Adverse Events + Management Flashcards
2 main strategies to reduce injection pain
1) minimize anxiety
2) technique considerations
T or F: always prep needle in pt view so they know its coming
F - prep needle out of pt view
strategy if injection multiple people in same family
start with most anxious person
Strategies when injecting kids basics
distract them
- get parent to restrain kid immediately before giving injection
- don’t give false reassurances
What is better when it comes to pain: fast insert + withdraw or slower + steadier
Fast
T or F: you can apply light pressure to to area injected after for IM + SC but not ID
T
Non pharm options for kids
- 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
T or F: topical local anesthetics can be applied before injection if needed
T- can apply
- don’t apply to damage skin
- may irritate if skin is sensitive
What are the topical local anesthetic options
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)
What does very common SEs mean (frequency)
> 1/10
Frequency of SE if its common
1/10 - 1/100
Frequency of SE if its uncommon
1/100- 1/1000
Frequency of SE if its rare
1/1000 - 1/10000
Frequency of SE if its very rare
< 1/10000
Which SEs need to be reported to HC
severe or unexpected SES
Passive surveillance of SEs
collect from all AES reporting done by HCP
Active SE surveillance
proactive, may be performed after serious AEs are detected
What are Ad hoc studies
additional surveillance or clinical studies done to characterize specific concerns, assess causal links or determine RFs that make an AE more likely to occur
How long after injections does most fainting occur
within 15 mins
What should be done if a pt leaves before the 15 min monitoring period post injection is done
document
Why is reporting AEs important
to help detect rare events not detect in clinical trials
When should AEs be reported
- severe
- unexpected type or frequency
- is concern to pt or HCP
- you don’t need to confirm a causal relationship
How do you report AEs / who do you report it do
- report to PH
- if reaction to non-vaccine injectable product—- report to manufacturer
What should you do to prepare for AES when doing injections
- 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
What is syncope
fainting
T or F: 89% of fainting occurs within the first 15 mins post injection
T
Why does fainting likely occur post injections
due to temporary loss of blood to brain
SS of syncope
pallor, sweating, dizzy, may have rhythmic jerking of limbs when unconscious
What are some preventative steps that can be taken when it comes to fainting + injections
- 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
Management strategies if feel like they are going to faint
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
When can breath holding occur
can occur in kids if they are upset or crying
——- agitated + then suddenly stop making noise (may show facial flushing or cyanosis)
T or F: breath holding with kids is super serious and requires treatment
F- no treatment needed
— kids with suddenly resume crying
Strategies to help with anxious people
support them with regular breathing
distraction
don’t prep needle in front of them
try to get it over with quickly
How frequently can local reactions occur with vaccines
up to 80%
Are local rxns more common with inactive or live vaccines
inactive (especially if contain adjuvant)
SS of local vaccine rxn
pain swelling + redness at site (mild + SL)
- onset: few hours
- duration: 1-2 days
can manage with OTC pain meds
What is the difference bw hives vs anaphylaxis reaction
swelling or local reaction: just that
- not full allergic reaction
— if have any other body system involved (sneezing, coughing, tearing) + hives: anaphylaxis
————— give E
T or F: you can apply ice to help with local rxn to vaccine
T
Can antihistamines be given to help with itch from local rxn to vaccine?
Yes - can give
— but ensure pt has someone to monitor them for the next hour at least (not alone)
- 2nd gen are better
How fast can anaphylaxis reaction occur
normally rapidly but can appear up to 30 mins post admin
What causes Anaphylactic reaction
mediated by IgE —- causes histamine release
- causes SM of GI and RT to spasm, bronchoconstriction, vasodilation, + increase BV permeability
SS of Anaphylactic Rxn
Normally includes 1+ body systems
Skin: rash
Respiratory: SM spasms, bronchoconstriction, mucus secretion, airway edema, sneezing
CV: hypotension, syncope, shock
How may kids explain anaphylactic rxn
throat is tingly or tongue is scratchy
Treatment for anaphylactic RX
- 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
Weight based dosing for E
0.01mL/kg to max of 0.5mg/dose
T or F: 1/4 of anaphylactic reactions have biphasic reaction
T- 1/4 have a low reaction occurring within 1-72 hrs of OG rxn
What does Epi helps with during Anaphylactic Rxn?
martian BP, inhibitor of further rxns
SEs of E
palpitations, tachycardia, flushing, headache
T or F: If not sure someone needs E, don’t give it to them as R> B of use
F - if think they need it—- give it to them because leaving anaphylaxis untreated is super serious
T or F: there is no absolute CI to E
T
T or F: Salbutamol use can be considered if bronchoconstriction if anaphylactic rxn is occurring to avoid E use
F- can use it but only after giving E
Weight based E doses
Conc of product: 1mg/mL
2- < 7 yrs (below 25kg) : 0.15mg
7+ - 12 (below 45kg): 0.3mg
> 12: 0.5mg
T or F: E auto injectors are made to go through clothing
T
Are E auto injectors latex free
yes
Admin instructions for E pen
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)
Which age/weight group should use junior Epipen
those who weigh up to 65lbs or 30kgs
- 0.15 mg dose
Who should use regular epipen
those who weigh over 30kg
— 0.3mg dose
What should all be included in anaphylaxis kit
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
