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Nausea and Vomiting - Definition

Unpleasant, painless sensation of potentially vomiting


Goal of Care

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



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


Guiding Principles

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


Guiding Principles - Dimenhydrinate

- 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


Intervention Guidelines - EMR/PCP/ACP

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

All above, plus;

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

NS IV fluids for dehydration as appropriate


Further Care

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