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handling_of_procedure_related_complications_and_specimens [2010/07/01 17:06] hyomul |
handling_of_procedure_related_complications_and_specimens [2010/07/02 01:55] hyomul |
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- | [[Page Printed from the Harborview Emergency Radiology Web Site| https://depts.washington.edu/uwerad/wordpress/?page_id=55]] | + | Page Printed from the Harborview Emergency Radiology Web Site [[http://depts.washington.edu/uwerad/]] |
- | ====== Treating Contrast Reactions ====== | + | * [[ https://depts.washington.edu/uwerad/wordpress/?page_id=55 | Treating Contrast Reactions ]] |
- | + | * [[ https://depts.washington.edu/uwerad/wordpress/?page_id=102 | Extravasation Policy ]] | |
- | 1. URTICARIA: | + | |
- | A. Mild urticaria and prutitis – Observation and H-1 antihistamine (diphenhydramine- 25-50mg PO/IM/IV) | + | |
- | B. Severe urticaria – ADD – IV fluids (normal saline, Lactated ringers) | + | |
- | ~Epinephrine (1:10,000)- 0.1mg – IV slowly | + | |
- | or Epinephrine (1:1000) – 0.1-0.3mg – subcutaneously | + | |
- | ~H-2 antihistamine- | + | |
- | -cimetidine injectable-300mg-diluted to 20 ml-IV slowly | + | |
- | -Pediatric-5-10mg/kg-diluted to 20ml- IV slowly | + | |
- | -ranitidine injectable-50mg-diluted to 20ml-IV slowly | + | |
- | 2. BRONCHOSPASM (ISOLATED): | + | |
- | A. Oxygen by mask – 10 L/min | + | |
- | B. Beta-2-agonist metered dose inhaler – 2-3 deep inhalations (metaproterenol, terbutaline or abuterol) | + | |
- | Use nebulizer if available- albuterol 0.5% solution- 0.5ml in 3ml normal saline- breathe through nebulizer tube for 8-10 minutes | + | |
- | C. Epinephrine – | + | |
- | ~Normal blood pressure- stable bronchospasm – | + | |
- | (1:1000)-0.1-0.2mg- may give 0.3mg – subcutaneously | + | |
- | -Pediatric- 0.01mg/kg up to 0.3mg maximum- subcutaneously | + | |
- | ~Progressive bronchospasm or decreased blood pressure – | + | |
- | (1:10,000) – 0.1mg – IV slowly | + | |
- | -Pediatric- 0.01mg/kg – IV slowly | + | |
- | 3. HYPOTENSION (ISOLATED): | + | |
- | A. Elevate patient legs | + | |
- | B. Oxygen by mask – 10 L/min | + | |
- | C. IV fluids (primary therapy)-normal saline or lactated ringers solution-Rapidly | + | |
- | ~If hypotension unresponsive- vasopressor (epinephrine or dopamine) | + | |
- | get appropriate assistance – Call CODE | + | |
- | ~Epinephrine – (1:10,000)- 0.1mg- IV slowly | + | |
- | ~IV solution – 1mg in 250ml D5W- start at 4mcgm/min (1ml/min) | + | |
- | 4. VAGAL REACTION (HYPOTENSION AND BRADYCARDIA): | + | |
- | A. Elevate patient legs | + | |
- | B. Oxygen by mask (10 L/min) | + | |
- | C. IV fluids- normal saline or lactated ringers solution- Rapidly | + | |
- | D. Atropine – 0.6-1.0mg IV- repeat q 3-5 min (as needed)- 3mg total | + | |
- | ~Pediatric- 0.02mg/kg IV-starting dose- 0.1-0.6mg dose- 2mg total | + | |
- | 5. ANAPHYLACATOID REACTION (GENERALIZED SYSTEMIC REACTION): | + | |
- | A. Suction – as needed | + | |
- | B. Elevate patient legs – if hypotensive | + | |
- | C. Oxygen by mask (10 L/min) | + | |
- | D. IV fluids – normal saline or lactated ringers solution- Rapidly | + | |
- | E. Epinephrine – (1:10,000)- 0.1mg- IV slowly – incrementally over 2-5 minutes | + | |
- | ~Pediatric- 0.01mg/kg – IV slowly – 0.1mg total (Limit amount of Epinephrine in patients taking non-cardioselective beta-adrenergic blocking drugs) | + | |
- | ~Alternate drug therapy for severe reaction in patients taking beta-adrenergic blocking medications- | + | |
- | ~Isoproterenol- (1:5000)- 0.2mg/ml- IV slowly- 0.5-1.0ml diluted to 10ml with normal saline- 1ml (20 microgram) increments | + | |
- | ~Glucagon- 1-5 mg IV bolus- followed by IV infusion of | + | |
- | 5-15 microgram/min (may cause hypotension) | + | |
- | F. Antihistamines- | + | |
- | ~H-1 blocker- diphenydramine 25-50mg- IV slowly- (may exacerbate or | + | |
- | cause hypotension-may thicken bronchial secretions) | + | |
- | ~H-2 blocker- cimetidine injectable 300mg- diluted to 20 ml- IV slowly | + | |
- | ~Pediatric- 5-10mg/kg- diluted- IV slowly | + | |
- | - ranitidine injectable 50mg- diluted to 20 ml- IV slowly | + | |
- | G. Beta-2-agonist metered dose inhaler- 2-3 deep inhalations | + | |
- | (metaproterenol, terbutaline or abuterol)- Use nebulizer if availablealbuterol | + | |
- | 0.5% solution- 0.5ml in 3ml normal saline- breathe through | + | |
- | nebulizer tube for 8-10 minutes | + | |
- | H. Corticosteroids- Hydrocortisone 200mg IV slowly | + | |
- | - Methylprednisolone 80mg IV slowly | + | |
- | 6. ANGINA: | + | |
- | A. Oxygen by mask – 10 L/min | + | |
- | B. IV fluids – very slowly | + | |
- | C. Nitroglycerin – 0.4mg-sublingually- may repeat q 15 minutes | + | |
- | D. Morphine – 2 mg IV slowly | + | |
- | 7. HYPERTENSION: | + | |
- | A. Oxygen by mask – 10 L/min | + | |
- | B. IV fluids – very slowly- primarily to maintain IV access | + | |
- | C. Nitroglycerin – 0.4mg-sublingually or 2% ointment topically-1-2 inch strip | + | |
- | D. If secondary to autonomic dysreflexia- | + | |
- | ~nifedipine 10mg capsule- punctured or chewed and swallowed | + | |
- | (nifedipine sublingually- is no longer recommended as the first line | + | |
- | drug for treatment of all hypertensive crises- due to very poor | + | |
- | sublingual absorption and reported serious adverse effects) | + | |
- | D. If secondary to pheochromocytoma- phentolamine- 5mg- IV slowly | + | |
- | 8. SEIZURES: | + | |
- | A. Protect patient | + | |
- | B. Airway- suction as needed- monitor airway for tongue obstruction | + | |
- | C. Oxygen by mask – 10 L/min | + | |
- | D. If caused by hypotension +/- bradycardia- treat per protocols | + | |
- | E. Uncontrolled- consider diazepam- 5mg IV slowly | + | |
- | 9. HYPOGLYCEMIA: | + | |
- | A. Oxygen by mask – 10 L/min | + | |
- | B. IV fluids – D5W | + | |
- | C. IV glucose – Dextrose 50% solution- IV push | + | |
- | D. Oral glucose – glass of orange juice plus sugar or glass of milk | + | |
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- | Click here to print. | + | |
- | This page is confidential. It is printed from the Harborview Emergency Radiology Web site. | + | |