fainting and anaphylaxis needlestick injuries
DESCRIPTION
Fainting and Anaphylaxis Needlestick Injuries. Bryna Warshawsky, MDCM, FRCPC Associate Medical Officer of Health Middlesex-London Health Unit. Fainting - Definition. Weak, lightheaded, pale, nauseated Falls on floor Brief seizure activity. Fainting Study. VAERS - 1990- October 1995 - PowerPoint PPT PresentationTRANSCRIPT
Fainting and AnaphylaxisNeedlestick Injuries
Bryna Warshawsky, MDCM, FRCPC
Associate Medical Officer of Health
Middlesex-London Health Unit
Fainting - Definition
Weak, lightheaded, pale, nauseated
Falls on floor
Brief seizure activity
Fainting Study
VAERS - 1990- October 1995 697 syncopal episodes reported Peak age 10-19 year olds - 45.4% Females 57.5% 80% occurred within 15 minutes of vaccine 27% had tonic or clonic movements 6 serious head injuries - 5 were male
Fainting Prevention
Stress free clinics - limit standing and waiting
Watch for people who look anxious, pale, sweaty, trembling or complain of dizziness, numbness or tingling
Vaccinate them when seated Escort them to mat or chair after vaccination
Fainting Management
Elevate feet Fan Cold cloth Seizures - avoid injury Vomits - recovery position, watch neck Prolonged - proceed as per anaphylaxis Serious injury - 911
Post Fainting Management
Get up slowly Check vitals Offer juice Keep in clinic for a half hour or longer Leave with an adult to continue to observe Avoid driving
Post Fainting Management
Advise client to contact doctor if head injury or seizure activity
Document incident Follow-up with client later if seizure
activity, injury or prolonged fainting episode
Anaphylaxis - Definition
Occurs in .11 to .31 per 100,000 vaccines Progresses over several minutes from mild to
severe Usually evident within 15 to 30 minutes Symptoms:
– hives, swelling of face and mouth, itchiness, tearing, nasal congestion, facial flushing, sneezing, coughing, wheezing, laboured breathing, hypotension, shock, collapse
Anaphylaxis - Prevention
Screen for allergy to egg or egg products Screen for allergy to past influenza vaccine Screen for allergy to other components of
the vaccine Screen for allergy to other vaccines which
may contain the same components
Anaphylaxis - Management
Two nurses Call ambulance Lay down and raise feet Assess airway, breathing, circulation
Anaphylaxis - Adrenaline
0.01 ml/kg of 1:1000 adrenaline (maximum 0.5 ml) in opposite limb of vaccine
Subcutaneously if mild reaction
Intramuscularly if severe reaction
Adrenaline by Age
Estimate dose based on age Mild reactions maximum 0.3 ml subQ Severe reactions maximum 0.5 ml IM Watch for elderly and people with cardiac
disease - may cause heart trouble Watch for people on beta-blockers - may
not respond to adrenaline
Adrenaline - Additional Doses
If vaccine subQ, give additional half dose of adrenaline subQ at injection site.
No adrenaline at injection site if vaccine IM as with influenza.
Mild reactions can repeat adrenaline two additional times at 20 minute intervals
Severe reactions can repeat adrenaline two additional times at 10 to 15 minute interval
Adrenaline - Additional Doses
Different limb for each additional dose Avoid limb which received vaccine
Anaphylaxis - Benadryl
Give after initial dose of adrenaline if client not responding well
Also give if responding well but need to maintain control because transfer to acute care facility more than 30 minutes away
Comes as elixir, capsule or injection Oral preferred if possible as injections are
painful
Anaphylaxis
Document all actions with times of events Vaccination Incident Report
Follow-up with client later in day
Should be kept in hospital to be sure stable - at least 12 hours for all but mildest case
Anaphylaxis - Preparation
Have kit with all necessary equipment Content of Emergency Bag Have instructions very handy Always keep people in the clinic area for at
least 15 minutes after vaccination Advise clients of the “What to Watch for..”
on the “After receiving the Influenza Vaccine Sheet”
Needlestick Injuries
Prevention is most important:– Never recap the needle– Never put the needle down on your table– Put needle directly into the sharps container– Watch where you are going when heading
towards the sharps container– Secure the client well; get your partner or team
leader to help hold if necessary
Hepatitis B Vaccine
Be sure to receive your vaccine series
Know your titre - tells you that vaccine worked
If you ever had a titre (10 IU/L), no concern re: hepatitis B
After the Poke
Let it bleed
Wash with soap and water
Remain calm - it will be alright
Follow-up of the Client
Most exposures are low risk, and reassurance is gained by testing the client
We will ask that the client be tested for:– HIV– Hepatitis B– Hepatitis C
Follow-up of Needlestick
Will make specific recommendations depending on situation, results of tests, your hepatitis B vaccination status
Report to occupational health or human resources and complete the required forms