Nausea and vomiting are common symptoms with causes ranging from gastroenteritis and pregnancy to heart attack, bowel obstruction and raised pressure inside the skull. The goal is to find dangerous causes, correct dehydration and control the symptoms.
Key symptoms
- Nausea, retching and repeated vomiting
- Abdominal pain, diarrhea or fever
- Thirst, dizziness on standing and less urine
- Blood or coffee-ground material in the vomit
- Headache, chest pain or a known pregnancy
What you find on exam
- Vital signs, including orthostatic changes
- Hydration: mucous membranes, skin turgor, capillary refill
- Abdomen: tenderness, distension, guarding, bowel sounds
- Neurological check if headache or vertigo
- Appearance of the vomit: blood, bile or fecal material
Tests
- Glucose; pregnancy test in women of childbearing age
- 12-lead ECG in older adults, diabetics or with chest discomfort
- Electrolytes, kidney function, lipase and liver tests
- Imaging if obstruction or a surgical abdomen is suspected
Treatment basics
- Position to protect the airway; suction if needed
- IV fluids for dehydration
- Ondansetron as the first-line antiemetic
- Treat the cause; nothing by mouth and a nasogastric tube for obstruction
- Oral rehydration in small sips once vomiting settles
Red flags
- Vomiting blood or coffee grounds
- Severe abdominal pain with distension or a rigid abdomen
- Signs of shock, severe headache or confusion
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.