Nausea and Vomiting

The hardest part about this chief complaint is expanding your differential beyond gastritis!!!



Step 1: Expand Your Differential Diagnosis



* Early appendicitis* Bowel obstructions* Myocardial infarction* Elevated ICP* Diabetic Ketoacidosis



Step 2: Give a Testing Plan



* High yield tests to consider* EKG – older adults* Pregnancy test – women of child bearing age* Electrolytes – most patients* Other tests to consider* CBC* LFTs/Lipase* Urinalysis



Step 3: Give a Treatment Plan



* IV fluids (1L normal saline)* Antiemetics* Ondansetron (Zofran)* Promethazine (Phenergan)* Prochlorperazine (Compazine)



Step 4: PO Challenge



* Prior to discharge patient needs to keep fluids down* Bonus points if you update your attending on this



Step 5: Repeat Abdominal Exam



* Perform this prior to discharging patient



Additional Reading



* Antiemetic Pearls (EM Cases)