Adverse Events + Management

Question 1

2 main strategies to reduce injection pain

Answer 1

1) minimize anxiety
2) technique considerations

Question 2

T or F: always prep needle in pt view so they know its coming

Answer 2

F - prep needle out of pt view

Question 3

strategy if injection multiple people in same family

Answer 3

start with most anxious person

Question 4

Strategies when injecting kids basics

Answer 4

distract them
- get parent to restrain kid immediately before giving injection
- don’t give false reassurances

Question 5

What is better when it comes to pain: fast insert + withdraw or slower + steadier

Answer 5

Fast

Question 6

T or F: you can apply light pressure to to area injected after for IM + SC but not ID

Answer 6

T

Question 7

Non pharm options for kids

Answer 7

• breastfeeding: feed them throughout injection

2+ or younger kids who aren’t breastfeeding: can give sweet tasting solution (2mL of 24-50% sugar solution 1-2 mins before)
—- can give lollipop if older

Question 8

T or F: topical local anesthetics can be applied before injection if needed

Answer 8

T- can apply
- don’t apply to damage skin
- may irritate if skin is sensitive

Question 9

What are the topical local anesthetic options

Answer 9

EMLA: contains 2.5% lidocaine + 2.5% prilocaine
- cream or patch
- onset : 1 hr (lasts 2)

Maxilene: Liposomal lidocaine 4% cream
- onset 20-60mins
- lasts up to 3 hrs

Ametop: tetracaien 4% gel
- onset 30-45mins
lasts 4-6 hrs (cover with occlusive dressing)

Question 10

What does very common SEs mean (frequency)

Answer 10

> 1/10

Question 11

Frequency of SE if its common

Answer 11

1/10 - 1/100

Question 12

Frequency of SE if its uncommon

Answer 12

1/100- 1/1000

Question 13

Frequency of SE if its rare

Answer 13

1/1000 - 1/10000

Question 14

Frequency of SE if its very rare

Answer 14

< 1/10000

Question 15

Which SEs need to be reported to HC

Answer 15

severe or unexpected SES

Question 16

Passive surveillance of SEs

Answer 16

collect from all AES reporting done by HCP

Question 17

Active SE surveillance

Answer 17

proactive, may be performed after serious AEs are detected

Question 18

What are Ad hoc studies

Answer 18

additional surveillance or clinical studies done to characterize specific concerns, assess causal links or determine RFs that make an AE more likely to occur

Question 19

How long after injections does most fainting occur

Answer 19

within 15 mins

Question 20

What should be done if a pt leaves before the 15 min monitoring period post injection is done

Answer 20

document

Question 21

Why is reporting AEs important

Answer 21

to help detect rare events not detect in clinical trials

Question 22

When should AEs be reported

Answer 22

• severe
• unexpected type or frequency
• is concern to pt or HCP
• you don’t need to confirm a causal relationship

Question 23

How do you report AEs / who do you report it do

Answer 23

• report to PH
• if reaction to non-vaccine injectable product—- report to manufacturer

Question 24

What should you do to prepare for AES when doing injections

Answer 24

• have anaphylaxis kit assembled + nearby
• have snacks + juice
• have space for patient to lie down
• must be able to observe pt for 15-30 mins
• need current CPR + first aid cert

Question 25

What is syncope

Answer 25

fainting

Question 26

T or F: 89% of fainting occurs within the first 15 mins post injection

Answer 26

T

Question 27

Why does fainting likely occur post injections

Answer 27

due to temporary loss of blood to brain

Question 28

SS of syncope

Answer 28

pallor, sweating, dizzy, may have rhythmic jerking of limbs when unconscious

Question 29

What are some preventative steps that can be taken when it comes to fainting + injections

Answer 29

- ask about needle anxiety or if had pass rxns - ensure in chair with back + armrest - don’t inject across a table or desk - if high risk of fainting: inject laying down

Question 30

Management strategies if feel like they are going to faint

Answer 30

if sitting: have them lean forward with head bw knees Laying down/ or if at risk of falling when sitting: guide to floor + go into recumbent position (on back with feet slightly elevated) —— loosen clothing around neck

Question 31

When can breath holding occur

Answer 31

can occur in kids if they are upset or crying ——- agitated + then suddenly stop making noise (may show facial flushing or cyanosis)

Question 32

T or F: breath holding with kids is super serious and requires treatment

Answer 32

F- no treatment needed — kids with suddenly resume crying

Question 33

Strategies to help with anxious people

Answer 33

support them with regular breathing distraction don’t prep needle in front of them try to get it over with quickly

Question 34

How frequently can local reactions occur with vaccines

Answer 34

up to 80%

Question 35

Are local rxns more common with inactive or live vaccines

Answer 35

inactive (especially if contain adjuvant)

Question 36

SS of local vaccine rxn

Answer 36

pain swelling + redness at site (mild + SL) - onset: few hours - duration: 1-2 days can manage with OTC pain meds

Question 37

What is the difference bw hives vs anaphylaxis reaction

Answer 37

swelling or local reaction: just that - not full allergic reaction — if have any other body system involved (sneezing, coughing, tearing) + hives: anaphylaxis ————— give E

Question 38

T or F: you can apply ice to help with local rxn to vaccine

Answer 38

T

Question 39

Can antihistamines be given to help with itch from local rxn to vaccine?

Answer 39

Yes - can give — but ensure pt has someone to monitor them for the next hour at least (not alone) - 2nd gen are better

Question 40

How fast can anaphylaxis reaction occur

Answer 40

normally rapidly but can appear up to 30 mins post admin

Question 41

What causes Anaphylactic reaction

Answer 41

mediated by IgE —- causes histamine release - causes SM of GI and RT to spasm, bronchoconstriction, vasodilation, + increase BV permeability

Question 42

SS of Anaphylactic Rxn

Answer 42

Normally includes 1+ body systems Skin: rash Respiratory: SM spasms, bronchoconstriction, mucus secretion, airway edema, sneezing CV: hypotension, syncope, shock

Question 43

How may kids explain anaphylactic rxn

Answer 43

throat is tingly or tongue is scratchy

Question 44

Treatment for anaphylactic RX

Answer 44

- call 911 - assess ABC, mental status, skin + BW - get pt into recumbent position with feet up - give E: 1:1000 IM into anterolateral aspect of thigh - may repeat E admin at 5 min intervals if needed (use different limb) - stabilize pt and ensure airway is open, monitor vials

Question 45

Weight based dosing for E

Answer 45

0.01mL/kg to max of 0.5mg/dose

Question 46

T or F: 1/4 of anaphylactic reactions have biphasic reaction

Answer 46

T- 1/4 have a low reaction occurring within 1-72 hrs of OG rxn

Question 47

What does Epi helps with during Anaphylactic Rxn?

Answer 47

martian BP, inhibitor of further rxns

Question 48

SEs of E

Answer 48

palpitations, tachycardia, flushing, headache

Question 49

T or F: If not sure someone needs E, don’t give it to them as R> B of use

Answer 49

F - if think they need it—- give it to them because leaving anaphylaxis untreated is super serious

Question 50

T or F: there is no absolute CI to E

Answer 50

T

Question 51

T or F: Salbutamol use can be considered if bronchoconstriction if anaphylactic rxn is occurring to avoid E use

Answer 51

F- can use it but only after giving E

Question 52

Weight based E doses

Answer 52

Conc of product: 1mg/mL 2- < 7 yrs (below 25kg) : 0.15mg 7+ - 12 (below 45kg): 0.3mg > 12: 0.5mg

Question 53

T or F: E auto injectors are made to go through clothing

Answer 53

T

Question 54

Are E auto injectors latex free

Answer 54

yes

Question 55

Admin instructions for E pen

Answer 55

blue to sky + orange to the thigh - voice assistance - pull from outer case - pull off red safety guard - place the black end against the middle outer thigh + press firmly + hold in place for 5 seconds (will hear click + hiss)

Question 56

Which age/weight group should use junior Epipen

Answer 56

those who weigh up to 65lbs or 30kgs - 0.15 mg dose

Question 57

Who should use regular epipen

Answer 57

those who weigh over 30kg — 0.3mg dose

Question 58

What should all be included in anaphylaxis kit

Answer 58

Auto injectors (both types) OR E vials/ampoules - if using ampoules: need 3 vials of 1:1000 solution, 1 cc with 25g 1” needle, 1 cc with 25g 5/8” needle; 3 25g needles (5/8, 1 and 1.5) - E dosing chart - alcohol swabs - tongue depressors - pocket mask - watch capable of measuring seconds