GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 248

signofvomiting,anunconsciouspersonmustberolledontothesidewiththeheadlowered.
The waist may be lifted if the person has not been involved in an accident that could have
produced a fractured spine. (If a blow to the head is responsible for the unconsciousness,
the individual should be assumed to have a cervical spine injury.) The headdown position
must be maintained until vomiting has ceased and vomitus cleared from the mouth. The
person must not be allowed to aspirate the vomited material.
Protracted vomiting sometimes ruptures small blood vessels in the lining of the lower
esophagus, and variable amounts of blood appear in the vomitus. Chronic use of aspirin
orothernonsteroidalanti-inflammatorydrugs(NSAIDs)orexcessivealcoholconsumption
can irritate the stomach and cause the vomitus to be bloody. When ulcers of the stomach or
duodenum cause vomiting, the vomitus may contain large quantities of blood that may be
black or look like coffee grounds.
Vomiting caused by minor disorders often stops without any treatment. After the first
bout the individual usually feels better and is able to resume limited activity. If vomiting
does not stop within a few hours, a serious underlying disease must be considered. Vomit-
ingmaybeanimportantsignofbraininjury,anacuteabdominaldisordersuchasintestinal
obstruction or appendicitis, drug overdose, and many other diseases. If a person has one of
thesedisorders,controllingvomitingwithmedicationscoulddelaydiagnosisanddefinitive
treatment but may be essential if the individual is not near a medical facility.
Whennounderlyingdiseasecanbeidentified,vomitingcanbetreatedsymptomatically.
If medications can be taken orally, prochlorperazine (Compazine®) or ondansetron (Zo-
fran®) can be given. Therapy should continue until the person has been asymptomatic
for at least four hours and can maintain adequate oral hydration. If oral drugs cannot
be retained, orally dissolving ondansetron tablets (Zofran ODT®) can be given or pro-
chlorperazine or promethazine (Phenergan®) rectal suppositories can be inserted every
four to six hours until oral medications can be kept down.
Treatment required for more than twenty-four hours should dictate evacuation. Drowsi-
ness is a common side effect of many drugs used to treat vomiting, but not ondansetron
andrelatedmedications.Whiletakingprochlorperazineorallyorusingeitheroftherecom-
mended suppositories, the individual must not take part in activities in which drowsiness
or inattentiveness could result in injury.
Ifvomitingisprolonged,thebodybecomesdepletedoffluidandsalt.Onrareoccasions,
vomiting cannot be stopped until the fluid and salt have been replaced. Treating such in-
tractable vomiting requires intravenous fluids. If fluids for intravenous therapy are not
available, the person must be evacuated.
Following recovery, fluids should be replaced as quickly as possible to correct dehydra-
tion.Theindividualshouldeatblandfoods,preferablyliquids,forabouttwenty-fourhours.
Motion Sickness