the contraindications for dimenhydrinate?

Answer 6

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

Question 7

What is the treatment for ondansetron?

Answer 7

• Weight= >25 kg
• Route= PO
• Dose= 4mg
• Max. single dose= 4mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 8

What is the treatment for dimenhydrinate? (Weight= >25kg to <50kg)

Answer 8

• Route= IM/IV
• Dose= 25mg
• Max. single dose= 25mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 9

What is the treatment for dimenhydrinate? (Weight= >50kg)

Answer 9

• Route= IM/IV
• Dose= 50mg
• Max. single dose= 50mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 10

What are the clinical considerations?

Answer 10

• IV administration of dimenhydrinate applies only to PCPs authorized PCP Autonomous IV
• Prior to IV administration, dilute dimenhydrinate (concentration of 50mg/1ml) 1:9 with Normal Saline or D5W. If administer IM do not dilute
• If a pt has received Ondansetron and has no relief of their nausea & vomiting symptoms after 30 mins, dimenhydrinate may be considered