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10 Nausea, vomiting and fever
  1. J Hall1,
  2. P Driscoll2
  1. 1GP Bromsgrove, Hon Lecturer in Emergency Care, Department of Anaesthetics, University of Birmingham, Birmingham, UK
  2. 2Consultant in Emergency Medicine, Hope Hospital, Manchester, UK
  1. Correspondence to:
 John Hall

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Nausea, vomiting, and fever are extremely common presenting complaints in pre-hospital medicine. They are often symptoms of a minor, self-limiting illness but can also be an early, or only, marker of an underlying, potentially life-threatening medical condition.

BOX 1 Article Objectives

  1. Perform a primary survey to identify and treat any life-threatening problem

  2. Identify key factors in the history and examination (as part of the secondary survey), which will be needed to identify the severity of the underlying condition as well as its possible cause

  3. To consider a list of differential diagnoses

  4. To introduce the concept of ‘little sick/big sick’

  5. Discuss treatment based on likely diagnoses and whether home or hospital management is appropriate

  6. Consider the need and practicality of follow up if not admitted


On first contact with the patient an assessment needs to be made as to whether they are Primary Survey Positive. If so the person requires immediate appropriate treatment and rapid transfer to hospital (see article 2 in this series, Emerg Med J 2004;21:216–25).

The Primary Survey box from article 3 (Chest Pain, Emerg Med J 2004;21:226–32) is repeated here as a refresher and is also slightly expanded to include further important triggers for these symptoms.

BOX 2 Primary Survey

Primary survey (Adult) —If any observations below are present then treat immediately and transfer to hospital.

  • Airway obstruction

  • Respiratory rate <10 or >29 per minute*

  • O2 sats <93%

  • Pulse <50 or >120*

  • Systolic BP <90 mm Hg

  • Glasgow coma score <12

  • Unexplained neurological signs

  • Unexplained rash

Since the signs/symptoms discussed in this chapter span the entire age spectrum, some of the parameters will need to be age adjusted. Those parameters requiring adjustment are asterisked. Box 3, below, sets out an evidence based paediatric adjusted physiological range for these parameters in children who are OK, even …

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