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?
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.
Ammonia inhalants were pulled some time ago - at least in my area. Not in use at all.
As to the incident - I agree. Vaso-vagal.
I've had it happen with a fingerstick and a tiny drop of blood - the person I was training went down . . .
My 18 yr. old son did this with a PPD skin test...not sure what the deal was as he has had plenty of injections, and has also donated blood without incident. He said "the bubble freaked (him) out." He had a bit of seizure type activity when he went down, less than 5 seconds. No one seemed concerned by that. I haven't had fainters do that--is it normal?
Regarding incident I referenced above, the pt was totally nonresponsive, tonic-clonic, loss of bladder control, postictal O2 sats remained low even on 4L O2. Even when pt started to respond, pt was not fully oriented, N/V present. That's why our doc made decision to ship via EMS. Later told my nursing supervisor that we need to post sign saying, "Warning: administering injections to pt may cause pt's spouse to have seizure." She thought that was pretty funny.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
Ammonia inhalants were pulled some time ago - at least in my area. Not in use at all.
steph
Really?? Huh, we still had them in the ED 2 years ago before I left there - was this a recent thing? I tried Googling to see if they were no longer indicated but couldn't find that info anywhere.
I have given several different injections which caused similar reactions. Anyone remember the swine flu vaccine? I gave shots to students at my university and I had several boys pass out cold. My DH has gone into shock giving blood My daughter has passed out during office procedures more times than I can count. In all cases, these people have gotten pale, nauseous, and disoriented. DD has thrown up. My DHs BP dropped to 60/0 and he woke up with oxygen and a fast D5W drip. The Red Cross told him thanks for the blood, but don't come back
Really?? Huh, we still had them in the ED 2 years ago before I left there - was this a recent thing? I tried Googling to see if they were no longer indicated but couldn't find that info anywhere.
One thing I noticed when I first joined allnurses was how different medical practice is from region to region. These inhalants were pulled from our ambulances and ER years ago. I can't find anything on ismp.org though.
I googled "ammonia inhalants still used?" and came up with this blog starting with this post from 2007:
"Ammonia was 'tipping point' in teen's boot camp death, doctor says"
By Emanuella Grinberg
Court TV
PANAMA CITY, Fla. — A Florida teen who collapsed during a confrontation with boot camp guards died of organ failure after they repeatedly used ammonia capsules to try to revive him, a doctor testified Thursday.
The encounter, which occurred on Martin Lee Anderson's first day at the Bay County Boot Camp, aggravated his pre-existing condition of sickle-cell trait, leading to his death, forensic pathologist Thomas Andrew said.
Drill instructors Henry Dickens, Charles Enfinger, Patrick Garrett, Raymond Hauck, Charles Helms Jr., Henry McFadden Jr., Joseph Walsh and nurse Kristin Schmidt each face up to 30 years in prison if convicted of aggravated manslaughter of a person under 18.
"Just a word of caution to EMS companies who uses Ammonia Inhalants. I looked through some EMT books and don't see where the use of Ammonia Inhalants are used in the assessment of level of consciousness.
Any thoughts on this? "
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"Ammonia inhalants were pulled some time ago. Aside from the possible complications with certain disease processes, it was found that the inhalants were often being used improperly. I believe they were pulled from South Carolina ambulances about 4 or 5 years ago."
. . ."During an October game against Detroit, television cameras caught Favre raising a white capsule to his nose and taking two small, short breaths. . . ."
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
Yep, not surprising - many professional athletes will try anything to get that "edge."
Thanks for the links - I wouldn't be surprised if kids were caught stealing them from EDs/docs' offices to get a "high." We used to keep ours taped to the walls years ago and then they told us we couldn't do that anymore so we kept them in a special little draw on top of our code carts that was easily accessible.
Yep, not surprising - many professional athletes will try anything to get that "edge."
Thanks for the links - I wouldn't be surprised if kids were caught stealing them from EDs/docs' offices to get a "high." We used to keep ours taped to the walls years ago and then they told us we couldn't do that anymore so we kept them in a special little draw on top of our code carts that was easily accessible.
You could get the same kinda high from sniffing horseradish!
Or just putting a bit too much on your bite of tri-tip.
The Red Cross told him thanks for the blood, but don't come back 
Spidey's mom, ADN, BSN, RN
11,305 Posts
Ammonia inhalants were pulled some time ago - at least in my area. Not in use at all.
As to the incident - I agree. Vaso-vagal.
I've had it happen with a fingerstick and a tiny drop of blood - the person I was training went down . . .
Crazy.
steph