FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Adult ondansetron orders exclude known or suspected pregnancy.
- Use the pediatric age restriction and fluid maximums explicitly; do not scale the adult ODT regimen by weight.
Assess before treating symptoms
- Evaluate airway protection, vomiting, perfusion, and signs of dehydration. Keep suction available and maintain the airway.
- An altered level of consciousness or severe poor perfusion should prompt the applicable broader condition order rather than an antiemetic-only approach.
Adult / adolescent
- For dehydration or poor perfusion with clear lungs/no CHF, give 250 mL saline boluses up to 1 L as needed for perfusion.
- For continued nausea/vomiting when pregnancy is not known or suspected: ondansetron 8 mg ODT, or 4 mg IV. The IV dose may repeat once after about 3 minutes for continued/recurrent symptoms.
- Transport to an appropriate ERC, with ALS escort when medication or fluids were needed.
Pediatric — SO-P-090
- For dehydration/poor perfusion, give 20 mL/kg saline IV/IO, maximum 250 mL per bolus, and contact base (pediatric-capable preferred). May repeat twice for 3 total boluses.
- Age 4 and older: give one 4 mg ondansetron ODT as tolerated. OCEMS does not list an ODT regimen below age 4 or routine pediatric IV ondansetron.
- If altered or unresponsive, check glucose and follow the pediatric hypoglycemia pathway, including its limited IO dextrose exception.
Reassess & handoff
- Reassess airway protection, vomiting frequency, mental status, vital signs, and response to fluid or medication. Document dose times and total fluid.
- Pediatric vomiting can accompany diabetic ketoacidosis with marked hyperglycemia; assess the underlying cause and perfusion, not just symptom relief.
UNDERSTAND THE CARE
Why an antiemetic is only one part of the assessment
Vomiting can create an airway problem and can also accompany a broader illness. Begin with consciousness, airway protection, circulation and the associated symptoms. The decision to treat nausea should not replace evaluation of poor perfusion, altered mental status or a possible metabolic problem.
Applying the guidance
The adult and pediatric pathways differ in fluid instructions and antiemetic eligibility. Keep the selected age group and route explicit and document the amount already given. After treatment, compare vomiting, mental status, perfusion and vital signs with baseline rather than recording only whether the patient feels less nauseated.
Putting it together
Teaching example: a vomiting child appears less nauseated but remains poorly perfused. The improvement in one symptom does not resolve the need for the pediatric perfusion pathway and its contact requirement.
Diagram text & teaching checkpoints
- Airway
- Consciousness and aspiration risk.
- Cause
- Look for systemic or metabolic illness.
- Age and route
- Choose the correct treatment pathway.
- Reassessment
- Symptoms AND perfusion response.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.