Policies And Guidelines

Question 1

Conditions that can potentially increase medical problems, and are asked

Answer 1

DART, P, MM, HD H CHF(heart), SH, Pul, Sz, Sc

Dehydration, advance age, renal dse, thyroid dse, pheochromocytoma, multiple myeloma, heart dse, hpn, chf, severe hyperurecemia, pulmonary dse, seizure, sickle cell

Question 2

Patients with rxn to iodinated contrast media have high risk for another rxn, instead advise a?

Answer 2

Non-contrast study, or another imaging modality

Question 3

Clinica history shall be elicited by radio clerk/intern/nurse with emphasis on indication of procedure, and then..

Answer 3

Radio resident/fellow/ radiologist, will give clearance and take informed consent

Question 4

patients who are known ____ and those with history of ____ to food and other medications have increased incidence of contrast related adverse events.

Answer 4

asthmatics and food allergies

Question 5

Current intake of medications like ___ increases risk of contrast reactions.

Answer 5

metformin,
metformin containing substance,
beta-adrenergic agents, 
inhibitors
NSAIDS
papaverine

Question 6

If with contraindicated drugs that inc risk of contrast reactions what to do?

Answer 6

patient shall stop taking the medications on the day of the procedure and 48 hours therafter upon the discretion of the AP.

Question 7

creatinine level is valid for?

Answer 7

1 month

Question 8

threshold values of creatinine for men and women?

Answer 8

men= 0.8 to 1.5
women= 0.6 ot 1.2

Question 9

patients with renal problems, paraproteinemias, elderly, neonates, and debilitated patients shall be given special attention with what?

Answer 9

1. HYDRATION= 1 ml of normal saline per Kg body weight 12 hours before and 12 hours after procedure is recommended
2. DIALYSIS. suggested since contrast agents are not protein bound.

Question 10

threshold values may defer the contrast enhanced procedure ? BP? HR? o2sat?

Answer 10

bp of less than 90/60
diastolic pressure of more than 100mmHg
pulse rate of less than 40 bpm
pulse oximetry reading of less that 95%

Question 11

if vital signs is outside of recommended range, what to do? (emergency case)

Answer 11

observe for 15 min unless emergency procedure is prioritized

Question 12

if vital signs is outside of recommended range, what to do? (non-emergency case)

Answer 12

wait for the AP’s decision. exam is deffered

Question 13

Immediately before the adminstration of iodinated IV contrast media, what is observed?

Answer 13

“time out”

1. reassess procedure indication, and contraindacatoin
2. check contrast regimen to be used
3. personnel are ready for adverse event
4. ask pt if with any questions

Question 14

what is a “test dose”?

Answer 14

1cc of non-ionic contrast medium diluted in 9cc of normal saline injected IV.
assessed for development of AE for 10-15 minutes

Question 15

what is a “test injection”

Answer 15

an injection of 10-20 cc of normal saline to confirm patency of the IV line.

Question 16

How much is a ‘full dose of contrast material?

Answer 16

2 cc/kg ( not more than 100cc in pedia, and 200cc in adults)

Question 17

The overall incidence of AE with universal non-ionic contrast agents ranges from?

Answer 17

0.2% to 3.1% most of which (>90%) are mild reactions.

Question 18

Serious reactions are rare and occur in?

Answer 18

1-2 per 10,000 exams using LOCM

Question 19

Delayed reactions are AE that occur within?

Answer 19

1 hour to 1 week after contrast media adminstration.

Question 20

Incidence of delayed reactions?

Answer 20

2% all are mild reactions.

Question 21

Two delayed reactions that can occur and may be more frequent in patients with renal dysfunction?

Answer 21

1. Iodide “mumps” (salivary gland swelling)

2. syndrome of acute polyarthropathy

Question 22

patients treated with this can develop delayed reactions after the administration of contrast media that mimic the side effects associated with the therapy?

Answer 22

interleukin 2 immunotheraphy

Question 23

Very late AE occur within?

Answer 23

more than 1 week after contrast medium injection.

Question 24

Severity of reactions: MILD?

Answer 24

sneezing
NAV
limited urticaria
cough
warmth
pallor
nasal stuffiness
headache
flushing
dizziness
altered taste
sweats

Question 25

Severity of reactions: MODERATE?

Answer 25

generalized urticaria,
wheezing, mild bronchospasm, laryngospasm, dyspnea
facial edema
vasovagal reaction
hypertension
hypotension
tachycardia
bradycardia

Question 26

Severity of reactions: SEVERE?

Answer 26

severe hypotension (bp