Notes – Nausea-Vomiting

Nausea-Vomiting

Patient Safety Considerations

  1. For very young pediatric patients, Ondansetron can be sedating

Notes/Educational Pearls

Key Considerations

  1. Ondansetron is preferred in children for the treatment of nausea and vomiting;
  2. IV form of ondansetron may be given PO in same dose
  3. Nausea and vomiting are symptoms of illness – in addition to treating the patient’s nausea and vomiting a thorough history and physical are key to identifying what may be a disease in need of emergent treatment (e.g. bowel obstruction, myocardial infarction, pregnancy)
  4. While ondansetron has not been adequately studied in pregnancy to determine safety, it remains a treatment option for hyperemesis gravidum in pregnant patient

Pertinent Assessment Findings

  1. Vital signs
  2. Risk factors for heart disease/EKG if applicable
  3. Pregnancy status
  4. Abdominal exam

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914131 – Medical-Nausea/Vomiting

Key Documentation Elements

  • Patient age
  • Patient weight and/or length-based weight measure for pediatric patients
  • Medications given, including time, provider level, dose, dose units, route, response and complications
  • Vital signs before and after medication administration
  • History and physical with regard to etiology of nausea/vomiting
  • EKG performed and interpretation documented if cardiac risk factors are present

Performance Measures

  • In patients with nauseaand vomiting, appropriate medication(s) was/were administered (including proper dosage) and the patient’s response to treatment is documented
  • Any event where complications occurred, such as a dystonic reaction, should have event and appropriate responsive interventions performed and documented
  • EMS Compass® Measure (for additional information, see http://www.emscompass.org)
    • PEDS-03: Documentation of estimated weight in kilograms. Frequency that weight or length-based estimate are documented in kilograms

References

  1. Beadle KL, Helbling AR, Love SL, April MD, Hunter CJ. Isopropyl alcohol nasal inhalation for nausea in the emergency department: a randomized controlled trial. Ann Emerg Med. 2016;68(1):1-9.
  2. Colletti J. Brown KM, Sharieff GQ, Barata IA, Ishimine P; ACEP Pediatric Emergency Medicine Committee. The management of children with fastroenteritis and dehydration in the emergency department. J Emerg Med. 2010;38(5):686-98.
  3. Kenneday D. Ondansetron and pregnancy: understanding the data. Obstet Med. 2016;9(1):28-33.
  4. Nausea and Vomiting of Pregnancy. The American College of Obstetricians and Gynecologists; September 2015. Practice Bulletin Number 153.
  5. Patanwala A, Amini R, Hays DP, Rosen P. Antiemetic therapy for nausea and vomiting in the emergency department. J Emerg Med. 2010;39(3):330-6.
  6. Salvucci AA, Squire B, Burdick M, Luoto M, Brazzel D, Vaezazizi R. Ondansetron is safe and effective for prehospital treatment of nausea and vomiting by paramedics. Prehosp Emerg Care. 2011;15(1):34-8.
  7. Warden CR, Moreno R, Daya M. Prospective evaluation of ondansetron for undifferentiated nausea and vomiting in the prehospital setting. Prehosp Emerg Care. 2008;12(1):87-91.