FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Nausea/vomiting within the applicable OCEMS adult or pediatric pathway.
Contraindications & local exclusions
- Injectable label: hypersensitivity to product/components or concomitant apomorphine. Some OCEMS adult pathways exclude known/suspected pregnancy; use the condition-specific order and do not describe pregnancy as a universal label contraindication.
Precautions
- Avoid in congenital long-QT syndrome; ECG monitoring is recommended for electrolyte abnormalities, CHF, bradyarrhythmias or QT-prolonging drugs. Serotonin syndrome is a warning. ODT and injectable products have distinct instructions.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- The adult standing order excludes known or suspected pregnancy.
- Do not let symptom control replace assessment of dehydration, poor perfusion, or an altered level of consciousness.
Use in OCEMS
- For ongoing nausea/vomiting in the applicable condition order. Treat associated airway risk and dehydration as well as symptoms.
- The oral dissolving tablet and IV preparation have different dosing instructions.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| ODT | 8 mg (two 4 mg tablets) dissolved orally, once, when pregnancy is not known or suspected. |
| IV | 4 mg IV; may repeat 4 mg once after approximately 3 minutes for continued/recurrent symptoms, when pregnancy is not known or suspected. |
Pediatric
- SO-P-090: children age 4 and older may receive one 4 mg ODT tablet dissolved orally, as tolerated.
- The cited pediatric nausea standing order does not provide routine IV dosing or an ODT dose below age 4. Do not infer a weight-scaled adult regimen.
Pediatric dose by age / weight
- SO-P-090 applies to ongoing nausea/vomiting. Age, not weight, determines eligibility for this fixed dose.
| Age / weight | Pediatric dose | Route / limit |
|---|---|---|
| Younger than 4; any weight | No dose in this pediatric standing order | Do not extrapolate from an adult IV dose |
| Age 4 and older; any eligible pediatric weight | 4 mg | One ODT tablet dissolved orally as tolerated |
Preparation & reassessment
- Stock includes 4 mg ODT and 4 mg/2 mL IV preparations. Verify the product and route.
- Keep suction available when needed. Reassess vomiting, airway protection, perfusion, and treatment response; follow the applicable fluid pathway.
VISUAL FIELD REFERENCE
Ondansetron: adult routes and pediatric age limit
Adult & pediatric guidance · ALS
- 8 mg · once
Adult ODT
8 mg (two 4 mg tablets) dissolved orally, once, when pregnancy is not known or suspected.
- 4 mg · one repeat
Adult IV
4 mg IV; may repeat 4 mg once after approximately 3 minutes for continued/recurrent symptoms, when pregnancy is not known or suspected.
- 4 mg ODT · once
Pediatric age 4 and older
SO-P-090: children age 4 and older may receive one 4 mg ODT tablet dissolved orally, as tolerated.
The cited pediatric nausea standing order does not provide routine IV dosing or an ODT dose below age 4. Do not infer a weight-scaled adult regimen.
- Do not let symptom control replace assessment of dehydration, poor perfusion, or an altered level of consciousness.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-M-060 · SO-P-090
UNDERSTAND THE CARE
Why age, route and indication must be checked independently
The adult oral and IV instructions are different, and the pediatric pathway is a fixed ODT dose with an age threshold. The presence of an injectable product on the ambulance does not establish a routine pediatric IV regimen. Check the relevant exclusions and the ability to tolerate oral treatment.
Applying the guidance
After medication, reassess vomiting, airway protection, mental status and perfusion. Continue the underlying illness and dehydration assessment even if nausea improves. Record the preparation, route, time and total amount; the adult IV repeat instruction is not an automatic repeat instruction for the ODT pathway.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Population
- Adult versus age-eligible pediatric pathway.
- Route
- ODT and IV instructions differ.
- Exclusions
- Pregnancy and product/clinical restrictions.
- Response
- Vomiting, airway safety and perfusion.
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.
Do not copy the IV repeat into the ODT pathway
Keep formulation, route and repeat permission together. The adult nausea order describes different oral and IV regimens. A permitted IV repeat does not establish an oral-tablet repeat, and the pediatric ODT pathway does not create a routine pediatric IV regimen. Avoid using stock availability to fill an absent instruction.
For example, a patient has already taken the indicated ODT treatment and continues to vomit during transport. Record the product, amount and time, reassess airway protection and perfusion, and follow the appropriate clinical and medical-direction pathway. Do not silently reinterpret the initial treatment as the first half of an IV sequence.
An improvement in nausea should be reported alongside the broader assessment: ongoing vomiting, suction or airway support, signs of dehydration or poor perfusion, and the response to any other indicated care. The adult standing order’s pregnancy wording remains a local pathway restriction; it should not be presented as a universal contraindication for every ondansetron product or setting.
Source: Nausea / Vomiting.