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FOCUSED SHIFT VIEW

Nausea & Vomiting

Not a GI complaint until the brain, heart, sugar, and pregnancy are clear.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Glucose, pregnancy, ECG — before the antiemetic is the diagnosis.
  2. Pain before vomiting leans surgical; bilious or feculent vomiting is obstruction until imaged.
  3. Then raised ICP, DKA/adrenal, and cannabinoid hyperemesis as an exclusion.

2 · Escalate now if

  • Bilious or feculent vomiting, or vomiting with peritonitis
  • Chest pain, dyspnea, or diaphoresis with vomiting
  • Headache, diplopia, or ataxia
  • Glucose high or very low; steroid-dependent patient
  • Positive hCG with pain or bleeding
  • Intractable vomiting with severe electrolyte derangement

3 · Immediate workup

  • Glucose, hCG, ECG
  • POCUS: AAA, free fluid, IUP, B-lines

4 · Don’t miss

  • Bowel obstruction / volvulus / perforation
    Bilious or feculent vomiting, distension, prior surgery, hernia — CT. Sigmoid/cecal volvulus is time-critical ischemia.
  • ACS / inferior MI
    Isolated vomiting, especially in women, elderly, and diabetics — ECG before the antiemetic is blamed for the “cure.”
  • Raised ICP / SAH / posterior stroke
    Headache, diplopia, ataxia, no abdominal findings — CT/MRI. Projectile vomiting is a clue, not a rule.
  • DKA / HHS / adrenal crisis / hyponatremia
    Glucose and electrolytes in every unexplained case. Steroid-dependent patients get stress-dose steroids.
  • Pregnancy complications (hyperemesis vs ectopic vs molar)
    hCG first; ketones and electrolytes in hyperemesis; ectopic if pain + bleeding.

5 · Disposition lane

Admit

Obstruction without ischemia, DKA on a protocol, hyperemesis with ketosis not yet reversed, inability to tolerate oral intake in a high-risk host.

Theatre / ICU / cath lab

Perforation, ischemic bowel/volvulus, ACS, raised ICP, adrenal crisis, airway from aspiration.