Protocol 2-990 - Vomiting

CMH EMS & MIH Protocols

RN:

Ensure completion of all applicable items above.

Consider IO NS/LR.

Adult:	Pediatric:
Consider Zofran 4 mg IV/IO/IM/IN/PO/SL (max 8 mg). Consider Phenergan 6.25-25 mg: IM OR IV/IO infused in NS/LR over 15-30 minutes OR Diluted in NS flush and pushed VERY slowly. Consider Benadryl 12.5-25 mg IV/IO/IM.	Greater than 2 years old: Consider Zofran 0.1-0.2 mg/kg IV/IO/IM/IN/PO/SL (max 8 mg). Click "calculate" to get dose. Consider Phenergan: 0.25-0.5 mg/kg IM OR Click "calculate" to get dose. 0.25-0.5 mg/kg IV/IO infused in NS/LR over 15-30 minutes OR Click "calculate" to get dose. 0.25 mg/kg diluted in NS flush and pushed VERY slowly. Click "calculate" to get dose. Consider Benadryl 0.1 mg/kg IV/IO/IM (max 25 mg). Click "calculate" to get dose.

Adult:

Pediatric:

Consider Zofran 4 mg IV/IO/IM/IN/PO/SL (max 8 mg).
Consider Phenergan 6.25-25 mg:

IM OR
IV/IO infused in NS/LR over 15-30 minutes OR
Diluted in NS flush and pushed VERY slowly.

Consider Benadryl 12.5-25 mg IV/IO/IM.

Greater than 2 years old:

Consider Zofran 0.1-0.2 mg/kg IV/IO/IM/IN/PO/SL (max 8 mg).

Click "calculate" to get dose.

Consider Phenergan:

0.25-0.5 mg/kg IM OR

Click "calculate" to get dose.

0.25-0.5 mg/kg IV/IO infused in NS/LR over 15-30 minutes OR

Click "calculate" to get dose.

0.25 mg/kg diluted in NS flush and pushed VERY slowly.

Click "calculate" to get dose.

Consider Benadryl 0.1 mg/kg IV/IO/IM (max 25 mg).

Click "calculate" to get dose.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914131 - Medical-Nausea/Vomiting

Citations:

Protocol 9-010 - References
Ballard & Vinson, 2019
Lindbald, Ting, & Harris, 2018
NASEMSO Medical Directors Council, 2017
Taney County Ambulance District, 2014

Change Log:

Date	Link to previous version	Description of change
12/12/14	pdf	Added clarification for pediatric dosages of Zofran and Phenergan.
12/15/14		Added Regalin medication.
04/14/15		Added comment that medication is not prophylactic.
11/17/15	pdf	Removed Regalin.
08/24/17	pdf	Removed comment that antiemetics cannot be used prophylactically. Added comment to use Phenergan diluted in NS flush.
09/22/17		Added PO/SL option for Zofran. Added Benadryl to adult and pediatric.
10/16/17		Removed requirement for motion sickness to administer Benadryl.
11/14/17	pdf	Changed minimum initial dosage of Phenergan to 6.25 mg to allow more flexibility.
04/18/20	pdf	Added content (without substantive modification) from old Protocol 6-040 - Control of Nausea.
06/06/21	pdf	Moved to emsprotocols.online
10/16/21		Addition of inhaled isopropanol for anti-nausea treatment by EMTs was approved by protocol committee on 5/26/21. However, Dr. Nicholes did not approve it on 6/8/21 stating the use of inhaled isopropanol in the ER, in his experience only last for seconds to minutes before they are nauseated again.
12/01/21		Updated link to Zofran.
02/28/22		Updated link for Phenergan.
03/16/23	pdf	Added statement that STEMI should be assumed with all vomiting until proven otherwise and 12-lead is required within 10 min. Clarified RN and medic roles. Added CP.
03/17/23		Updated links to NS.
03/20/23		Changed link for Benadryl.
04/28/23	pdf	Tweaked indication for 12-lead. Added nausea instead of just vomiting as an indication, but clarified UNKNOWN CAUSE as a condition.

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Protocol 2-990 - Vomiting

EMD:

EMR:

EMT:

AEMT:

RN:

Medic:

CP:

Citations:

Change Log: