Vomiting and Diarrhea History Signs and Symptoms Differential · Age · Pain · CNS (increased pressure, headache, stroke, · Time of last meal · Character of pain (constant, CNS lesions, trauma or hemorrhage, vestibular) · Last bowel movement/emesis intermittent, sharp, dull, etc.) · Myocardial infarction · Improvement or worsening · Distention · Drugs (NSAID's, antibiotics, narcotics, with food or activity · Constipation chemotherapy) · Duration of problem · Diarrhea · GI or Renal disorders · Other sick contacts · Anorexia · Diabetic ketoacidosis · Past medical history · Radiation · Gynecologic disease (ovarian cyst, PID) · Past surgical history Associated symptoms: · Infections (pneumonia, influenza) · Medications (Helpful to localize source) · Electrolyte abnormalities · Menstrual history (pregnancy) Fever, headache, blurred vision, · Food or toxin induced · Travel history weakness, malaise, myalgias, cough, · Medication or Substance abuse · Bloody emesis / diarrhea headache, dysuria, mental status · Pregnancy changes, rash · Psychological Serious Signs / Symptoms NO Hypotension, poor YES perfusion, shock IV Procedure IV Procedure P IO Procedure I IV Procedure Consider 2 Large Bore sites I Adult Medical Section Protocols Nausea / Vomiting P Nausea / Vomiting Blood Glucose Analysis Diabetic Protocol Blood Glucose Analysis Procedure if indicated Procedure Adult Pain Control Abdominal Pain YES Protocol YES Abdominal Pain if indicated Signs / Symptoms Appropriate Signs / Symptoms Suggesting Cardiac Cardiac Protocol(s) Suggesting Cardiac Etiology as indicated Etiology Improving YES YES Improving NO NO Exit to I Hypotension / Shock Protocol Notify Destination or Contact Medical Control 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 Vomiting and Diarrhea Adult Medical Section Protocols 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.