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Syncope after injection?

Posted

Haven't been here in quite awhile except to research things. I used to come here when I was considering nursing school. I'm now in MA school (yeah, I know the common opinion here on MA's :o).

I thought I'd see if I could get some input here.

One of the girls in my class passed out today.

She had just gotten an IM injection of sterile saline water (we're

doing injections) in the deltoid. She wasn't afraid of the injection at all as

she's had numerous surgeries. She'd also already received 3 subQ's and a couple of ID's (on other days) with no adverse reaction.

She appeared to have a seizure while she was out, although I would

venture to say it was convulsive syncope and not an epileptic

seizure. My husband has epilepsy so I'm familiar with that scenario. Her BP was low after the episode. She

has a huge lump on her head above her ear as she hit a desk and the

floor.

They took her to the hospital and did x-rays, EKG, blood work and

everything came back fine. They didn't do an EEG, which I thought they would. I just got off the phone with her awhile

ago and she said she doesn't think the girl who gave her the

injection aspirated on her. Could this have caused this to happen? The Emergency room told her it was "caused by the injection" but

didn't elaborate. They just put syncope on her discharge papers.

I told her I'd neb on the internet and see if I could dig anything

up. She was perfectly fine when she received the injection...even

telling the girl who gave her the injection that she didn't even

feel it...within a minute after that, she said she felt dizzy and

needed to sit down...then she hit the floor.

I'd sure appreciate any responses.

Lorraine

Antikigirl, ASN, RN

Specializes in Education, Acute, Med/Surg, Tele, etc. Has 13 years experience.

I would be looking more carefully at her BP and EKG! Could have been coinsidence, could have been a stressful day? Coffee? Got up to fast after the injection? Of course we can also ask...Pregnant? Any new medications? Ever fainted before? Crowded room? Too hot in that room? What was your CBG? Did you eat that day? Did they even take a BMP or Chem 7??? How are your electrolytes because out of whack can mean down on the floor!? Dehydrated? Any history of heart probelms? Migraines? HTN? Hyper or hypo thyroid in your history? Asthma or respiratory probelms?................................

I would have the ER elaborate on their ideas of "it was caused by the injection"..cause I think a bit of smoke was coming out of their butts! I don't buy it! Sounds like a very convienient way to get her out of their ED!

Seek into underlying causes...

And when you said aspirated..are you thinking that putting normal saline in a blood vessel will hurt you? Ummmmmm no! That is what we do with IV's! ;). Or do you think a bubble got in??? Again...our blood is full of this wonderul life giving substance called blood gasses, and is made up of the exact same thing as any bubble you got into the syringe...and that tiny amount would not cause any ill effects...takes quite a bit even central line to cause probelms! So it wasn't a bubble either FYI ;).

All she told me was that they "did blood work" and told her "everything came back normal"

They said her EKG was fine and her BP was about normal by the time they actually saw her (you know what some ER's are like). I was with her at lunch and she was fine, not stressed or anxious, doesn't drink coffee. She did have a bladder infection a week or so ago and was on antibiotics for that. She said the ATB course is done but she thinks she still has a bit of the bladder infection. Pregnant...I wouldn't have a clue and wouldn't ask. She was standing for the injection, it wasn't overcrowded or hot in the room. She ate lunch about an hour before all this happened. I don't know any of her history except that she had a seizure when she was 5 because of a fever. She said no prior history of fainting. She said she feels totally exhausted and like she got hit by a truck. That's very similar to how my DH says he feels after a seizure.

I'm not sure what she was thinking as far as aspirating goes. She just said that she didn't think the girl who gave her the injection remembered to aspirate and wondered if that had anything to do with it.

Thanks for the informative response. That's why you guys are nurses and we're MA's. I can't believe that the ER couldn't give her a more definitive answer. They just sent her home and told her not to drive for 2 days.

LorraineCNA

I would be looking more carefully at her BP and EKG! Could have been coinsidence, could have been a stressful day? Coffee? Got up to fast after the injection? Of course we can also ask...Pregnant? Any new medications? Ever fainted before? Crowded room? Too hot in that room? What was your CBG? Did you eat that day? Did they even take a BMP or Chem 7??? How are your electrolytes because out of whack can mean down on the floor!? Dehydrated? Any history of heart probelms? Migraines? HTN? Hyper or hypo thyroid in your history? Asthma or respiratory probelms?................................

I would have the ER elaborate on their ideas of "it was caused by the injection"..cause I think a bit of smoke was coming out of their butts! I don't buy it! Sounds like a very convienient way to get her out of their ED!

Seek into underlying causes...

And when you said aspirated..are you thinking that putting normal saline in a blood vessel will hurt you? Ummmmmm no! That is what we do with IV's! ;). Or do you think a bubble got in??? Again...our blood is full of this wonderul life giving substance called blood gasses, and is made up of the exact same thing as any bubble you got into the syringe...and that tiny amount would not cause any ill effects...takes quite a bit even central line to cause probelms! So it wasn't a bubble either FYI ;).

delta32

Specializes in ICU/CCU, Rehab, insurance, case manager. Has 5 years experience.

All she told me was that they "did blood work" and told her "everything came back normal"

They said her EKG was fine and her BP was about normal by the time they actually saw her (you know what some ER's are like). I was with her at lunch and she was fine, not stressed or anxious, doesn't drink coffee. She did have a bladder infection a week or so ago and was on antibiotics for that. She said the ATB course is done but she thinks she still has a bit of the bladder infection. Pregnant...I wouldn't have a clue and wouldn't ask. She was standing for the injection, it wasn't overcrowded or hot in the room. She ate lunch about an hour before all this happened. I don't know any of her history except that she had a seizure when she was 5 because of a fever. She said no prior history of fainting. She said she feels totally exhausted and like she got hit by a truck. That's very similar to how my DH says he feels after a seizure.

I'm not sure what she was thinking as far as aspirating goes. She just said that she didn't think the girl who gave her the injection remembered to aspirate and wondered if that had anything to do with it.

Thanks for the informative response. That's why you guys are nurses and we're MA's. I can't believe that the ER couldn't give her a more definitive answer. They just sent her home and told her not to drive for 2 days.

LorraineCNA

its sounds like she just vasovagaled.. it happens when people are anxious.

chip193

Specializes in ER.

Haven't been here in quite awhile except to research things. I used to come here when I was considering nursing school. I'm now in MA school (yeah, I know the common opinion here on MA's :o).

I thought I'd see if I could get some input here.

One of the girls in my class passed out today.

She had just gotten an IM injection of sterile saline water (we're

doing injections) in the deltoid. She wasn't afraid of the injection at all as

she's had numerous surgeries. She'd also already received 3 subQ's and a couple of ID's (on other days) with no adverse reaction.

She appeared to have a seizure while she was out, although I would

venture to say it was convulsive syncope and not an epileptic

seizure. My husband has epilepsy so I'm familiar with that scenario. Her BP was low after the episode. She

has a huge lump on her head above her ear as she hit a desk and the

floor.

They took her to the hospital and did x-rays, EKG, blood work and

everything came back fine. They didn't do an EEG, which I thought they would. I just got off the phone with her awhile

ago and she said she doesn't think the girl who gave her the

injection aspirated on her. Could this have caused this to happen? The Emergency room told her it was "caused by the injection" but

didn't elaborate. They just put syncope on her discharge papers.

I told her I'd neb on the internet and see if I could dig anything

up. She was perfectly fine when she received the injection...even

telling the girl who gave her the injection that she didn't even

feel it...within a minute after that, she said she felt dizzy and

needed to sit down...then she hit the floor.

I'd sure appreciate any responses.

Lorraine

It is doubtful that she had her first seizure at the same time as her 4th or 5th injection of the day. People may feel that they're ready for another injection, and they may appear to be, but then CN X kicks in and you're picking them up off the floor!

As for the EEG - don't expect them ordered in the ER. They're not an emergent test, but something that can be ordered by the PCP.

What does concern me more is how did your classmate wind up falling over? Was she not seated when she was on the receiving end? That's what you really need to look at!

chip193

Specializes in ER.

I would be looking more carefully at her BP and EKG! Could have been coinsidence, could have been a stressful day? Coffee? Got up to fast after the injection? Of course we can also ask...Pregnant? Any new medications? Ever fainted before? Crowded room? Too hot in that room? What was your CBG? Did you eat that day? Did they even take a BMP or Chem 7??? How are your electrolytes because out of whack can mean down on the floor!? Dehydrated? Any history of heart probelms? Migraines? HTN? Hyper or hypo thyroid in your history? Asthma or respiratory probelms?................................

I would have the ER elaborate on their ideas of "it was caused by the injection"..cause I think a bit of smoke was coming out of their butts! I don't buy it! Sounds like a very convienient way to get her out of their ED!

Seek into underlying causes...

And when you said aspirated..are you thinking that putting normal saline in a blood vessel will hurt you? Ummmmmm no! That is what we do with IV's! ;). Or do you think a bubble got in??? Again...our blood is full of this wonderul life giving substance called blood gasses, and is made up of the exact same thing as any bubble you got into the syringe...and that tiny amount would not cause any ill effects...takes quite a bit even central line to cause probelms! So it wasn't a bubble either FYI ;).

Umm...

Blood is not made up of blood gasses. Blood gasses are measure of the various gasses that are dissolved in the blood (or attached to the Hemeoglobin).

You are correct in your statement that a small bubble will not do any damage, but, recall, that a large amount of air will lead to an air embolism and the possibility of death. And it takes less air in a central line to cause a problem than a peripheral one.

neneRN, BSN, RN

Specializes in Emergency, Trauma. Has 8 years experience.

sounds like she vagaled down...not an uncommon response in some people, even though she may not have done it before with previous injections. And yes, like the ER doc says, most likely her body's response to the injection she had just received. This would explain the low BP, as with a vagal response, your HR and BP will drop, thus causing the syncope. If this was the cause, the tests in the ER would most likely all be fine. An EEG is not something done from the ER, it's a test that may have been performed if there were any findings indicating a need for hospital admission.

Although I'd have to go with the vagal response as my best bet, another possible cause may have been that she was a little dehydrated...you mentioned that she had a recent infection, without adequate hydration, she could have possibly been a little orthostatic (she was standing when it happened, right?)- if she went by ambulance, I would assume that EMS gave some IVF en route, which would have pumped her up to a normal BP.

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

And thats why we didnt give each other injections at my nursing school. We did it on a dummy arm or butt. With the technology out there it seems to me there should be no reason what so ever to be doing so as well. The only thing I recall doing on a classmate was the always popular bed bath-- just do a search the threads are were interesting.

RJ :)

Nurse Ratched, RN

Specializes in Geriatrics/Oncology/Psych/College Health.

its sounds like she just vasovagaled.. it happens when people are anxious.

My bet, too. Hubby just did it last week while donating blood.

And thats why we didnt give each other injections at my nursing school. We did it on a dummy arm or butt. With the technology out there it seems to me there should be no reason what so ever to be doing so as well. The only thing I recall doing on a classmate was the always popular bed bath-- just do a search the threads are were interesting.

RJ :)

But PLEASE, do not let a classmate perform a bedbath on me.

Yikes!!!!

NurseFirst

My bet is also that she vagaled down. I have had several people do that when I ahve started IVs....they get nervous, and sort of 'bear down' and stimulate their vagus nerve...poof...bradycardia...hypotension.....faint! I have noticed that it seems to happen more frequently in adolescents and middle aged men, for some reason.

This is very common...like posters have said more to MEN...especially those with lots of tattoos. :rotfl: And for the test...sounds like they did all those that are warranted. When this happens in the ED we give them a fluid bolus and give the same dx. now if your classmate happens to be older then this would warrant observation for a day.

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