Professional Documents
Culture Documents
A. GENERAL POLICY
Local factors such as anticipated EMS response time, the availability of a physician and the
ability of trained personnel to initiate an emergency procedure in the event of vasovagal
syncope, and/or an acute anaphylaxis/allergic reaction will determine the need for supplies
beyond the minimum and expanded protocol/procedure for some clinics. Emergency plans
and procedures should be coordinated with the local Emergency Medical System (EMS).
All emergency drugs and supplies should be kept together in a secured kit or cart that is
easily moveable and readily accessible/visible during clinic service hours. Inventory should
be checked monthly with careful attention to medication expiration dates and the working
condition of equipment.
Emergency kits/carts are those drugs and supplies which may be required to meet the
immediate therapeutic needs of clients and which are not available from other authorized
sources in sufficient time to prevent risk or harm to clients. Medications may be provided for
use by authorized health care personnel in emergency kits/carts, provided such kits/carts
meet the following requirements:
1. Storage
2. Labeling - Exterior
3. Labeling Interior
4. Removal of Medications
5. Inspections
Each emergency kit/cart shall be opened and its contents inspected by the
authorized personnel monthly with the exception of oxygen (every 6 months).
The monthly inspection shall be documented on an Emergency Check-Off Log
sheet which includes:
a. the listing of all emergency supplies and equipment,
b. the name of the medication(s), its strength, quantity, lot # and expiration
date,
c. the staff members name who performed the inspection and
d. the inspection date.
Upon completion of the inspection, the emergency kit/cart shall be resealed with
the appropriate disposable plastic key.
6. Minimum Medication(s)
7. Minimum Supplies
GUIDELINES FOR
VASOVAGAL SYNCOPE (FAINTING)
Vasovagal syncope is usually due to emotional stress related to fear or pain (e.g., having
blood drawn or an injection).
OBJECTIVE
The following may be observed:
1. Fall in blood pressure.
2. Slow pulse.
3. Pallor, perspiration.
4. May progress to loss of consciousness.
PROCEDURE
1. Place client in recumbent position; lower head to the extent possible and turn head
to side (prevents aspiration and tongue blocking airway). If sitting, do not lower
head by bending at waist (may further compromise venous return to heart).
3. Monitor blood pressure and pulse; observe the client until completely recovered.
4. Do not give anything by mouth or allow the client to resume an upright position until
feeling of weakness has passed.
6. If client does not stabilize, call EMS or refer to closest medical facility.
REFERENCES
3. Local anesthetics.
OBJECTIVE a. Apprehension.
b. Flushing and/or skin edema.
c. Palpitations.
d. Numbness and tingling.
e. Itching.
f. Localized or generalized urticaria (rash, welts).
g. Choking sensation. (Indicates laryngeal edema which may
precipitate closure of the airway.)
h. Coughing and wheezing.
i. Difficulty breathing.
j. Nausea and vomiting.
k. Dizziness and fainting.
PLAN THERAPEUTIC
Child older than 2 years of age: 1.25 mg/kg/dose (max 50mg) PO STAT
Adult: 50 mg to 100 mg PO STAT
Diphenhydramine IM Dosing
1 mg/kg body weight, up to 100 mg
OR
Diphenhydramine IM Dosing
(Dosing by body weight is preferred.)
(The standard dose is 1 mg/kg body weight,
up to 100 mg)
Weight* Diphenhydramine Dose
lbs (kg) (Injection: 50 mg/mL)
24-37 (11-17) 15 mg / 0.3 mL
37-51 (17-23) 20 mg / 0.4 mL
51-77 (23-35) 30 mg / 0.6 mL
77-99 (35-45) 40 mg / 0.8 mL
>99 (>45) 50 to 100 mg / 1 2 mL
future.
c. If the causative agent was a medication
being dispensed for additional use at
home, then this plan should be
reconsidered and an alternative
medication should be used that is in a
different chemical family which is not
regarded as having cross-reactivity with
the causative agent.
NOTE: Skin reactions that are extensive, but absolutely
confined to the skin, do not qualify as severe allergic
reactions; however, if tongue swelling is involved, this does
represent an anaphylactic reaction if present, proceed to 2.
below. Severe lip swelling (huge, bordering on grotesque)
may indicate additional swelling in the oropharynx if
present, proceed to 2. below.
Step 3 Procedures
a. Place patient in supine POSITION, legs
elevated.
b. Assure OPEN AIRWAY and begin CPR if
indicated.
c. Begin monitoring VITAL SIGNS with BP every
5 minutes.
d. Help to maintain position of comfort (sitting if
wheezing; supine with legs elevated if light-
headed or in shock).
e. Oxygen at 4-6L/minute by nasal cannula, face
mask
OR
blow-by, if indicated and available.
f. Monitor with pulse-oximeter, if available.
CLIENT EDUCATION/COUNSELING
When a client is given an agent (e.g., antibiotic or vaccine) capable of
inducing anaphylaxis, he/she should be advised or encouraged to remain
in the clinic for at least 30 minutes.
REFERRAL
FOLLOW-UP
Name: ______________________________________
_______________________________________________________________________________
_______________________________________________________________________________
SIGNATURE OF RN/APRN:
__________________________________________________________
DISPOSITION: __________________________________________________________________
REVIEWER: ____________________________________________________________________
DOB:_________________
2. Assure AIRWAY.
Check VITAL SIGNS q 5 minutes.
CPR if necessary. VITAL SIGNS
Time B/P Pulse Resp
_____ _ __/_ __ ____ __
3. FOR ITCHING, REDNESS, WELTS/HIVES OR GI SYMPTOMS: _____ _ __/_ __ ____ __
Diphenhydramine 12. 5 mg/5 mL Elixir OR _____ _ __/_ __ ____ __
Diphenhydramine 25 mg or 50 mg Capsules _____ _ __/_ __ ____ __
_____ __ _/_ __ ____ __
CHILD at least 2 years of age _____ __ _/_ __ ____ __
1.25 mg/kg/dose (up to 50 mg) PO, once _____ __ _/_ __ ____ __
ADULT 50-100 mg PO, STAT
OR
Diphenhydramine 50 mg/mL (vial) IM CPR Indicated: ________YES ______NO
TIME CPR started:__________AM / PM
WEIGHT IM DOSE
TIME CPR ended: __________AM / PM
24-37 lbs (11-17 kg) 15 mg / 0.3 mL
37-51 lbs (17-23 kg) 20 mg / 0.4 mL
51-77 lbs (23-35 kg) 30 mg / 0.6 mL
Diphenhydramine
77-99 lbs (35-45 kg) 40 mg / 0.8 mL
12.5 mg/5 mL (Elixir/Solution)
>99 lbs (>45 kg) 50 mg to 100 mg/1 -2 mL
OR 25 mg, 50 mg (Capsules)
TIME ORAL DOSE
4. FOR RESPIRATORY/CIRCULATORY SIGNS/SYMPTOMS
_______ ________
_______ ________
Epinephrine 1 mg/mL = 1:1,000 wt/volume (w/v)
WEIGHT IM DOSE
< 9 lbs (< 4 kg) Weigh/calculate dose
Diphenhydramine 50 mg/mL vial
9-15 lbs (4-7 kg) 0.05 mg / 0.05 mL TIME IM DOSE
15-24 lbs (7-11 kg) 0.10 mg / 0.10 mL
24-31 lbs (11-14 kg) 0.13 mg / 0.13 mL _______ ________
31-37 lbs (14-17 kg) 0.16 mg / 0.16 mL
37-42 lbs (17-19 kg) 0.18 mg / 0.18 mL
42-51 lbs (19-23 kg) 0.20 mg / 0.20 mL Epinephrine 1:1000 w/v ampule
51-77 lbs (23-35 kg) 0.30 mg / 0.30 mL
TIME DOSE ROUTE
77-99 lbs (35-45 kg) 0.40 mg / 0.40 mL
>99 lbs (>45 kg) 0.50 mg / 0.50 mL _______ ________ IM
_______ ________ IM
May repeat every 15-20 minutes as needed, for a total of 3 doses (no _______ ________ IM
more than 1.5 mL [1.5 mg] total).
Methylprednisolone Sodium Succinate IM
TIME DOSE ROUTE
AND, to decrease intensity/severity of delayed reactions
_______ IM
Methylprednisolone Sodium Succinate 2 mg/kg IM
(according to dosing table on p. 13.10).
TIME EMS ARRIVED:___________AM/PM
REFERENCES
Staff member(s) listed below participated in training updates for all age ranges and
performed in a mock emergency drill on .
(Date)
Printed Name______________________________
Signature__________________________________ Date
Printed Name_______________________________
Signature__________________________________ Date
EMERGENCY CHECKLIST
FOR PUBLIC HEALTH CLINIC SITES
PURPOSE
To assure that each site is equipped and prepared to handle emergencies that may occur.
The Nursing Supervisor and District Public Health Nursing & Clinical Director will assure that
this checklist is completed annually for each site and that follow-up occurs for any
inadequacies/incomplete areas.
County______________________
Signature _____________________________________
Signature _____________________________________
B. Client Outcome
C. Recommendations/Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Site__________________________________ Date___________________
Signature _______________________________________