CPG_Nausea and Vomiting

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CPG_Nausea and Vomiting
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  Clinical Practice Guidelines: Medical/Nausea and vomiting  Disclaimer and copyright ©2016 Queensland GovernmentAll rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner. The QAS accepts no responsibility for any modication, redistribution or use of the CPM or any part thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering ambulance services for, and on behalf of, the QAS.Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents.While effort has been made to contact all copyright owners this has not always been possible. The QAS would welcome notication from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome, please forward to: Clinical.Guidelines@ambulance.qld.gov.au This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.   Date February, 2015 Purpose To ensure consistent management of patients with Nausea and vomiting. Scope Applies to all QAS clinical staff.  Author  Clinical Quality & Patient Safety Unit, QAS Review date February, 2017 URL https://ambulance.qld.gov.au/clinical.html  94 QUEENSLAND AMBULANCE SERVICE  Nausea and vomiting Nausea and vomiting   are common symptoms that can be caused by a wide variety of conditions. Nausea is the sensation of having the urge to vomit, while vomiting is forcing stomach contents up through the oesophagus to the mouth.The symptoms of nausea and vomiting are caused by signals from the lateral reticular formation in the medulla oblongata. These signals may be activated by metabolic abnormalities in the blood, balance centres in the ear, CNS dysfunction, gastrointestinal triggers or sensory and emotional stimulation. The underlying condition causing the symptoms should be determined while concurrently treating the nausea and/or vomiting as some disease processes may not respond as well to the usual antiemetic therapy. For example ondansetron and the other 5HT3 blockers have minimal effect on nausea and vomiting due to motion sickness. Possible causes can be separated into: Primary (due to a GI illness): ã Delayed gastric emptying (e.g. gastroparesis, bowel obstruction, gastric irritation)ã Infection (e.g. gastroenteritis)  Secondary  ã Infection (e.g. urinary tract infection, pneumonia, viral hepatitis, cholecystitis, appendicitis)ã Malignancyã Treatment related (e.g. chemotherapy, medications)ã Metabolic disorders (e.g. ARF, hypercalcaemia, DKA)ã Raised intracranial pressure (e.g. meningitis, SOL, TBI)ã Vestibular disturbance (e.g. drug toxicity, ear infections, benign paroxysmal positional vertigo, motion sickness)ã Emotion/pain/anxietyã Pregnancyã Other (e.g. food allergies/poisoning, toxic ingestion, migraine, cyclic vomiting syndrome) Figure2.23  95 QUEENSLAND AMBULANCE SERVICE    Clinical features   Risk Assessment ã The clinical presentation of nausea and vomiting is variable and will depend upon the underlying cause.ãVomiting in patients with ALOC increases the potential for airway compromise.ãStimulation of the gag reflex/vomiting causes a spike in intracranial pressure.  Additional information ãThe risk/benefit of antiemetic therapy should be considered for each patient. e  Consider: ã Antiemeticã Analgesiaã IV fluid CPG: Paramedic Safety CPG: Standard CaresTransport to hospital Pre-notify as appropriate Investigate and treat underlying causes Note:  Officers are only to perform procedures  for which they have received specific training and authorisation by the QAS.
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