Management of Acute Contrast Reactions in Adults

Question 1

Transient NAV?

Answer 1

obtain V/s
monitor and observe pt until symptoms improve/disappear
supportive treatment
give d/c instructions

Question 2

severe, protracted NAV?

Answer 2

obtain v/s

if stable, take pt to ED fro appropriate anti-emetic and hydration theraphy

Question 3

urticaria

Answer 3

1. d/c injection of contrast if not completed
2. if transient and symptom disappear= no tx necessary but monitored for 1 hour until no progression. instruct before d/c
3. if increasing in number, persistent, not tolerated by pt. give: a) diphenhydramine 25 - 50mg po/im/iv. b) advise that drowsiness and hypotension may occur. c) continue to observe and monitor for another 1 hour after diphenhydramine adminstration d) before d/c explain situation and provide proper instructions e) someone should be with the patient upon d/c
4. sever or widely disseminated a) epiniphrine (1:1000) 0.1-0.3 ml SC (0.1-0.3mg) if no cardiac contraindication b) monitor obtain v/s c) if stable accompany to ED after providing initial therapy

Question 4

facial edema/laryngeal edema

Answer 4

1. epiniphrine (1:1000) 0.1 - 0.3 ml (0.1- 0.3mg) SC or IM if no cardiac contraindication. if hypotensive give epinephrine (1:10000) 1 ml slow IV =(0.1mg) maximum of 1mg
2. give O2 6-10 liters/min
3. monitor v/s
4. symptoms may progress to severe respiratory distress

Question 5

bronchospasm

Answer 5

1. give 02 at 6-10 liter/min
2. monitor v/s ecg, o2sat, bp
3. give beta agonist inhalers: metaproterenol, terbutaline, albuterol 2-3 puffs repeat as neede.
4. if unresponsive to inhalers give epiniphrine (1:1000) 0.1 to 0.3 ml IM or SC. if hypotensive give epiniphrine (1:10,000) 1 ml slow IV (=0.1mg) maximum of 1mg.
   “alternatively” give aminophylline: 6mg/kg IV in D5W over 10-20 minutes (as LD) then 0.4 to 1 mg/kg/hr as needed
5. call a code could easily progress may need intubation when o2 at

Question 6

Pulmonary edema

Answer 6

1. elevate torso; rotating tourniquets
   2.give o2 at 6-10 liter/min via face mask
2. monitory v/s: ecg, o2 sat, bp
3. Give diuretics: furosemide 20 to 40mg slow IV
4. consider morphine 1-3 mg IV
5. corticosteroids are optional
6. transfer to ED or ICU
   8 anticipated progression into severe resp distress

Question 7

Hypotension with tachycardia

Answer 7

1. trendelenburg position: legs at 60 deg or more
2. monitor: ecg, o2sat, bp
3. give o2 at 6 -10 liter/min via face mask.
4. rapid IV administration of large volumes of LR or PNSS
5. if poorly responsive give: epiniphrine (1:10,000) 1ml slow IV (=0.1mg) maximum of 1mg if no cardiac contraindication.
6. seek assistance and call code

Question 8

Hypotension with bradycardia

Answer 8

1. monitor v/s
2. trendelenburg position 60 degrees
3. give o2 at 6 -10 liter/min
4. give rapid fluid replacement with ringer’s lactated or NSS
5. give atropine 0.6-1.0 mg slow IV if not responsive to steps 2 and 4
6. seek assistance and call code

Question 9

hypertension, severe

Answer 9

1. give 02 at 6-10 liters/ min
2. monitor v/s ecg, bp, o2sat
3. give nitroglycerine 0.4mg tablet SL (may repeat x3)
4. transfer to ICU or ED
5. For PHEOCHROMOCYTOMA: phentolamine 5mg IV
6. anticipate progression and call a code when necessary

Question 10

Seizure or convulsions

Answer 10

1. give o2 at 6-10 liters/min
2. careful monitoring of respirations v/s ecg, bp, o2sat
3. consider diazepam: 5mg IV or Midazolam 0.5- 1.0 mg IV
4. call neuro service
5. if longer effect needed: phenytoin infusion 15-18 mg/kg at 50 mg/min
6. call a code.

Question 11

unconsciousness, unresponsive, pulseless, collapsed patient

Answer 11

1. call a code.
2. institute BLS a) establish airway head tilt chin lift b) initiate ventilation and CPR c) continue until help arrives.
3. give epinephrine 1m IV/IO repeat every 3 to 5 minutes
4. IV fluids rapid replacement with Ringer’s lactate or normal saline