Nausea and Vomiting

Summary: <br> The hardest part about this chief complaint is expanding your differential beyond gastritis!!!<br> <br> <br> <br> Step 1: Expand Your Differential Diagnosis<br> <br> <br> <br> * Early appendicitis* Bowel obstructions* Myocardial infarction* Elevated ICP* Diabetic Ketoacidosis<br> <br> <br> <br> Step 2: Give a Testing Plan<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 3: Give a Treatment Plan<br> <br> <br> <br> * IV fluids (1L normal saline)* Antiemetics* Ondansetron (Zofran)* Promethazine (Phenergan)* Prochlorperazine (Compazine)<br> <br> <br> <br> Step 4: PO Challenge<br> <br> <br> <br> * Prior to discharge patient needs to keep fluids down* Bonus points if you update your attending on this<br> <br> <br> <br> Step 5: Repeat Abdominal Exam<br> <br> <br> <br> * Perform this prior to discharging patient<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Antiemetic Pearls <a href="https://emergencymedicinecases.com/em-drugs-that-work-part-2/">(EM Cases)</a><br>