Emergency Medical Protocol For Management Of Anaphylactic ...
Medical Management of Vaccine Reactions in Adult Patients
All vaccines have the potential to cause an adverse reaction. In order to minimize adverse reactions, patients should be
carefully screened for precautions and contraindications before vaccine is administered. Even with careful screening,
reactions may occur. These reactions can vary from trivial and inconvenient (e.g., soreness, itching) to severe and life
threatening (e.g., anaphylaxis). If reactions occur, staff should be prepared with procedures for their management. The
table below describes procedures to follow if various reactions occur.
Reaction
Symptoms
Management
Localized
Soreness, redness, itching, or swelling at
Apply a cold compress to the injection site.
the injection site
Consider giving an analgesic (pain reliever) or
antipruritic (anti-itch) medication.
Slight bleeding
Apply an adhesive compress over the injection site.
Continuous bleeding
Place thick layer of gauze pads over site and
maintain direct and firm pressure; raise the
bleeding injection site (e.g., arm) above the level
of the patient’s heart.
Psychological
Fright before injection is given
Have patient sit or lie down for the vaccination.
fright and
syncope
Extreme paleness, sweating, coldness of the
Have patient lie flat or sit with head between
(fainting)
hands and feet, nausea, light-headedness,
knees for several minutes. Loosen any tight
dizziness, weakness, or visual disturbances
clothing and maintain an open airway. Apply
cool, damp cloths to patient’s face and neck.
Fall, without loss of consciousness
Examine the patient to determine if injury is
present before attempting to move the patient.
Place patient flat on back with feet elevated.
Loss of consciousness
Check the patient to determine if injury is
present before attempting to move the patient.
Place patient flat on back with feet elevated.
Call 911 if patient does not recover immediately.
Anaphylaxis
Sudden or gradual onset of generalized itching,
See “Emergency Medical Protocol for
erythema (redness), or urticaria (hives);
Management of Anaphylactic Reactions in
angioedema (swelling of the lips, face, or
Adults” on the next page for detailed steps to
throat); severe bronchospasm (wheezing);
follow in treating anaphylaxis.
shortness of breath; shock; abdominal
cramping; or cardiovascular collapse.
(continued on page 2)
Technical content reviewed by the Centers for Disease Control and Prevention, Nov. 2006.
www.immunize.org/catg.d/p3082.pdf • Item #P3082 (11/06)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
(continued from page 1)
Emergency Medical Protocol for Management of Anaphylactic Reactions in Adults
Supplies Needed
Aqueous epinephrine 1:1000 (i.e., 1 mg/mL) dilution, in
Adult airways (small, medium, and large)
ampules, vials of solution, or prefilled syringes, including
Sphygmomanometer (adult and extra-large cuffs) and
epinephrine autoinjectors (e.g., EpiPen). If EpiPens are
stethoscope
stocked, at least three adult EpiPens (0.30 mg) should be
Adult size pocket mask with one-way valve
available.
Alcohol swabs
Diphenhydramine (Benadryl) injectable (50 mg/mL solu-
tion) and 25 mg or 50 mg capsules or tablets and syrup
Tourniquet
(12.5 mg/5 mL suspension)
Tongue depressors
Syringes: 1–3 cc, 22–25g, 1", 1½", and 2" needles for
Flashlight with extra batteries (for examination of the
epinephrine and diphenhydramine (Benadryl)
mouth and throat)
Wristwatch with second hand
Cell phone or access to an on-site phone
Signs and Symptoms of Anaphylactic Reaction
Sudden or gradual onset of generalized itching, erythema (redness), or urticaria (hives); angioedema (swelling of
the lips,face, or throat); bronchospasm (wheezing); shortness of breath; shock; abdominal cramping; or cardio-
vascular collapse.
Treatment in Adults
a. If itching and swelling are confined to the injection site where the vaccination was given, observe patient
closely for the development of generalized symptoms.
b. If symptoms are generalized, activate the emergency medical system (EMS; e.g., call 911) and notify the on-call
physician. This should be done by a second person, while the primary nurse assesses the airway, breathing, circulation,
and level of consciousness of the patient.
c. Administer aqueous epinephrine 1:1000 dilution intramuscularly, 0.01 mL/kg/dose (adult dose ranges from 0.3 mL
to 0.5 mL, with maximum single dose of 0.5 mL).
d. In addition, for systemic anaphylaxis, administer diphenhydramine either orally or by intramuscular injection; the
standard dose is 1–2 mg/kg, up to 100 mg maximum single dose.
e. Monitor the patient closely until EMS arrives. Perform cardiopulmonary resuscitation (CPR), if necessary, and maintain
airway. Keep patient in supine position (flat on back) unless he or she is having breathing difficulty. If breathing is
difficult, patient’s head may be elevated, provided blood pressure is adequate to prevent loss of consciousness. If blood
pressure is low, elevate legs. Monitor blood pressure and pulse every 5 minutes.
f. If EMS has not arrived and symptoms are still present, repeat dose of epinephrine every 10–20 minutes for up to 3 doses,
depending on patient’s response.
g. Record all vital signs, medications administered to the patient, including the time, dosage, response, and the name of
the medical personnel who administered the medication, and other relevant clinical information.
h. Notify the patient’s primary care physician.
Sources:
1. American Academy of Pediatrics. Passive Immunization. In: Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases.
27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:64–66.
2. American Pharmacists Association, Grabenstein, JD, Pharmacy-Based Immunization Delivery, 2002.
3. Got Your Shots? A Providers Guide to Immunizations in Minnesota, Second Edition, Minnesota Department of Health, 2001:80-82.
These standing orders for the medical management of vaccine reactions in adult patients shall remain in effect for
patients of the _____________________________________ until rescinded or until _________________.
name of clinic
date
Medical Director’s signature
Effective date
Immunization Action Coalition • www.immunize.org • www.vaccineinformation.org • www.immunize.org/catg.d/p3082.pdf
