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handling_of_procedure_related_complications_and_specimens [2010/07/01 23:01] hyomul |
handling_of_procedure_related_complications_and_specimens [2010/07/12 14:56] 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/]] |
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- | ====== Treating Contrast Reactions ====== | + | |
- | + | ||
- | ===== 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) | + | |
- | ==== E. 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 | + | |
- | + | ||
+ | * [[ https://depts.washington.edu/uwerad/wordpress/?page_id=55 | Treating Contrast Reactions ]]:Needs Login | ||
+ | * [[ https://depts.washington.edu/uwerad/wordpress/?page_id=102 | Extravasation Policy ]]:Needs Login | ||