I Thought That Squirrel Tasted Funny…

Nausea and Vomiting…

We are constantly being harassed and bombarded by invaders: allergens and “stuff” in the air that are trying to get a foothold in us and cause problems. One of our first lines of defense is to simply expel these invaders and send them back to where they came from. These defenses consist of sneezing, to blow them out of our nose; coughing, to rid our lungs of the pests; having bouts of diarrhea to clear out our intestinal tract; and vomiting, to empty the stomach and upper small intestine.

Sneezing, coughing, and diarrhea can be a bit of nuisance, but nausea and vomiting are things we would all like to avoid.

Two of the most common symptoms associated with illness and stress are nausea and vomiting. Their causes are many and include infections, viruses, food poisoning, appendicitis, and peritonitis, as well as motion sickness, intestinal blockage, concussion, migraines, and anxiety. These symptoms can also indicate very serious life-threatening illnesses such as a heart attack, meningitis, encephalitis, kidney disease, liver disease, brain tumors, or cancer.

Nausea is that vague uneasy sensation that you are going to vomit. Vomiting is the action by which the stomach contents are expelled out of the mouth. The sensation of nausea and the action of vomiting are controlled by the vomiting center in the brain, the Area Postrema.

The Area Postrema receives signals from four locales around the body. Three are in the gastrointestinal tract: the mouth, stomach, and intestines. These react to taste, as well as toxins in food which can cause food poisoning. The fourth locale is the brain, which constantly monitors the bloodstream for the chemicals of infections as well as certain medications that can cause nausea and vomiting.

The vestibular (balance) apparatus in the ears, when out of kilter, can also cause dizziness, nausea, and vomiting. And the brain can even induce nausea and vomiting from unpleasant sights, smells, and even thoughts.

Nausea and vomiting are symptoms of an underlying problem. Fortunately, the problem is usually benign and self-limiting. The primary concerns are the risks of dehydration from not drinking and electrolyte depletion from vomiting. If associated with diarrhea, the loss of electrolytes becomes an even greater risk. How do you get fluids into someone who is nauseous and throwing up?

The Principles of Managing Nausea and Vomiting

Try to prevent dehydration by taking small sips of a clear fluid often. This is preferred to drinking a larger volume less frequently because an upset stomach will only tolerate small amounts of fluid. Drink liquids such as water, ginger ale, fruit juices, or electrolyte drinks like Gatorade. Cold fluids are tolerated better than hot fluids.

Electrolyte solutions are commonly referred to as oral rehydration solutions and they contain small amounts of sugar (carbohydrates), salt (sodium and chloride), and potassium. Electrolytes are charged ions in the blood and tissues are that responsible for nerve and cardiac electrical impulses, muscle contraction, and gates or channels in cell membranes. They are vital. The most important electrolytes are sodium, potassium, chloride, and calcium, and depletion of these will affect homeostasis (the ability to maintain stable internal physiological conditions).

Remedies for Nausea

Herbal

Dilute solutions of a ginger, peppermint, or chamomile tea will help to control nausea.

Over-The-Counter (OTC) Medications

Pepto-Bismol (bismuth subsalicylate) will help to calm the stomach and control diarrhea. Pepto-Bismol cannot be used in someone who is allergic to aspirin. It should also not be used in children and teenagers younger than 18 years old if there is a chance that the illness is associated with viral influenza or chickenpox, due to the risk of Reye’s Syndrome, a life threatening encephalopathy.

OTC antihistamines such as dimenhydrinate, diphenhydramine, and meclizine may help with nausea and vomiting caused by motion sickness.

Prescription Drugs for Nausea and Vomiting

A variety of medications for nausea and vomiting are used depending on the underlying diagnosis and cause. Two of the most common drugs for treating nausea and vomiting are Phenergan and Compazine. Both are available as suppositories so they will not contribute to the problem of nausea.

  • Phenergan (promethazine) suppository 25mg, one per rectum every 12 hours as needed for nausea and vomiting.
  • Compazine (prochlorperazine) suppository 5mg, one per rectum every 12 hours as needed for nausea and vomiting.

Once the patient is feeling better and their appetite has returned, advance the diet slowly with small quantities of bland food, such as the BRAT diet – Bananas, Rice, Applesauce, and Toast. Avoid greasy, hard-to-digest foods for 24 hours.

When to Seek Help

 The vast majority of the time the causes of nausea and vomiting are benign and self-limiting. However, it is time to seek help if the nausea and vomiting are associated with:

  • a fever greater than 102.5°F/39°C
  • a change in level of consciousness
  • seizure activity
  • bright red blood or digested blood (the latter looks like coffee grounds) in the vomitus
  • vomiting that is frequent and copious and causes the patient to become progressively dehydrated symptoms lasting more than 24 hours that are not easily controlled.

It Ain’t Always Obvious…

The Instinctive Drowning Response, so named by Francesco A. Pia, Ph.D., is what people do to avoid actual or perceived suffocation in the water. And it does not look like most people expect it to. When someone is drowning there is very little splashing, and no waving or yelling or calling for help of any kind. To get an idea of just how quiet and undramatic drowning can be, consider this: It is the number two cause of accidental death in children age 15 and under (just behind vehicle accidents). 50 percent of them will do so within 20 metres of a parent or other adult. In 10 percent of these drownings, the adult will actually watch them do it, having no idea it is happening.

Drowning does not look like drowning. Dr. Pia, in an article he wrote for the Coast Guard’s On Scene magazine, described the instinctive drowning response like this:

  • Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is a secondary or overlaid function. Breathing must be fulfilled before speech occurs.
  • Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
  • Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
  • Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer or reaching out for a piece of rescue equipment.
  • From beginning to end of the Instinctive Drowning Response, people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs. (Source: On Scene magazine: Fall 2006 page 14)

This doesn’t mean that a person who is yelling for help and thrashing isn’t in real trouble — they are experiencing aquatic distress. Not always present before the instinctive drowning response, aquatic distress doesn’t last long, but unlike true drowning, these victims can still assist in their own rescue. They can grab lifelines, reach for throw rings, etc.

Look for these other signs of drowning when persons are in the water:

  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes closed
  • Hair over forehead or eyes
  • Not using legs
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over onto the back
  • Appears to be climbing an invisible ladder

So, if someone falls overboard and everything looks okay, don’t be too sure. Sometimes the most common indication that someone is drowning is that they don’t look as if they’re drowning. They may just look as if they are treading water and looking up at the deck. One way to be sure? Ask them, “Are you alright?” If they can answer at all, they probably are. If they return a blank stare, you may have less than 30 seconds to get to them. And parents — children playing in the water make noise. When they get quiet, you need to get to them and find out why.