Always follow BLS and ACLS Guidelines as indicated and most
importantly, your clinical judgement
Remember your ABCs (Airway, Breathing, Circulation)
Call for help (EMT/code team) immediately if necessary
Whenever epinephrine is administered, consider cardiac
contraindications
For pediatric patients, remember appropriate medication dosing
(typically weight based)
Urticaria
Discontinue contrast administration
Usually, no treatment needed
Mild to Moderate Reaction: Benadryl 25-50 mg PO/IM/IV (adult
dosing); advise patient not to drive home alone after treatment;
Pediatric Dose is 1 mg/kg up to 50 mg
Severe Reaction: Epinephrine SC (1:1000) 0.1-0.3 mL (equivalent
to a dose of 0.1-0.3 mg)
Facial or Laryngeal Edema
Oxygen (6-10L/min)
Epinephrine SC (1:1000) 0.1-0.3mL (equivalent to
0.1-0.3mg)
If hypotension, give Epinephrine (1:10,000) 1mL slowly IV
(equivalent to 0.1mg) and up to 1 mg as needed
Bronchospasm
Oxygen (6-10L/min)
Give beta agonist inhalers (Albuterol, bronchodilators)
Epinephrine SC (1:1000) 0.1-0.3mL (equivalent to
0.1-0.3mg)
If hypotension, give Epinephrine (1:10,000) 1mL slowly IV
(equivalent to 0.1mg) and up to 1 mg as needed
Alternatively: Aminophylline 6 mg/kg IV in D5W over 10-20
minutes (loading dose), the 0.4-1.0 mg/kg/hr, as needed or
Terbutaline 0.25-0.50 mg IM/SC
Call for help for severe bronchospasm (if O2 Sat persistently
less than 90%), transfer to ICU as indicated
Hypotension with
Tachycardia
Trendelenberg position or elevate legs
IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry),
and EKG
Oxygen (6-10L/min)
Rapid bolus of large volumes of normal saline (NS)
If poorly responsive, give Epinephrine (1:10,000) 1mL slowly IV
(equivalent to 0.1mg) and up to 1 mg as needed
Hypotension with Bradycardia
(Vasovagal Reaction)
Trendelenberg position or elevate legs
IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry),
and EKG
Oxygen (6-10L/min)
Rapid bolus of large volumes of normal saline (NS)
Atropine 0.6-1.0mg IV slowly, Repeat atropine up to a total
dose of 0.04 mg/kg (2-3mg in adult)
Hypertension, Severe
IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry),
and EKG
Nitroglycerine 0.4mg tablet, sublingual (may repeat x 3), or
topical 2% ointment, apply 1 inch strip
Sodium nitroprusside: solution must be diluted with 5% Dextrose
before infusion; must maintain monitoring for decreases in blood
pressure; infusion pump necessary to titrate
For pheochromocytoma - phentolamine 5.0mg (1.0mg in children)
IV
Seizures or Convulsions
Oxygen (6-10L/min)
Consider Benzodiazepine such as Valium 5mg or Versed 0.5mg
IV
If longer effect needed, obtain consultation from neurology;
consider Dilantin infusion 15-18mg/kg at 50mg/min as indicated
Monitor (Rhythm, Blood Pressure, Pulse Oximetry) and call code
team as indicated
Administer Diuretics (for example, Lasix 40 mg IV, slowly
pushed)
Consider morphine. Corticosteroids optional. Transfer to
ER/ICU/CCU
References
ACR Manual on Contrast Media
Note
These guidelines are adapted based on references noted above.
These are not absolute guidelines and all treatment strategies
should be decided upon by physician and unique patient
situation.
