Table 1

 Subjective and objective information that needs to be elicited from the patient presenting with nausea or vomiting

The symptomGeneral
How long has the symptom been present?Baseline vital signs are measured.
How long have the symptoms been a problem?Is there any evidence of dehydration?
How often has the person vomited in the past few hours?Look in the mouth/ears. Check lymph glands.
Is there any blood or mucus in the vomit?Look for evidence of jaundice.
What colour is the vomit?Is there a rash or wide-spread muscle tenderness?
Associated symptomsSystems exam as indicated by history
Is there any associated pain? – where is it and does it radiate anywhere?Neurological
Is there any diarrhoea – if so is there any blood or mucus in it?Is there any headache, visual symptoms, altered level of consciousness, or neurological signs including abnormal tone in children?
Possible infective contacts/travelChest – as indicated by the history.
Does anyone else in the family have the same problems?Abdomen
What does the patient/family think is the cause? Have they been abroad, if so where?Is there any abdominal pain? – if so the abdomen should be palpated and listened to for signs of bowel disease or obstruction and the renal angles palpated for tenderness.
Past HistoryAre there any urinary or gynaecological symptoms e.g. dysuria and frequency or vaginal discharge?
Is there a significant past medical history of similar episodes or recent illness/surgery? Is the patient immunocompromised by pre-existing illness or recent treatment – they will usually have a letter from hospital explaining the risks if this is likely.Tests
Has the patient taken any drugs prescribed or otherwise? – if not should they have?Check a urine specimen if possible (nephur test or combistix) checking for nitrites or cells.
Is the patient pregnant? – if so how pregnant?Check a BM test in the very young and the elderly even if there is no history of diabetes.