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Nausea and Vomiting

Date Last Search Run: Feb 01, 2022
Table last updated: Oct 25, 2021
Data last added: Apr 23, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)      
3 (weak evidence exists)      


Interventions

Antiemetic (Central)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Reduction in nausea determined by Visual Analog Scale Patient ED-MD Barrett TW., DiPersio DM., Jenkins CA., Jack M., McCoin NS., Storrow AB., et al. A randomized, placebo-controlled trial of ondansetron, metoclopramide, and promethazine in adults. Am J Emerg Med 2011; 29(3):247-55. Medline
I Supportive (Green) Reduction in nausea Patient ED-MD Braude D., Crandall C. Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: A randomized, double-blind, noninferiority trial. Acad Emerg Med 2008; 15(3):209-15. Medline
I Supportive (Green) Reduction of vertigo symptoms Patient ED-MD Ercin D, Erdur B, Turkcuer I, Seyit M, Ozen M, Yilmaz A, et al. Comparison of efficacy dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo; a randomized study. Am J Emerg Med 2021; 40:77-82. Medline
I Supportive (Green) Hospitalization rates Patient ED-MD Stork CM., Brown KM., Reilly TH., Secreti L., Brown LH. Emergency department treatment of viral gastritis using intravenous ondansetron or dexamethasone in children. Acad Emerg Med 2006; 13(10):1027-1033. Medline
I Supportive (Green) Nausea and vomiting incidence Patient In-Patient Tramer MR., Walder B. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: A quantitative systematic review. Anesth Analg 1999; 88:1354-61. Medline
I Supportive (Green) Functional symptoms of motion sickness Patient In-Patient Weinstein SE., Sterns RM. Comparison of marezine and dramamine in preventing symptoms of motion sickness. Aviation, Space and Environmental Med 1997; 68:890-894. Medline
I Neutral (Yellow) Efficacy of reduction of nausea intensity Patient ED-MD Meek R, Mee MJ, Egerton-Warburton D, Graudins A, Meyer A, Pouryahya P, et al. Randomized Placebo-controlled Trial of Droperidol and Ondansetron for Adult Emerg Department Patients With Nausea. Acad Emerg Med 2019; 26(8):867-77. Medline
II Supportive (Green) Change in VAS nausea rating Patient PH-Paramedic Fullerton L., Weiss SJ., Froman P., Oglesbee S., Cheney P. Ondansetron oral dissolving tablets are superior to normal saline alone for prehospital nausea. Prehosp Emerg Care 2012; 16(4):463-8. Medline
II Supportive (Green) Hospitalization Patient ED-MD Hervas D., Armero C., Carrion T., Utrera JF., Hervas JA. Clinical and economic impact of oral ondansetron for vomiting in a pediatric emergency department. Pediatr Emerg Care 2012; 28(11):1166-8. Medline
II Supportive (Green) Mean time from administration to disposition Patient ED-MD Mayhall EA., Gray R., Lopes V., Matteson KA. Comparison of antiemetics for nausea and vomiting of pregnancy in an emergency department setting. Am J Emerg Med 2015; 33(7):882-6. Medline
III Supportive (Green) Reduction nausea Patient SIM Muth ER., Jokerst M., Sterns RM, et al. Effects of dimenhydrinate on gastric tachyarrhythmia and symptoms of vection-induced motion sickness. Aviation, Space and Environmental Med 1995; 66:1041-5. Medline
III Supportive (Green) Nausea and vomiting severity Patient OR Salvucci AA., Squire B., Burdick M., Luoto M., Brazzel D., Vaezazizi R. Ondansetron is safe and effective for prehospital treatment of nausea and vomiting by paramedics. Prehosp Emerg Care 2011; 15(1):34-8. Medline
III Supportive (Green) Nausea scales Patient PH-Paramedic Warden CR., Moreno R., Daya M. Prospective evaluation of Ondansetron for undifferentiated nausea & vomiting in the prehospital setting. PEC 2008; 12:87-91. Medline
III Supportive (Green) Nausea visual analogue scale rating Patient SIM Weichenthal L., Soliz T. The incidence and treatment of prehospital motion sickness. Prehosp Emerg Care 2003; 7(4):474-476. Medline

Antiemetic (GI Action)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Reduction in nausea determined by Visual Analog Scale Patient ED-MD Barrett TW., DiPersio DM., Jenkins CA., Jack M., McCoin NS., Storrow AB., et al. A randomized, placebo-controlled trial of ondansetron, metoclopramide, and promethazine in adults. Am J Emerg Med 2011; 29(3):247-55. Medline
I Supportive (Green) Reduction in nausea Patient ED-MD Braude D., Crandall C. Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: A randomized, double-blind, noninferiority trial. Acad Emerg Med 2008; 15(3):209-15. Medline
I Supportive (Green) Incidence of vomiting Patient ED-MD Chae J., Taylor DM., Frauman AG. Tropisetron versus metoclopramide for the treatment of nausea and vomiting in the emergency department: A randomized, double-blinded, clinical trial. Emerg Med Australas 2011; 23(5):554-61. Medline
I Supportive (Green) Reduction in vomiting Patient ED-MD Epifanio M, Portela JL, Piva JP, Ferreira CHT, Sarria EE, Mattiello R. Bromopride, metoclopramide, or ondansetron for the treatment of vomiting in the pediatric Emerg Department: A randomized controlled trial. J Pediatr 2018; 94(1):62-8. Medline
I Supportive (Green) Reduction in vertigo intensit Patient ED-MD Ercin D, Erdur B, Turkcuer I, Seyit M, Ozen M, Yilmaz A, et al. Comparison of efficacy dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo; a randomized study. Am J Emerg Med 2021; 40:77-82. Medline
I Supportive (Green) - Patient Lacroix G., Lessard MR., Trepanier CA. Treatment of post-operative nausea and vomiting: Comparison of propofol, droperidol and metoclopramide. Can J Anaesth 1996; 43:115-20 Medline
I Supportive (Green) Hospitalization rates Patient ED-MD Stork CM., Brown KM., Reilly TH., Secreti L., Brown LH. Emergency department treatment of viral gastritis using intravenous ondansetron or dexamethasone in children. Acad Emerg Med 2006; 13(10):1027-1033. Medline
I Supportive (Green) Nausea and vomiting incidence Patient In-Patient Tramer MR., Walder B. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: A quantitative systematic review. Anesth Analg 1999; 88:1354-61. Medline
II Supportive (Green) Mean time from administration to disposition Patient ED-MD Mayhall EA., Gray R., Lopes V., Matteson KA. Comparison of antiemetics for nausea and vomiting of pregnancy in an emergency department setting. Am J Emerg Med 2015; 33(7):882-6. Medline
II Supportive (Green) Vomiting during the primary and secondary survey Patient In-Patient Vermeijden HD., Leenen LPH., van PM, Dijkgraaf MGW., Hietbrink F. Analysis of two treatment modalities for the prevention of vomiting after trauma Orogastric tube or anti-emetics. Injury 2017; 48(10) 2106-11. Medline
III Supportive (Green) Change in nausea score Patient ED-MD Cham S., Basire M., Kelly AM. Intermediate dose metoclopramide is not more effective than standard dose metoclopramide for patients who present to the emergency department with nausea and vomiting: A pilot study. Emerg Med Australas 2004; 16(3):208-11. Medline

Isopropyl alcohol
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Nausea numerical rating scale Patient ED-MD Beadle KL, Helbling AR, Love SL, April MD, Hunter CJ. Isopropyl Alcohol Nasal Inhalation for Nausea in the Emerg Department: A Randomized Controlled Trial. Ann Emerg Med 2016; 68(1):1-9.e1. Medline
I Supportive (Green) Nausea Patient ED-MD Candemir H, Akoglu H, Sanri E, Onur O, Denizbasi A. Isopropyl alcohol nasal inhalation for nausea in the triage of an adult emergency department. Am J Emerg Med 2021; 41:9-13. Medline


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