›Immediate stabilization workflow
›Airway protection threshold
›Cardiac monitor when severe dehydration or electrolyte derangement
›Two large bore IV when shock physiology
›Point of care glucose early
Fluid and electrolyte correction
›Rehydration strategy
›Isotonic crystalloid bolus 10 to 20 mL per kg for hypovolemia
›Reassess perfusion after each bolus
›Avoid large free water in hyponatremia
›Electrolyte repletion
›Potassium replacement target above 3.5 mmol/L when safe
›Magnesium replacement target above 0.8 mmol/L when QTc risk
›Phosphate replacement when severe hypophosphatemia
Antiemetic escalation ladder
›Stepwise pharmacotherapy
›Ondansetron IV 4 mg once
›Repeat ondansetron IV 4 mg after 15 to 30 minutes if partial response
›Metoclopramide IV 10 mg once
›Prochlorperazine IV 10 mg once
›Haloperidol IV 2.5 mg once local protocol dependent
›Droperidol IV 1.25 mg once local protocol dependent
›Adjuncts
›Diphenhydramine IV 25 mg for dystonia prophylaxis with dopamine antagonists
›Acetaminophen for pain when appropriate
›Avoid opioid escalation when possible
Syndrome specific management
›Cannabinoid hyperemesis syndrome
›Topical capsaicin 0.025 to 0.1 percent to abdomen or arms
›Haloperidol low dose strategy local protocol dependent
›Cannabis cessation counseling and referral pathway
›Cyclic vomiting syndrome
›Treat as migraine phenotype when present
›IV fluids and antiemetics as above
›Consider triptan therapy when typical migraine features and no contraindications
›Gastroparesis flare
›Metoclopramide strategy with dystonia risk counseling
›Avoid anticholinergics and opioids when possible
›Diabetes glucose optimization pathway
›Hyperemesis gravidarum
›Thiamine IV 100 mg before dextrose containing fluids when prolonged poor intake
›Doxylamine pyridoxine pathway local protocol dependent
›Obstetric consultation criteria
Targeted etiologic pathways
›Suspected obstruction
›NPO
›NG tube decompression when significant distension and persistent vomiting
›Early surgical consultation
›Suspected GI bleeding
›Large bore IV access
›Type and screen
›Proton pump inhibitor IV local protocol dependent
›Suspected DKA
›DKA protocol local protocol dependent
›Potassium threshold logic before insulin
Monitoring and reassessment loop
›Reassessment structure
›Symptom response check at 15 to 30 minutes after each antiemetic step
›Repeat vitals after fluids
›Repeat electrolytes after significant replacement
›Urine output monitoring goal at least 0.5 mL per kg per hour