Nausea & Vomiting
Treatment of moderate to severe nausea and vomiting
⚠️ Consider serious causes: Overdose, trauma, head injury, pregnancy, ACS, sepsis, heat stroke, DKA, etc.
Assessment
PCP, RPN, LPN, RN and up:
- History of presenting illness
- Brief physical - neuro & GI systems
- Full VS, consider postural drop, glucometer, AVPU/GCS
Treatment Options
Mild Nausea (no vomiting last 20 min)
| Medication | Dose |
|---|---|
| Ondansetron (Zofran) SL/ODT | 4 mg SL |
| Dimenhydrinate (Gravol) PO | 50 mg PO with sips of water |
Moderate to Severe / Active Vomiting
PCP, RPN, LPN, RN, ACP:
- Dimenhydrinate (Gravol) 25-50 mg IM OR 25 mg IV
- Dilute IV dosing with 4.5cc NS - give SLOW push over 2 min (prevent phlebitis)
- May repeat 25 mg IV after 15 min if no improvement
NOTE: If patient overly drowsy, consider ondansetron instead (Gravol causes sedation)
Contraindications
| Medication | Contraindications |
|---|---|
| Ondansetron | Allergy, pregnancy (known/potential), prolonged QT syndrome |
| Dimenhydrinate | Allergy, co-administration with diphenhydramine |
Cautions for Dimenhydrinate: Glaucoma, increased intra-ocular pressure, prostatic hyperplasia, urinary obstruction
Alternate Medications (with CDM order)
- Ondansetron (Zofran) 4-8 mg SL or IV
- Metoclopramide (Maxeran) 10 mg oral or IV
⚠️ Report: Report every use to operations lead
Source: Odyssey Medical Consulting
Version: 2023-06-21