Help the patient with nausea and vomiting
Nausea and vomiting
Nausea is an unpleasant sensation in the epigastric, retrosternal region and in the mouth, comes before vomiting.Often it is accompanied by an increase in heart rate, shortness of breath, tachycardia.Nausea is the result of excitation of the emetic center, but its intensity is not sufficient for the occurrence of vomiting.Nausea is almost always precedes vomiting, but not always it ends.
Vomiting is a reflex act, which takes place during the removal of gastric contents from the body through the mouth or nose.It vomiting associated with the development anastaltic waves resulting from the reduction of the stomach and the pyloric opening of the cardiac sphincter, at the same time than there is a reduction of abdominal and diaphragmatic muscles and the yield of gastric contents out.During emesis vomit not get into the respiratory tract because lying soft palate and the larynx, the epiglottis and on the contrary, is lowered, closing the airway lumen.
vomiting almost always accompanie
should know that physiologically vomiting considered a protective reaction of the organism in response to a hit in the gastro-intestinal tract of toxic substances.
Nausea and vomiting are the only manifestation of a large variety of diseases.
most common cause of vomiting is a pathology of the gastrointestinal tract:
• acute abdominal pathology: appendicitis, acute cholecystitis, adhesive disease, tumors of the gastrointestinal tract, hernia, acute peritonitis;
• chronic diseases of the gastrointestinal tract: chronic esophagitis, gastritis, peptic ulcer, gastro-oesophageal reflux disease, peptic ulcer and duodenal ulcer, obstruction of the esophagus due to esophageal cancer, or as a result of compression of the tumor in the lung or bronchi;
• poisoning or acute gastritis, resulting in acute infectious diseases of the digestive system.
often cause nausea and vomiting is the accumulation of blood in endogenous and exogenous toxic substances that have an irritating effect directly on the vomiting center.Hematogenous-toxic mechanism of vomiting occurs in diabetes, hepatic, renal and adrenal insufficiency, disorders of acid-base balance of the body, with far advanced forms of cancer, alcohol intoxication.
Another cause of nausea and vomiting is a pathology of the central nervous system.Vomiting of central origin may occur in hydrocephalus, tumors, hemorrhages and injuries of the brain, infectious diseases of the nervous system (encephalitis, meningoencephalitis), the labyrinth disease (acute labyrinthitis, Meniere's disease).As a rule, in diseases of the nervous system is not preceded by nausea vomiting, and before her appearance the patient feels headache, there is an increased sensitivity to light.
Less common cause of nausea and vomiting is a cardiac pathology, namely, acute myocardial infarction, especially the back wall and transmural as well as chronic heart failure.
It should be remembered that the cause of nausea and even vomiting may be taking certain medications (chlorpromazine, amitriptyline, opioids, digoxin, phenytoin, carbamazepine, Depakine, metronidazole), and psychogenic (negative emotions are caused by an unpleasant view or smell things, fear andanxiety) or mental disorders (anorexia, bulimia).
To clarify the causes of vomiting is necessary to pay attention to the nature of vomit, according to which the vomiting can be eaten on the eve of svezhesedennoy or food, bile, blood ( "coffee grounds" - a modified blood under the influence of hydrochloric acid), fecal and purulent.Attention should be paid to the volume of vomitus (vomit "fountain"), whether there is a patient relieved after vomiting, the time of vomiting (in the morning on an empty stomach or after a meal), the multiplicity of vomiting (multiple persistent or single).
As mentioned above, nausea and vomiting - is only manifestation of the disease, not the disease itself, which is why the basic treatment should be directed at eliminating the disease, which led to them.
to improve patient well-being symptomatic treatment.
In the event of sickness the patient is recommended to breathe deeply and slowly, which reduces the contraction of the stomach muscles.Often, a few sips of carbonated liquid at room temperature can help reduce symptoms.
During vomiting there is loss of fluid from the body, which can lead to hypovolemia, cardiac disorders and kidney function, which is why you need to make up for the lost volume of the liquid.If the patient is conscious, give the liquid through the mouth, in small sips, 5-15 ml every 5 minutes.When insufficient oral rehydration carried intravenous fluids.Power should also be fractional, small portions (a few tablespoons) and consist only of a light meal.If the cause of vomiting is food poisoning or an intestinal infection, and acute oral poisoning, it is necessary as soon as possible to wash out the stomach, it is best through a tube.
Drug treatment of nausea and vomiting carried antiemetics - blockers of dopamine receptors.These include the following drugs:
• thiethylperazine (torekan) - the drug is assigned to 1 tablet (6.5 mg) 1-3 times a day, or 1 suppository 2 times a day, or 1-2 ml of 0,65% solution;
• Reglan (metoclopramide, Raglan) - available in tablets for oral administration through 5, and 10 mg in vials for intramuscular injection.Children over 6 years assigned to 1 / 2-1 tablet 3 times a day, adults - 1 -2 tablets 3 times a day before meals or 2 ml of 0.5% solution 1-3 times a day;
• domperidone (Motilium, Motilak) - the drug is prescribed to children at the rate of 0.25 mg / kg body weight, for children weighing 20-30 kg on 1/2 tablets to children weighing more than 30 kg: 1 tablet 3 timesday for 15-30 minutes before a meal, but I adult tablet 3-4 times a day.The drug is available in tablets of 10 mg;
• ondansetron (Zofran, Latran) - drug is given at the rate of 0.15 mg / kg 3 times a day.