Vomiting

Inclusion Criteria: Nausea, prolonged vomiting, or those actively vomiting after EMS arrival with no other symptoms or complaints.

        
          Basic Level

1. Assess and support ABCs.
   
   
2. Place the patient in a position of comfort or in left lateral position. If evidence of shock, place the patient supine with the feet elevated and monitor airway closely. Treat shock according to the Shock guidelines.
   
   
3. Administer oxygen, as needed to maintain a SpO2 of at least 96%.
   
   
4. Perform a blood glucose analysis and treat hypoglycemia per Altered Level of Consciousness guidelines.
   
   
   Advanced Level
   
   
5. Apply ECG and EtCO2 monitors if respiratory distress or shock is present or develops.
   
   
6. Consider establishing IV access at a TKO rate or use a saline lock. If fluid resuscitation is needed:
   

   Adult 250 ml boluses as needed (up to 1,000 ml)

   Pediatric 20 ml/kg bolus

   
   
   
7. For nausea and/or vomiting

   Adult Promethazine 12.5 mg – 25 mg SLOW IVP or IM Flush IV push with 10 ml saline, OR Ondansetron HCl 2 mg SLOW IVP (given over 1 minute) Maximum cumulative dose of 4 mg Do not administer both medications to the same patient	Pediatric Do not administer promethazine to the pediatric patient. Ondansetron HCl 0.1mg/Kg SLOW IVP (given over 1 minute) Maximum cumulative dose of 4 mg. Do not administer to children under two years of age.
   NOTE: Individual departments may carry only one of these medications; They are not required to carry both.

   
   
   
8. Monitor vital signs during transport.
   
   
9. For additional patient care considerations not covered under standing orders, consult BioTel.

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