EMT Standing Orders

• Establish IV access if the patient appears dehydrated.
• Start 500 mL 0.9% NaCl IV fluid bolus for dehydration.
• May repeat 250 mL IV bolus if transport exceeds 15 minutes and the patient’s condition has not improved.
• Apply 12 leads ECG
• Call for AEMT/Paramedic intercept if needed & assist them in patient care.

AEMT/PARAMEDIC STANDING ORDERS - Adult

• Prochlorperazine 5 - 10 mg IV, or 5 mg IM
• Metoclopramide 5 mg IV.o May repeat any of the above medications once after 10 minutes if nausea/vomiting persists
• Apply ECG; monitor for arrhythmia.

AEMT/PARAMEDIC STANDING ORDERS - Adult Pediatric

• Ondansetron 2 mg by Oral for patient 8 - 15 kg, 4 mg by Oral patient ≥ 16 kg
• Ondansetron 0.1 mg/kg IV (maximum single dose 4mg).
• Consider 20 mL/kg IV fluid bolus for dehydration.
• For motion sickness: consider diphenhydramine:
  • Adult: 25 mg PO/chewed
  • Ages 2 - 5 years : 6.25 mg PO
  • Ages 6 - 11 years: 12.5 - 25 mg PO

Paramedic only: May repeat IM prochlorperazine or metoclopramide every 4 – 6 hours as needed. Nausea, vomiting and epigastric abdominal pain may be signs of acute coronary syndrome in adults. Consider obtaining and transmitting ECG, if available.

PEARLS:

• To reduce the incidence of dystonic reactions, administer prochlorperazine and metoclopramide slowly, over 1 - 2 minutes.
• Consider other causes of nausea such as the following: cardiac, GI bleeding, pregnancy, toxicology, and diabetes.
• Nausea/vomiting is a common finding associated with acute coronary syndrome. Consider obtaining a 12-lead ECG when appropriate.
• Do not administer Ondansetron if the patient has known, prolonged QT on ECG.