Category Archives: Nausea / Vomiting

A patient that sustained a head injury and initially presented in an altered state. The patient then improved to an unaltered state, and presented with Nausea/Vomiting, does the patient qualify for Ondansetron administration?

Can we give Gravol to a patient who is pregnant? Are there any concerns or is it totally safe?

Antiemetics: unrelated to our current directives but I was just wondering what the rationale was for specifically using dimenhydrinate as our prehospital antiemetic option? As I understand it, and I've had a number of conversations with physicians of different disciplines regarding the same, dimenhydrinate is most effective for motion sickness, and other antiemetics exist that are typically more effective for the types of emesis that we typically deal with in the field.

Can you give gravol to a normally altered (Alzheimer’s) patient?

Hi Doc(s), Two unrelated questions I've been pondering over the last couple of days: 1. In the field I've noticed some paramedics withhold dimenhydrinate administration if the patient has already taken any Gravol in the last 4-6 hours. However, the medical directive does not specify a time and simply states overdose on antihistamines or anticholinergics or tricyclic antidepressants. My understanding of their logic is that additional Gravol may cause an overdose in the patient however Gravol brand themselves recommend a dose of 1-2 50mg capsules every 4hrs PRN... Could you please provide some further clarification on this practice, and if we should still be administering it if we do not suspect an overdose but that the medication has been taken appropriately. (and similar practice for if the patient is taking tricyclics or anticholinergics as prescribed to them) 2. I recently had a COPD exacerbation patient who I believe would have benefitted greatly from CPAP. He had equal lung sounds through all fields with no paroxysmal chest movement, however there was a recent history of a collapsed lung approx. 6 weeks prior. (Unknown cause, from his history I suspect possibly a bleb/bullae) The current extenuating circumstance of COVID-19 aside, should CPAP be considered in this patient? Although I am not suspecting a current pneumothorax, due to the recent history I would think that weakening of the lung tissues could put the patient at greater risk for a recurrent event if subjected to significant positive pressures. Thank you and stay safe!

I am an PCP IV certified paramedic, working with a non IV medic. If we have a hypoglycemic patient do I need to attend & consider D10/D50 or can my non IV partner treat the patient with Glucagon instead?” Same question for Gravol; do they need to get it IV or can non IV certified medic give it IM?

How should I proceed if the patient I’m treating tells me that they have already self-administered Gravol, within the past hour, but has since vomited multiple times. Do I proceed with IV Gravol as she has likely thrown up her self-administered dose?

When considering Gravol, if the pt has taken any antihistamines, anticholinergics, or tricyclic anti depressants should we withhold Gravol or only if they already appear to have overdosed? For example, would it be o.k. to give the patient Gravol if they take a daily antihistamine for allergies?

Question: In reference to LOA and gravol administration: a patient who has had a fall and struck their head, has a GCS of 14 (4,4,6) and is alert to person but not place and time, confused about previous events, but can follow commands and is answering some questions appropriately (ie... Birthday, wifes name). Does this rule them out for gravol? My concern is if they are nauseated and we dont treat it early, vomiting and being supine on a spinal board can be very difficult to manage by yourself. I appreciate the definition of LOA is a GCS less than normal for the patient. Can you explain the reasoning for this condition?

Question: I had a scenario where my patient stated he had a few drinks and was slightly drowsy, he answered all my questions fine and was alert to person place and time, once in the ambulance he became nauseous and began vomiting two emesis bags full, I gave gravol in this situation after listing off the contraindications and patient confirming there were none. My question is, would this have been acceptable?

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