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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

Fainting and AnaphylaxisNeedlestick Injuries

Bryna Warshawsky, MDCM, FRCPC

Associate Medical Officer of Health

Middlesex-London Health Unit

Fainting definition
Fainting - Definition

  • Weak, lightheaded, pale, nauseated

  • Falls on floor

  • Brief seizure activity

Fainting study
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
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
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
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 management1
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
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
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
Anaphylaxis - Management

  • Two nurses

  • Call ambulance

  • Lay down and raise feet

  • Assess airway, breathing, circulation

Anaphylaxis adrenaline
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
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
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 doses1
Adrenaline - Additional Doses

  • Different limb for each additional dose

  • Avoid limb which received vaccine

Anaphylaxis benadryl
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


  • 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
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
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
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
After the Poke

  • Let it bleed

  • Wash with soap and water

  • Remain calm - it will be alright

Follow up of the client
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
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