Adult Medical Section Protocols PID) , ) IO ProcedureIO Shock influenza P Symptoms NO Procedure Exit to Etiology Protocol IV Procedure Improving duced trauma or hemorrhagetrauma or , vestibular) Abdominal Pain , Signs / Nausea Vomiting / Blood Glucose Analysis Suggesting Cardiac Hypotension / (pneumonia, Consider 2 Large Bore sites ial infarction ogic disease (ovarian cyst ogical yte abnormalitiesyte , narcotics, NSAID's, antibiotics IV Procedure ancy (increased pressureheadache, , stroke, cation or Substance abuse s ( betic ketoacidosis orRenal disorders I YES Infections Electrol Food or toxin in Medi Pregn Psychol CNS CNS lesions Myocard Drug chemotherapy) GI Dia Gynecol YES YES · · · · · · · Differential · · · · · , , Symptoms shock etc.) , ) dull, Protocol Appropriate if indicated if indicated as indicated , myalgiascough, , perfusion Protocol 35 Diabetic Protocol Adult Pain Control Hypotension, poor blurred vision Cardiac Protocol(s) Notify Destination or sharp, , Contact Medical Control Serious Signs / malaise, , dysuriamental status , tion P xia , iation racter of pain (constantracter of stipation rrhea headache , YES Cha Disten Con Dia Anore Rad Pain intermittent, NO YES Helpful to localize source Helpful Associatedsymptoms : ( Signs and Symptoms Signs · · · · · · Fever · weakness, headache changes, rash Vomiting and Diarrhea and Vomiting Symptoms NO pregnancy) Procedure ( Etiology IV Procedure Improving history Abdominal Pain l history Signs / Nausea Vomiting / nt orworseningnt Blood Glucose Analysis Suggesting Cardiac Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS l movement/emesis l history story y emesis / diarrhea cations tion of problem I I Medi Menstrua Travel hi Blood Other sick contacts Past medica Past surgical Last bowe Improveme Dura Age meal Time of last with food or activity Revised 8/13/2012 · · · · · · · · History · · · · Vomiting and Diarrhea Adult Medical Section Protocols Adult Medical

Pearls · Recommended Exam: Mental Status, Skin, HEENT, Neck, Heart, Lungs, Abdomen, Back, Extremities, Neuro · The use of metoclopramide (Reglan) may worsen diarrhea and should be avoided in patients with this symptom. · Choose the lower dose of promethazine (Phenergan) for patients likely to experience sedative effects (e.g., Age ≥ 60, debilitated, etc.) When giving promethazine IV dilute with 10 mL of normal saline and administer slowly. · Document the mental status and vital signs prior to administration of Promethazine (Phenergan). · Isolated vomiting in pediatrics may be caused by pyloric stenosis, bowel obstruction, and CNS processes (bleeding, tumors, or increased CSF pressures).

Revised Protocol 35 8/13/2012 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS