Vasovagal hypotension

[CommunityRNBSN, BSN, RN]

I work in a Community Health Clinic, so we don’t see a lot of emergencies. A rapid response usually means somebody slipped on the stairs. Anyway, yesterday I gave a girl (27 years old) a Covid vaccine and when she stood up to leave, she immediately got dizzy. I had her sit back down and I got her some water and got my BP cuff. Her speech became slow, she was pale, and starting to “slump over” to one side while sitting. She was so diaphoretic she was dripping and her BP was... 66 over 22!  Y’all. I was not prepared for that. I had her lie down on the exam table and within a few moments she was feeling better. 
I handled it fine in the moment but once she was recovered I felt like an ambulance needed to come get me. 

[MunoRN, RN]

Needle phobia that results in vasovagal syncope or near-syncope is not all that rare, it's estimated to occur in about 3% of the population.  So for every 33 people you administer a vaccine to, 1 will have some degree of a vasovagal response, ranging from feeling a bit flushed and lightheaded to loss of consciousness.

The reassuring thing is that it's self-limiting since it's caused by conscious thought, once the patient loses the ability for conscious thought the mechanism goes away, in other words you can't really die from it or have permanent injury as a result of it.  

[JKL33]

It's really unfortunate that any vaccine site decided to shut down due to a small amount of people with similar issues (referring to recent news items).

I wonder if the over-concerned know that sometimes people pass out when watching someone else undergo something needle-related, too.

Anyway, OP, you did good. Yes it is scary if you haven't seen it much before but it is just as Muno described.

[CommunityRNBSN, BSN, RN]

10 hours ago, MunoRN said:

Needle phobia that results in vasovagal syncope or near-syncope is not all that rare, it's estimated to occur in about 3% of the population.  So for every 33 people you administer a vaccine to, 1 will have some degree of a vasovagal response, ranging from feeling a bit flushed and lightheaded to loss of consciousness.

The reassuring thing is that it's self-limiting since it's caused by conscious thought, once the patient loses the ability for conscious thought the mechanism goes away, in other words you can't really die from it or have permanent injury as a result of it.  

Yes— the primary thing I was concerned about was her hitting her head on our hard tile floor if she lost consciousness. She was sitting in a chair at the time and I started moving stuff in case we needed to lower her onto the floor! But she was able to move to the exam table. 
 

It was also odd that she said “I get shots all the time, I always get a flu shot and this has never happened before.”  I bet she’ll have a needle phobia NOW even though she didn’t arrive with one haha. 

[JKL33]

1 hour ago, CommunityRNBSN said:

“I get shots all the time, I always get a flu shot and this has never happened before.”

It isn't really odd given some of the commentary to which people have been exposed. That's just a flu shot and this is a big scary gene therapy shot that might alter your DNA, make you sterile or maybe even grow extra appendages because no one knows the "long-term effects."

I am not disparaging her or her unfortunate experience, but the mind is a powerful thing and some who receive the immunization, whether they have previously had actual needle phobia or not, have a lot of thoughts swirling around in their head, even subconsciously, related to the ways this has been talked about. A baseline of general apprehension.

 

[Hannahbanana, BSN, MSN]

I had a similar completely unexpected physiological response when a new piece of equipment in a gym unexpectedly tipped and dumped me on the floor. As I had recently had ortho surgery and I fell on that side, it was quite painful (though nothing broke). I said a bad word or two, and sat gathering myself for a minute, doing a quick inventory to see if I was injured - not, other than my pride. Staff arrived and help me get up, and after that I became woozy. They thought their BP auto cuff wasn’t working bec they got a BP <80 systolic and couldn’t palpate my pulse— vasovagal all the way! and they implied I fell because I passed out. No, I fell because the equipment wasn’t secured and tipped over. I got woozy several minutes afterwards. Nice try, though. It passed quickly. No harm done. 
Got my vaccines and had no such reaction ? 

[CommunityRNBSN, BSN, RN]

54 minutes ago, Hannahbanana said:

I had a similar completely unexpected physiological response when a new piece of equipment in a gym unexpectedly tipped and dumped me on the floor. As I had recently had ortho surgery and I fell on that side, it was quite painful (though nothing broke). I said a bad word or two, and sat gathering myself for a minute, doing a quick inventory to see if I was injured - not, other than my pride. Staff arrived and help me get up, and after that I became woozy. They thought their BP auto cuff wasn’t working bec they got a BP <80 systolic and couldn’t palpate my pulse— vasovagal all the way! and they implied I fell because I passed out. No, I fell because the equipment wasn’t secured and tipped over. I got woozy several minutes afterwards. Nice try, though. It passed quickly. No harm done. 
Got my vaccines and had no such reaction ? 

How dramatic! And also embarrassing of course. 

I’ve never fainted but I remember having near-syncope once. I was around 11 and my best friend and I decided to dress up as a two-headed ghost for Halloween. So we were attached together and covered in a sheet and also had our faces caked in makeup, and undoubtedly also dehydrated. We were at one of those huge, crowded, overheated “fall festival” things in the gym of our elementary school. We were standing in line for some sort of game and everything started to go black. I disconnected from my friend, sat on the floor, and got fussed over quite a bit. 

[Hannahbanana, BSN, MSN]

Yeah, we had a little talk about how you should be sure a new patient has been properly oriented to the equipment and to be within touching range until everything is fine. We did a little role play about how their deposition was going to go ...  I told them I wasn't going to sue them but they really need to be more careful about old broads on their second visit, because the next old broad might break a hip or hit her head or something...

[amoLucia]

Needle phobia = anxiety = vasovagal response. Happens all the time.

Even occurs after other procedures. How well I've experienced that occurring.

[2BS Nurse, BSN]

Extremely common. I ask every patient if they are feeling dizzy before and after after giving any vaccine. I've heard of this happening when patients get botox and dermal fillers!