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)