4.1 Anaphylaxis / Severe Allergic Reaction

Recognition

• Difficulty breathing, wheezing, shortness of breath.
• Swelling of lips, tongue, throat, or face.
• Generalized hives, itching, flushing.
• Dizziness, faintness, weak or rapid pulse.
• Nausea, vomiting, abdominal pain.

Immediate Actions

1. Stop all procedures immediately.
2. Call 911 and state: “Suspected anaphylactic reaction at medspa.”
3. Lay patient supine with legs elevated, unless breathing is easier upright.
4. Administer epinephrine IM (per standing orders and training) into lateral thigh.
5. Consider oxygen if available and authorized.
6. Monitor airway, breathing, and circulation until EMS arrives.
7. Document symptoms, time of onset, medications given, and response.

4.2 Mild–Moderate Allergic Reaction

Recognition

• Localized itching, redness, or hives at treatment site.
• Mild swelling without breathing difficulty.
• Sneezing, runny nose, watery eyes.

Actions

1. Stop treatment and assess airway/breathing.
2. Notify on-site provider.
3. Apply cool compresses as appropriate.
4. Administer oral antihistamine as allowed by standing orders.
5. Observe patient for 30–60 minutes for any progression.
6. Provide written instructions and schedule follow-up if needed.

4.3 Vasovagal Reaction / Fainting

Recognition

• Pale, sweaty, clammy skin.
• Dizziness, nausea, visual changes, feeling of warmth.
• Slow pulse; brief loss of consciousness in some cases.

Actions

1. Stop procedure immediately.
2. Lay patient flat and elevate legs 8–12 inches.
3. Monitor airway and breathing.
4. Apply cool compress to forehead/neck.
5. Check vital signs if equipment and training are available.
6. Do not allow patient to stand for at least 15 minutes after recovery.
7. Call 911 if loss of consciousness is prolonged (> 60 seconds), seizure-like activity occurs, or recovery is not typical.

4.4 Cardiac Event / Chest Pain

Recognition

• Chest pressure, squeezing, or pain that may radiate to jaw, arm, or back.
• Shortness of breath, sweating, nausea.
• Feeling of impending doom.

Actions

1. Stop all procedures.
2. Call 911 immediately.
3. Place patient in a comfortable position (usually semi-reclined).
4. Monitor airway, breathing, and circulation.
5. If authorized by provider and standing orders, consider aspirin administration, unless contraindicated (allergy, active bleeding, etc.).
6. Do not allow patient to drive after event.

4.5 Respiratory Distress / Asthma

Recognition

• Shortness of breath, labored breathing, wheezing.
• Use of accessory muscles to breathe, difficulty speaking.

Actions

1. Stop procedure and sit patient upright.
2. Encourage slow, controlled breathing.
3. Assist patient with their own prescribed inhaler if available.
4. Use clinic albuterol inhaler if authorized by standing orders.
5. Call 911 if breathing does not quickly improve or if severe.

4.6 Seizure

Recognition

• Loss of consciousness with jerking movements, or staring spells.
• Possible incontinence.

Actions

1. Call 911.
2. Ease patient to the floor if possible and protect head with a folded towel.
3. Do not restrain movements and do not place anything in mouth.
4. Roll patient onto side after convulsions to protect airway.
5. Time the seizure and report duration to EMS.

4.7 Hypertensive or Hypotensive Episode

Hypertensive (Very High BP)

• Severely elevated BP reading (per provider-defined threshold, e.g., >180/110).
• Headache, vision changes, chest pain, shortness of breath, confusion.

1. Stop treatment and recheck BP after a brief rest.
2. Call provider for guidance.
3. Call 911 if symptoms suggest emergency (chest pain, neurologic changes, severe headache).

Hypotensive (Very Low BP)

• Dizziness, weakness, pale/clammy skin, low readings vs. baseline.

1. Lay patient supine and elevate legs.
2. Monitor symptoms and vitals if available.
3. Call 911 if not improving or if associated with chest pain, altered mental status, or severe symptoms.

4.8 Hypoglycemia (Low Blood Sugar)

Relevant for weight-loss patients, diabetics, and fasting clients.

Recognition

• Shakiness, sweating, hunger, confusion, irritability.
• In severe cases: confusion, seizure, loss of consciousness.

Actions (Conscious Patient)

1. Provide fast-acting carbohydrates (e.g., juice or glucose gel) per standing orders.
2. Reassess symptoms after 10–15 minutes.
3. Give a small snack containing protein/carbs once improved.
4. Advise patient to follow up with their primary provider.

Unconscious or Unable to Swallow

1. Call 911 immediately.
2. Do not give food or drink by mouth.
3. Place patient in recovery position (on side) and monitor airway.

4.9 Nausea, Vomiting & Aspiration Risk

Actions

1. Stop treatment.
2. Sit patient upright or slightly forward.
3. Provide emesis bag and cool compress.
4. If vomiting while lying down, immediately turn patient onto side to protect airway.
5. Call 911 if breathing difficulties or altered mental status occur.

4.10 Burns (Thermal, Chemical, Laser)

Mild Burn (Redness, No Blistering)

1. Stop treatment and remove heat source.
2. Cool area with cool (not ice-cold) compresses.
3. Apply soothing topical product per provider-approved list.
4. Provide aftercare instructions and schedule follow-up if needed.

Moderate to Severe Burn (Blistering, Deep or Large)

1. Stop treatment and cool area with room temperature saline or water (for limited time).
2. Do not pop blisters.
3. Cover with non-adherent sterile dressing.
4. Call provider; consider same-day urgent care or ER referral.
5. Call 911 for extensive, facial, airway, or serious burns.

4.11 Local Anesthetic / Lidocaine Toxicity

Recognition

• Early: metallic taste, tinnitus, circumoral numbness, dizziness.
• Later: agitation, seizures, arrhythmias, decreased consciousness.

Actions

1. Stop all lidocaine administration immediately.
2. Call provider urgently.
3. Call 911 if moderate or severe symptoms present.
4. Position patient safely and monitor airway and breathing.

4.12 Laser Eye Injury

Recognition

• Eye pain, vision changes, flashes, floaters after accidental exposure.

Actions

1. Stop laser immediately and secure device.
2. Do not rub eyes.
3. Call provider and arrange urgent ophthalmology evaluation.
4. Document laser settings and circumstances.

4.13 Needle Stick Injury & Blood Exposure

Immediate Actions

1. Wash area immediately with soap and water.
2. Do not squeeze or “milk” the wound aggressively.
3. Notify supervisor and provider.
4. Follow clinic’s bloodborne pathogen exposure control plan.
5. Arrange prompt medical evaluation for source and exposed staff, if indicated.
6. Complete incident report the same day.

4.14 Injectable Filler Emergencies

This section applies to clinics performing hyaluronic acid filler injections. All details (doses, products) must be defined by the supervising provider and reflected in standing orders.

4.14.1 Vascular Occlusion (Suspected)

Recognition

• Immediate severe pain at or near injection site (beyond expected discomfort).
• Skin changes: blanching, mottling, livedo reticularis, dusky discoloration.
• Delayed capillary refill compared to surrounding skin.

Immediate Actions

1. Stop injections immediately.
2. Keep patient in clinic; inform supervising provider at once.
3. Massage affected area firmly if advised by provider and manufacturer guidance.
4. Apply warm compresses if directed by provider (to encourage vasodilation).
5. Administer hyaluronidase according to clinic-specific vascular occlusion protocol and standing orders (dose, dilution, and pattern defined by provider).
6. Reassess capillary refill and skin color frequently.
7. Consider ophthalmology emergency referral if any vision changes, eye pain, or neurologic symptoms occur; call 911.
8. Provide clear documentation and arrange close follow-up (often within 24 hours or sooner).

4.14.2 Tyndall Effect / Superficial Placement

Recognition

• Bluish hue under skin where filler is too superficial.

Actions

1. Do not attempt additional filler in the area.
2. Provider may choose conservative hyaluronidase administration as per protocol or schedule for later correction.
3. Provide patient education and follow-up.

4.14.3 Nodules, Delayed Inflammatory Reactions

Recognition

• Firm lumps, nodules, or redness days to weeks after injection.
• Possible tenderness or swelling.

Actions

1. Schedule in-person evaluation with injector or provider.
2. Document timing, product, and lot number.
3. Provider may choose massage, hyaluronidase, and/or medication as clinically indicated.