Approach to vomiting (acute) Quiz: Ace Your Exams
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A 42-year-old man presents to the emergency department for evaluation of acute-onset nausea and multiple episodes of non-bloody vomiting that began 4 hours ago. He reports associated severe, sharp, intermittent right-sided flank pain radiating into the right groin. He has not had a fever, diarrhea, or recent dietary changes. He describes a similar episode several years ago that resolved without intervention. Temperature is 37.2°C (99.0°F), blood pressure 140/90 mmHg, heart rate 100 beats per minute, respiratory rate 18 breaths per minute, and oxygen saturation is 99% on room air. On examination, he appears uncomfortable and restless, frequently shifting positions. Physical examination reveals marked tenderness over the right costovertebral angle. The abdomen is soft, nondistented, and nontender, without abdominal rebound or guarding. Urinalysis shows hematuria. Which of the following is the best next step in management?
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