Nausea-Vomiting

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg 
□ No Zofran in patients who are less than 1 year old
□ Projective vomiting/green vomiting in less than 2 months old is abnormal
□ Tachycardia is first sign of dehydration
□ Ask about urine output		□ Fever 
□ Pain 
□ Constipation 
□ Diarrhea 
□ Anorexia 
□ Hematemesis 
□ Bilious emesis		□ CNS (Increased ICP, headache, stroke, □ CNS lesions, Trauma, or hemorrhage) 
□ Vestibular 
□ AMI 
□ Small bowel obstruction
□ Drugs (NSAIDS, antibiotics, narcotics, chemotherapy) 
□ GI or GU disorders 
□ Uremia 
□ Gynecologic disease (Ovarian Cyst / PID) 
□ Infections (pneumonia, influenza) 
□ Electrolyte abnormalities 
□ Food or Toxin induced 
□ Pregnancy 

Clinical Management Options

EMT-B
• Oxygen, target SpO2 92 – 96% 
• Basic Airway Management as needed 
• Orthostatic vital sign assessment if appropriate 
• Allow patient to inhale isopropyl (rubbing) alcohol for aromatherapy to treat nausea 
Paramedic
• Consider vascular access 
• 12 lead ECG in adults>50
• Consider Ondansetron 
• Consider IV fluid with Isotonic Crystalloid as needed for dehydration 
• Reduce the amount of IV fluids if there is a history of CHF
Consult Online Medical Control as Needed

Pearls

  • Assess number of times of emesis 
  • Appearance of emesis: bloody, coffee ground, bilious – green bile – solids and liquid or just liquid 
  • Heart rate: One of the first clinical signs of dehydration, usually increased heart rate, tachycardia increases as dehydration becomes more severe, very unlikely to be significantly dehydrated if heart rate is close to normal. 
  • Consider small bowel obstructions in patients who have abdominal distension with nausea and vomiting. 
  • Remember to consider exposures and ingestions in some populations