VOMITING

Inclusion Criteria:  Patients with nausea or 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 the left lateral position.  If there is evidence of shock, place the patient supine with the feet elevated, if tolerated, and monitor the airway closely.  Treat shock according to the SHOCKGuidelines.
3. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
4. Perform a POC glucose analysis and treat hypoglycemia according to the 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

• Normal Saline 20 mL/kg boluses IV/IO, as needed (up to a total of 1 L).
  
  

Pediatric

• 20 mL/kg Normal Saline IV/IO bolus.
• May repeat twice.
• Contact BioTel if additional boluses are required, especially if DKA, cardiac history or signs of volume overload (e.g. JVD, rales).

7. For nausea and/or vomiting
   

Adult

• Promethazine 12.5 mg – 25 mg IM only.
• Ondansetron HCl 4 mg Slow IV or IO (given over 1 minute), or IM or IN; OR
• Ondansetron 4 mg tablet (Zofran® ODT) sublingual (SL);
• Do not administer both promethazine and ondansetron to the same patient.
  

Pediatric

• Do not administer promethazine to the pediatric patient.
• Ondansetron HCl 0.1mg/kg SLOW IV or IO (given over 1 minute), or IN.  Maximum total dose = 4 mg.  Do not administer IM, or to children less than two years of age; OR
• Ondansetron 4 mg tablet (Zofran® ODT) sublingual (SL):
• 2 to 5 years of age & less than 20 kg: 2 mg.
• At least 5 years of age & at least 20 kg: 4 mg.
• Do NOT administer to children under 2 years of age

NOTE: Individual agencies 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.