UW MSK Residents' Manual

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handling_of_procedure_related_complications_and_specimens [2010/07/01 21:56]
hyomul 		handling_of_procedure_related_complications_and_specimens [2010/07/02 01:55]
hyomul
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-[[ https://​depts.washington.edu/​uwerad/​wordpress/?​page_id=55 | Page Printed from the Harborview Emergency Radiology Web Site]]+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 +
-  - 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 +
-  +
- +
-Click here to print. +
-This page is confidential. It is printed from the Harborview Emergency Radiology Web site.+
  
handling_of_procedure_related_complications_and_specimens.txt · Last modified: 2012/04/03 01:54 (external edit)

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