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The hardest part about this chief complaint is expanding your differential beyond gastritis!!!

Step 1: Expand Your Differential Diagnosis

  • Early appendicitis
  • Bowel obstructions
  • Myocardial infarction
  • Elevated ICP
  • Diabetic Ketoacidosis

Step 2: Give a Testing Plan

  • High yield tests to consider
    • EKG – older adults
    • Pregnancy test – women of child bearing age
    • Electrolytes – most patients
  • Other tests to consider
    • CBC
    • LFTs/Lipase
    • Urinalysis

Step 3: Give a Treatment Plan

  • IV fluids (1L normal saline)
  • Antiemetics
    • Ondansetron (Zofran)
    • Promethazine (Phenergan)
    • Prochlorperazine (Compazine)

Step 4: PO Challenge

  • Prior to discharge patient needs to keep fluids down
    • Bonus points if you update your attending on this

Step 5: Repeat Abdominal Exam

  • Perform this prior to discharging patient

Additional Reading