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)