Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNMedical Emergencies: Nausea, Vomiting and Diarrhea -7050

NAUSEA, VOMITING AND DIARRHEAPatient Complaint of Nausea, Vomiting or Diarrhea in the Absence of Trauma

History Age Past medical/ surgical history Medications Onset and duration of symptoms Palliation/ Provocation Contacts with other sick persons Travel history Bloody emesis or diarrhea Fever Last meal eaten, Last bowel

movement Menstrual history / possible

pregnancy

Signs and Symptoms Pain (location/migration, radiation) Abdominal tenderness Nausea, vomiting Diarrhea, bloody stool Dysuria, Abdominal distention Constipation Anorexia Pregnancy Associated symptoms: Fever,

headache, weakness, malaise, myalgias, cough, mental status changes, rash

ASSESSMENT CNS (Increased cranial

pressure, headache, stroke, CNS lesions, trauma, hemorrhage, vestibular)

Drugs (NSAIDs, antibiotics, narcotics, chemotherapy)

Myocardial Infarction Peptic ulcer disease/

Gastritis Gallbladder-Cholecystitis Pancreatitis, Appendicitis Kidney stones, Diverticulitis Bladder or Prostate disorder Pelvic (PID, Normal or

Ectopic Pregnancy, ovarian cyst)

Bowel obstruction, Renal disease

Gastroenteritis (Infectious) Diabetic ketoacidosis

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level providers are responsible for lower level treatments***

Initial Patient Contact (2000). Infection Control Guidelines (1031). Oxygen Administration as indicated (9000). Temperature Measurement (9047). Do not give patient anything by mouth. R Consider Orthostatic Blood Pressure Measurement. Assist ALS with cardiac Monitor or 12-lead EKG (9030) if indicated. Transport to receiving facility as indicated with ALS intercept if patient is

severely ill.

E Establish IV with NS, draw labs; do not delay transport for IV access.2

Consider blood glucose analysis (9040).2

If orthostatic, administer bolus of NS, 10-20 cc/kg IV. Check breath sounds after bolus.2

A ALS required for Hypotension, Gravid patient with other signs or

symptoms, or possible Myocardial Infarction. Gentle palpation of abdomen for masses, pulsation, rigidity, guarding, and listen

for bowel sounds as part of more detailed examination. Consider possible Pregnancy or Ectopic Pregnancy. Consider 12-lead EKG if Nausea/Vomiting could be of cardiac origin (5000). Consider Promethazine 6.25- 25 mg IV/IM, or Odansetron 4 mg IV for

nausea/vomiting. Odansetron may also be given orally 4-8 mg PO every 8 hours (prophylactic indication).

P

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 4/01/14 final 5/14/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNMedical Emergencies: Nausea, Vomiting and Diarrhea -7050

** Call Medical Control for severe Hypotension, Suspected Ectopic Pregnancy and unstable patients.** M

2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:Document the mental status and vital signs prior to administration of any anti-emetics.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 4/01/14 final 5/14/2023 page 2 of 2