TWENTY

Twenty twenty,

Trouble aplenty.

Twenty twenty-one, 

Battle yet to be won. 

Twenty twenty-two, 

You’ll be vaccinated too. 

Slowly, slowly, we’ll see.

We’ll get there, maybe.

Protocol for Emergency Treatment of Anaphylaxis (after Covid-19 vaccination)

1. Patient to be observed for 30 mins in the clinic after Covid-19 vaccine (and patient to observe himself for 24 hrs at home).

2. Diagnose anaphylaxis.

-Urticaria, angioedema

-Dyspnea, wheeze

-Dizziness, syncope, hypotension

-Nausea, vomiting, diarrhea, cramping abdominal pain

-Flush

-Upper airway edema

-Headache

-Rhinitis

-Substernal pain

-Pruritus without rash

-Seizure

3. Call 995 immediately.

4. Place patient in recumbent position and elevate lower extremities, but treat patient sitting up if he is breathless.

5. Monitor vital signs frequently (every two to five minutes) and stay with the patient.

6. Administer adrenaline 1:1,000 (weight-based) adults: 0.01 mL per kg, up to a maximum of 0.2 to 0.5 mL every 10 to 15 minutes as needed; children: 0.01 mL per kg, up to a maximum dose of 0.2 to 0.5 mL by SC or IM route and, if necessary, repeat every 15 minutes, up to two doses.

7. Maintain airway with an oropharyngeal airway device. Administer oxygen (if you have), usually 8 to 10 L per minute; lower concentrations may be appropriate for patients with chronic obstructive pulmonary disease.

8. IM Piriton 1 ml stat.

9. IM Adrenaline 0.15 to 0.3 mL, into injection site (left deltoid) to inhibit further absorption of the injected substance (vaccine).

10. Set up IV line to treat hypotension with IV fluids.

11. Treat bronchospasm with Ventolin nebuliser 2 mls:1 ml saline stat.

12. Give IM hydrocortisone 100 mg stat or tab prednisone 20 mg stat orally in mild cases. This does not work immediately but reduces the risk of recurring or protracted anaphylaxis. These doses can be repeated every six hours, as required.

13. All fatal and life-threatening events are to be reported to HSA within 24 hrs and all other Severe Adverse Events and Adverse Events of Special Interest within 48 hrs online at https://www.hsa.gov.sg/adverse-events. Fatal events also are to be reported to the Coroner.