pt pass out after IM ceftriaxone inj

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Hi,

I work in an outpatient clinic. Today, after I gave IM Ceftriaxone 500 mg/2ml sterile water to a young male's lt gluteal maximus, immediately after pt states feeling not right, thirsty, dizzy,and want to vomit. No, the pt denies allergic to penicillin. He is allergic to pollen and has asthma. He did states he is afraid of inj (but many pt said that also). I got basin and water for him while another nurse stay with him. When i came back, the patient pass out right in front of me. Code was called, many nurses, MDs came to help. Pt regain consciousness after calling his name and shaking him. Vitals and BS done within normal, but pt is perspiring a lot. Rapid response team came and send pt to ER. According to ER's diagnosis, pt has vasovagal reaction.

The other day, another pt perspired a lot and feel dizzy after receiving Hep B inj by another nurse. The nurse didn't call code. After check vitals, nurse asked the pt's doctor to re-examine him, and pt is discharged home. In doctor's note, it says pt is afraid of needle.

In both instances, pt afraid of needle, but didn't reveal their fearfulness through their body languages before receiving inj. It's after inj, they react to it.

Do you have similar experiences with your pt and what did you do about it?

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Specializes in PeriOperative.

Sounds like classic vasovagal syncope. Saw it first hand when my son was born and my husband hit the floor.

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Specializes in Hem/Onc/BMT.
Sounds like classic vasovagal syncope. Saw it first hand when my son was born and my husband hit the floor.

Hehehehehe...

I'm sorry... I know syncope is no laughing matter, but picturing the above scene in my head... hehe...

Ahem, I hope your husband didn't get hurt?

To OP: I never witnessed a patient actually losing consciousness, but long time ago when I was a med tech in military, I remember a young girl who became really, scarily pale and diaphoretic after I drew her blood. We had her sit down with her head between her knees. I wonder if that's still done?

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

Agree; a vasovagal reaction...typical s & s.

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Specializes in LPN, Peds, Public Health.

Agreed.

It happens. Just make sure they are safe, keep them from hitting their head (if you see them start to go down)... it also helps to let them lie there with their feet propped up for a bit.

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Specializes in geriatrics,med/surg,vents.

My Dad and both brothers will do the same thing at the sight of blood.My older brother will manage to keep it together until he gets the person to the hospital ER if he has to but then...I swear you can see the little stars circling around his head just like in a cartoon and down he goes.

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I had the same thing happen to me 25 years ago as a student nurse awaiting my finals. I gave a young guy a tetorifice, and pooofff he was gone. Scared the heck out of me- thought I had killed a patient before even gaining my registration!! Luckily the staff nurse I was workign with explained it al to me.

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Specializes in Emergency, medical-surgical,.

It happened to a young male when taking a blood sample!

Fortunately he was already lying on a bed, because there wasn`t

enough time to catch him.

It was my first experience with vasovagal syncope, first week after graduation.

Now 3 years leter I am regularly confronted with that kind of reaction, not scaring me anymore!

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Clinic I work at administers Ceftriaxone via IM frequently. Per instructions on the vial, we mix it with Lidocaine 1%. Some patients have passed out, become diaphoretic, etc. I typically ask patients if they have any problems receiving injections, blood draws, etc. and if so, I have patient lie down prior to procedure. Occasionally I find out after the fact that patient has had nothing to eat all day, BS is low, so that's probably contributing factor to event. From my experience, adolescent & adult males seem more prone to passing out (especially big guys with tattoos - go figure). Recently, while administering IM GM injection to patient, the patient's spouse said, "I'm going to pass out," laid down on the floor, and starting seizing. Stabilized and shipped pt out EMS, and pt later dx with vasovagal syncope. That's some of the most excitement that I've experienced while giving an injection, especially since it was pt's spouse. Rarely a dull moment in the medical field.

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sounds like vasovagal to me too... have had many a pt scared of needles. A few who passed out while starting IV.

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Specializes in CVICU, Obs/Gyn, Derm, NICU.

Probably vasovagal.

In a busy ED ...can get a little tired of this, especially when it's a visitor.

Often young males... late teens into 40's....with poor selfcare and lack of common sense (no food or fluids all day).

I have learnt to recognise the 'type' and put them outside for blood draws, IV's, wound care etc.

Not meaning to sound callous ....but so tedious handling this when juggling several other p'ts who are actually ill

Sense of humour really runs out when I let the delicate 35 yr old type back in in the room, congratulate myself on avoiding a faint ....and then he sees the IV cannula (all nice and neat....no blood visible) AND DECIDES TO HAVE HIS FAINT.

Oh if we could bring back compulsary military training ...it's what some of these people need :lol2:

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

Is it possible to have ammonia inhalants available? If truly just a fainting episode due to a vasovagal reaction, this will typically bring them around quickly.

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