Contrast Reactions Guide

For all cases

  1. Always follow BLS and ACLS Guidelines as indicated and most importantly, your clinical judgement

  2. Remember your ABCs (Airway, Breathing, Circulation)

  3. Call for help (EMT/code team) immediately if necessary

  4. Whenever epinephrine is administered, consider cardiac contraindications

  5. For pediatric patients, remember appropriate medication dosing (typically weight based)

Urticaria

  1. Discontinue contrast administration

  2. Usually, no treatment needed

  3. Mild to Moderate Reaction: Benadryl 25-50 mg PO/IM/IV (adult dosing); advise patient not to drive home alone after treatment; Pediatric Dose is 1 mg/kg up to 50 mg

  4. Severe Reaction: Epinephrine SC (1:1000) 0.1-0.3 mL (equivalent to a dose of 0.1-0.3 mg)

Facial or Laryngeal Edema

  1. Oxygen (6-10L/min)

  2. Epinephrine SC (1:1000) 0.1-0.3mL (equivalent to 0.1-0.3mg)

  3. If hypotension, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed

Bronchospasm

  1. Oxygen (6-10L/min)

  2. Give beta agonist inhalers (Albuterol, bronchodilators)

  3. Epinephrine SC (1:1000) 0.1-0.3mL (equivalent to 0.1-0.3mg)

  4. If hypotension, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed

  5. Alternatively: Aminophylline 6 mg/kg IV in D5W over 10-20 minutes (loading dose), the 0.4-1.0 mg/kg/hr, as needed or Terbutaline 0.25-0.50 mg IM/SC

  6. Call for help for severe bronchospasm (if O2 Sat persistently less than 90%), transfer to ICU as indicated

Hypotension with Tachycardia

  1. Trendelenberg position or elevate legs

  2. IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and EKG

  3. Oxygen (6-10L/min)

  4. Rapid bolus of large volumes of normal saline (NS)

  5. If poorly responsive, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed

Hypotension with Bradycardia (Vasovagal Reaction)

  1. Trendelenberg position or elevate legs

  2. IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and EKG

  3. Oxygen (6-10L/min)

  4. Rapid bolus of large volumes of normal saline (NS)

  5. Atropine 0.6-1.0mg IV slowly, Repeat atropine up to a total dose of 0.04 mg/kg (2-3mg in adult)

Hypertension, Severe

  1. IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and EKG

  2. Nitroglycerine 0.4mg tablet, sublingual (may repeat x 3), or topical 2% ointment, apply 1 inch strip

  3. Sodium nitroprusside: solution must be diluted with 5% Dextrose before infusion; must maintain monitoring for decreases in blood pressure; infusion pump necessary to titrate

  4. For pheochromocytoma - phentolamine 5.0mg (1.0mg in children) IV

Seizures or Convulsions

  1. Oxygen (6-10L/min)

  2. Consider Benzodiazepine such as Valium 5mg or Versed 0.5mg IV

  3. If longer effect needed, obtain consultation from neurology; consider Dilantin infusion 15-18mg/kg at 50mg/min as indicated

  4. Monitor (Rhythm, Blood Pressure, Pulse Oximetry) and call code team as indicated

Pulmonary Edema

  1. Elevate Torso, rotating tourniquets (venous compression)

  2. Oxygen (6-10L/min)

  3. Administer Diuretics (for example, Lasix 40 mg IV, slowly pushed)

  4. Consider morphine. Corticosteroids optional. Transfer to ER/ICU/CCU

References

  1. ACR Manual on Contrast Media

Note

  1. These guidelines are adapted based on references noted above. These are not absolute guidelines and all treatment strategies should be decided upon by physician and unique patient situation.