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Fainting and Anaphylaxis Needlestick Injuries

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

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Fainting and Anaphylaxis Needlestick Injuries

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  1. Fainting and AnaphylaxisNeedlestick Injuries Bryna Warshawsky, MDCM, FRCPC Associate Medical Officer of Health Middlesex-London Health Unit

  2. Fainting - Definition • Weak, lightheaded, pale, nauseated • Falls on floor • Brief seizure activity

  3. 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

  4. 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

  5. Fainting Management • Elevate feet • Fan • Cold cloth • Seizures - avoid injury • Vomits - recovery position, watch neck • Prolonged - proceed as per anaphylaxis • Serious injury - 911

  6. 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

  7. 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

  8. 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

  9. 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

  10. Anaphylaxis - Management • Two nurses • Call ambulance • Lay down and raise feet • Assess airway, breathing, circulation

  11. 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

  12. 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

  13. 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

  14. Adrenaline - Additional Doses • Different limb for each additional dose • Avoid limb which received vaccine

  15. 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

  16. 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

  17. 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”

  18. 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

  19. 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

  20. After the Poke • Let it bleed • Wash with soap and water • Remain calm - it will be alright

  21. 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

  22. 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

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