II. Indications: Immediate Evaluation

  1. Hematemesis
  2. Persistent Abdominal Pain longer than 2 hours
  3. Possible Intestinal Obstruction
    1. Intussusception
    2. Volvulus
  4. Possible Ileus or Appendicitis
  5. Abdominal or Head Trauma
  6. Suspected poison or Foreign Body Ingestion
    1. Ask parents to examine vomitus for pills or leaves
    2. Common ingestions
      1. House Plant
      2. Medication
      3. House cleaning chemical or cleanser
      4. Coins
  7. Pediatric Dehydration
    1. Infant under age 1 year: Last Urine > 8 hours prior
    2. Child over age 1 year: Last Urine >12 hours prior
  8. Difficult arousal
  9. Stiff neck (Have child touch chin to chest)

III. Indications: Clinical evaluation within 16 hours

  1. Acute Vomiting (if 3 or more episodes)
    1. Age <6 months old: Vomiting persists >12 hours
    2. Age <2 years old: >24 hours
    3. Age >2 years old: >48 hours
  2. See more quickly if Diarrhea accompanies Vomiting

IV. Indications: Routine clinical evaluation in 1-2 weeks

  1. Recurrent Vomiting (assess for psychogenic cause)

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