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handling_of_procedure_related_complications_and_specimens

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Page Printed from the Harborview Emergency Radiology Web Site

1. URTICARIA:

A. Mild urticaria and prutitis

– Observation and H-1 antihistamine (diphenhydramine- 25-50mg PO/IM/IV)

B. Severe urticaria

  1. ADD – IV fluids (normal saline, Lactated ringers)
  2. Epinephrine (1:10,000)- 0.1mg – IV slowly
  3. Epinephrine (1:1000) – 0.1-0.3mg – subcutaneously
  4. 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)

  1. normal saline or lactated ringers solution-Rapidly
  2. If hypotension unresponsive- vasopressor (epinephrine or dopamine)
  3. get appropriate assistance – Call CODE
  4. Epinephrine – (1:10,000)- 0.1mg- IV slowly
  5. 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

  1. H-1 blocker : diphenydramine 25-50mg- IV slowly- (may exacerbate or cause hypotension-may thicken bronchial secretions)
  2. 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

handling_of_procedure_related_complications_and_specimens.1278056324.txt.gz · Last modified: 2012/04/03 01:53 (external edit)