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treating_contrast_reactions [2012/04/03 01:54]
 treating_contrast_reactions [2012/04/03 01:54] (current)
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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
 + 
treating_contrast_reactions.txt · Last modified: 2012/04/03 01:54 (external edit)

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