Emergency Body CT > Contrast Reactions > Contrast Reactions (1)


Contrast Reactions (1)

The overall incidence of adverse affects from IV contrast administration varies from 1-2% for non-ionic agents to 5% for ionic agents. The incidence of severe reactions range from 0.01% for non-ionics to 0.1% for ionics.

Possible reactions to IV contrast include: nausea, vomiting, urticaria, vasovagal response, laryngospasm, seizures, bronchospasm, cardiac arrythmias, and cardiovascular collapse.

Recommended treatment protocols (ACR Manual for Contrast Media, 4th Edition) for some of the more serious reactions are as follows:

Urticaria
1) Discontinue injection if not completed.
2) No treatment needed in most cases. Observe for progression of symptoms.
3) H1-receptor blocker: Dephenhydramine (Bendadryl) PO/IM/IV 25-50 mg or Hydroxyzine (Vistaryl) PO/IM/IV 25-50 mg H2-receptor blocker may be added.
4) If severe or widely disseminated: Epinephrine SC (1:1000) 0.1-0.3 ml (=0.1-0.3 mg) (if no cardiac contraindications)

Facial or Laryngeal Edema
1) Alpha agonist Epinephrine SC (1:1000) 0.1-0.3 ml (=0.1-0.3 mg) or If hypotension is evident, Epinephrine (1:10,000) slowly IV 1.0 ml (=0.1 mg) Repeat as necessary up to a maximum of 1.0 mg
2) Oxygen 6-10 L/min (via mask)

If not responsive to therapy or obvious acute laryngeal edema, seek appropriate assistance.

Bronchospasm
1) Oxygen 6-10 L/min (via mask)
2) Monitor: EKG, O2 saturation, and blood pressure
3) Beta-agonist inhalers [metaproterenol (Alupent), albuterol (Proventil)]
4) Epinephrine SC (1:1,000) 0.1-0.3 ml (=0.1-0.3 mg) If hypotension is present, Epinephrine (1:10,000) slowly IV 1.0 ml (=0.1mg)

Repeat as needed up to a maximum of 1.0 mg

Hypotension with Tachycardia
1) Legs elevated or Trendelenburg position
2) Monitor: EKG, pulse oximetry, blood pressure
3) Oxygen 6-10 L/min (via mask)
4) Rapid administration of large volumes of isotonic Ringer's lactate or normal saline

If poorly responsive:
Epinephrine (1:10,000) slowly IV 1.0 ml (=0.1 mg)
Repeat as needed up to a maximum of 1.0 mg
If still poorly responsive:
CALL CODE

Hypotension with Bradycardia
1) Legs elevated or Trendelenburg position
2) Monitor patient's vital signs
3) Oxygen 6-10 L/min (via mask)
4) Fluid replacement with Ringer's lactate or normal saline
5) Atropine 0.6-1.0 mg IV slowly, may repeat up to a maximum of 2-3mg in an adult

Seizure
1) Consider diazepam (Valium) 5.0 mg IV or midazolam (Versed) 2.5 mg IV
2) Oxygen 6-10 L/min (via mask)
3) If longer effect needed, obtain consultation.
4) Monitor vital signs - if caused by hypotension, treat hypotension.

 

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