Two areas in the medulla are primarily responsible for the central control of vomiting. The vomiting center is responsible for the muscular control of vomiting and is closely related to the nearby chemoreceptor trigger zone which responds to blood-borne emetic stimuli from outside the blood-brain barrier. Stimuli and the neurotransmitters involved in these pathways are illustrated in Fig 1. Common etiological factors for vomiting in the critically ill are listed in Table,!..
Fig. 1 Pathways involved in the control of vomiting. Receptor types are indicated as follows: Ach, acetylcholine; D 2, dopamine type 2; H-,, histamine type 1; 5HT3,
5-hydroxytryptamine type 3.
Table 1 Etiological factors related to vomiting in critical care patients
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