Symptom: Vomiting

Initial Grading Reminder

Grade 1: 1-2 episodes (separated by 5 minutes) in 24 hrs
Grade 2: 3-5 episodes (separated by 5 minutes) in 24 hrs
Grade 3: ≥6 episodes (separated by 5 minutes) in 24 hrs; tube feeding, TPN, or hospitalization indicated
Grade 4: Life-threatening consequences; urgent intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had issues with nausea/vomiting in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you taken anything to relieve the vomiting? Any medications, OTCs, supplements, or marijuana?

Grade the symptom

Ask the patient:

How many times have you vomited in the past 24 hours?  Are you keeping any fluids down?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any bloating, diarrhea, abdominal (belly) pain, or fever? Any change in your mood? Do you feel confused or cloudy? Any headache or dizziness?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

  • Click Here for Telephone Triage

    Suggested Intervention

    Patients with moderate or worse vomiting need to be seen if anti-emetics are not effective.

    Patients with any of the red-flag symptoms should be seen immediately.

  • Click Here for In-Office Triage

    Differential Diagnosis

    What do you suspect is the cause of the vomiting?