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