Nausea and Vomiting
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 4 March 2018
⏱️ 8 minutes
🧾️ Download transcript
Summary
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)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this week's |
| 0:06.2 | episode of the EM Clerkship Podcast. I received an email a few weeks ago from Janice in Germany, |
| 0:14.8 | who wrote requesting a really good episode idea. I was kind of surprised that I hadn't done |
| 0:20.2 | this one yet, actually actually because it's so |
| 0:22.0 | common. So here we go. This week, we are talking about nausea and vomiting, definitely core high-yield |
| 0:28.9 | material. The most important thing to know about nausea and vomiting is that you have to expand your brain out from just GI causes because the differential |
| 0:41.5 | truly is huge. |
| 0:44.8 | Toxins, huge list, prescription drugs, alcohol, inseds, infections can trigger this, |
| 0:52.2 | pylinoffritis comes to mind. |
| 0:54.6 | Neuro. |
| 0:55.2 | What about brain masses? |
| 0:56.8 | Pseudotumor. |
| 0:58.4 | Cardiovascular, M.I. |
| 1:01.3 | Electrolites, D.K.A. |
| 1:03.0 | Thyroid stuff. |
| 1:04.1 | Pain itself. |
| 1:05.1 | All can trigger vomiting. |
| 1:07.1 | The differential is massive. |
| 1:10.0 | So you absolutely must expand your brain out past GI and take a good history and do your screening exam. |
| 1:18.7 | It's true. The most likely cause of somebody with nausea and vomiting is gastritis. No big deal. But it's a mistake to lock down on that too early. So with that said, |
| 1:31.2 | step one, you're presenting this patient, giving your history and the abnormals from your exam, |
| 1:36.4 | and it's time to explain your differential. But it's so big. So how do you do this? Here's what you |
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