3.10. NAUSEA/VOMITING

Related Names

Gastroenteritis, vomiting.

Purpose of assistance

Reduce the discomfort that accompanies vomiting and nausea.

Patient description

Inclusion criteria

Nausea and/or vomiting.

Exclusion criteria

No recommendations.

Patient care

Condition assessment

1. Standard inspection procedure (determination of vital signs).
2. Medical history and physical examination to look for potential causes of nausea and vomiting (e.g. gastrointestinal origin, cardiovascular, gynaecological, hypoglycaemia, hyperglycaemia).

Treatment and intervention

1. Administration of antiemetic drugs (optional if available; all drugs that can be administered in/in can be administered in/c):

a) ondansetron (contraindicated in suspected or confirmed diagnosis of prolonged QT syndrome)

adults:

4 mg IV/oral/sublingual

OR

4 mg sublingual in tablet form for resorption

children (6 months – 14 years): 0.15 mg/kg IV/oral (maximum dose – 4 mg);

b) metoclopramide

adults: 10 mg IV/IV/C

children (over 2 years old and weighing from 12 kg):

0.1 mg/kg w/w

OR

IV (maximum dose – 10 mg), can be repeated after 20-30 minutes in the absence of relief;

c) prochlorperazine

adults: 5 mg IV/IV/m

children (over 2 years old and weighing from 12 kg):

0.1 mg/kg w/w slowly

OR

Deep in/m (maximum dose – 10 mg);

d) diphenhydramine

adults: 12.5-25 mg IV/IV/m/oral

children (over 2 years old and weighing 12 kg): 0.1 mg/kg IV (maximum dose – 25 mg);

g) isopropyl alcohol (isopropanol) – allow the patient to inhale isopropyl alcohol vapors from the wipe three times every 15 minutes.

2. For signs of hypovolemia, inject 0.9% sodium chloride:

a) adults: 500 ml IV/IV/c in the absence of contraindications (heart failure, renal failure);
b) children: 10-20 mg/kg IV in the absence of contraindications;
c) can be repeated if necessary.

Patient safety

1. For young children, ondansetron can have a sedative effect.

2. Dystonic and extrapyramidal symptoms can be side effects of antiemetic drugs – if they appear, use diphenhydramine:

a) adults: 25-50 mg IV/IV/m/oral;
b) children: 1 mg/kg IV/IV/m/oral (maximum dose – 50 mg).

Useful information for training

Key points

1. Ondansetron is more suitable for treating nausea and vomiting in children.

2. Metoclopramide has fewer side effects in children than prochlorperazine.

3. Prochlorperazine and metoclopramide (phenothiazines) tend to cause dystonic reactions:

a) some phenothiazines can provoke respiratory depression, especially when used in combination with other drugs that cause respiratory depression. Some phenothiazines can cause malignant neuroleptic syndrome;
b) prochlorperazine is strictly prohibited for use in children younger than 2 years.

4. Ondansetron in soluble form may also be administered orally at the same dose.

5. Nausea and vomiting are symptoms of the disease – in addition to treating the symptoms of nausea and vomiting, a detailed physical examination and examination of previous medical history can help identify the disease that is the cause of emergency treatment (e.g., intestinal obstruction, myocardial infarction, pregnancy).

6. Although ondansetron was not adequately investigated during pregnancy to determine safety, it remains a treatment option for hyperemesis in pregnant women.

Relevant evaluation results

1. Vital signs.
2. Risk factors for heart disease/ECG withdrawal (if possible).
3. Statement of pregnancy.
4. Examination of the abdomen.

Key elements of documentation

1. Age of the patient.
2. Child weight and/or weight (measured using the height/weight scale).
3. Medications administered, including time, service provider level, dose, dose units, route, response, and complications.
4. Vital signs before and after drug administration.
5. Medical history and detailed physical examination, taking into account the etiology of nausea/vomiting.
6. ECG removal and documentation or existing cardiac risk factors.

Criteria for the effectiveness of care

1. In patients with nausea and vomiting, appropriate medications (including the appropriate dose) were prescribed and the patient’s response to treatment was documented.
2. In the presence of any complications, for example, a dystonic reaction, it is necessary to conduct appropriate interventions with subsequent documentation of all interventions.