What is the protocol for a patient with severe nausea and vomiting?

• A. Administer antiemetics and observe.
• B. Begin immediate nasogastric feeding.
• C. Perform surgical consult.
• D. Consider dehydration and administer IV fluids if necessary.

Answer: (D)

Managing severe nausea and vomiting starts with stabilizing the patient by addressing hydration and volume status. The priority is to assess for dehydration and, if needed, administer IV fluids to restore circulating volume, support blood pressure, and correct any electrolyte imbalances. This early fluid support creates the safest foundation for any further treatment and testing.

While antiemetics can help with nausea, they don’t fix dehydration. Giving them and simply observing might allow deterioration if fluid loss is significant. Beginning nasogastric feeding right away isn’t appropriate when someone is vomiting severely, as tolerance and risk of aspiration need to be considered first. A surgical consult isn’t indicated unless there’s a suspected surgical cause of vomiting. The best initial protocol is to address dehydration with IV fluids to stabilize the patient.