CONTRAST REACTION MANAGMENT

  1. Stop the contrast
  2. Start with cardiac leads, pulse ox, BP cuff
  3. Get oxygen face mask ready
  4. Get the Anaphylaxis kit
  5. Know your BLS/ACLS




ANAPHYLAXIS KIT CONTENTS

  1. Albuterol nebulizer 0.083% (2.5 mg/3 mL)
  2. Diphenhydramine 50 mg vial
  3. Epinephrine 1:1,000 vial (1 mL)
  4. Glucagon 1 mg/1 mL vial
  5. Methylprednisolone 125 mg/2 mL vial
  6. 18G 1-1/2" safety needle
  7. 1 mL syringe
  8. Alcohol prep pads
  9. Anaphylaxis box diagram
  10. Pediatric dosing charg (glucagon/methylprednisolone)
  11. Anaphylaxis adult algorithm


Rapid Response Team/CODE call 23-4444


REFERENCES
  • The information contained on this page reflects the Manual on Contrast Media 12/19/17
  • Refer to your contrast reaction cards (currently under construction)
  • Check the current SLRH Department of Radiology guidelines for the official policy


LIMITED CUTANEOUS REACTION: rash or mild hives
  1. Stop injection, no treatment needed in most cases, observe
  2. Diphenhydramine (Benadryl®) PO 25-50 mg


SEVERE DISSEMINATED URTICARIA
  1. Diphenhydramine (Benadryl®) IM or IV 25-50 mg
  2. Epinephrine IM (1:1,000) 0.3 mL (0.3 mg)


BRONCHOSPASM AND/OR FACIAL OR LARYNGEAL EDEMA
  1. O2 6-10 liters/min (via mask)
  2. Attach monitors
  3. Beta-agonist inhalers 2-3 puffs, repeat prn (albuterol, metaproterenol (Alupent®), terbutaline (Brethaire®) 
  4. If unresponsive to inhalers, give Epinephrine IM (1:1,000) 0.3 mL (0.3 mg)
  5. OR if hypotension evident, Epinephrine (1:10,000) slowly IV 1 mL (0.1 mg), repeat PRN to max 1 mg


ANAPHYLACTOID REACTION: hypotension and tachycardia
  1. Legs elevated > 60° or Trendelenburg position
  2. Give O2 6-10 liters/min (via mask)
  3. Attach monitors
  4. NS or LR 1000 mL bolus 
  5. Unresponsive to IVF: Epinephrine (1:10,000) slowly IV 1 ml (=0.1 mg), repeat prn to max 1 mg


VAGAL REACTION: hypotension and bradycardia
  1. Legs elevated > 60° or Trendelenburg position
  2. Give O2 6-10 liters/min (via mask)
  3. Attach monitors
  4. NS or LR 1000 mL bolus
  5. Unresponsive to IVF: Atropine 0.6-1 mg IV slowly, repeat atropine up to total of 0.04 mg/kg (2-3 mg) in adult 


HYPERTENSIVE CRISIS
  1. Give O2 6-10 liters/min (via mask)
  2. Attach monitors
  3. Give nitroglycerin 0.4 mg SL (may repeat x 3) OR topical 2% ointment, apply 1 inch strip
  4. Transfer to intensive care unit or emergency department
  5. For pheochromocytoma—phentolamine 5 mg IV


SEIZURES
  1. Give O2 6-10 liters/min (via mask)
  2. Attach monitors
  3. Anticonvulsants 
    • Lorazepam (Ativan®) 4 mg IV
    • Diazepam (Valium®) 5-10 mg IV
    • Midazolam (Versed®) 0.5-1 mg IV
  4. Call Rapid Response Team 23-4444 


PULMONARY EDEMA
  1. Elevate torso; rotating tourniquets (venous compression)
  2. Give O2 6-10 liters/min (via mask)
  3. Give diuretics – furosemide (Lasix®) 20-40 mg IV, slow push
  4. Consider giving morphine (1-3 mg IV)
  5. Transfer to intensive care unit or emergency department
  6. Corticosteroids optional

HOSPITAL EMERGENCY CODES

CODEMEANINGIMMEDIATE RESPONSE 
Medical CodeCardiopulmonary response
  • Initiate BCLS
  • Code team responds to provide ACLS
Rapid Response TeamRRT
  • RRT responds to location to initiate resuscitation of patient, visitor or employee
Code RedSmoke/Fire condition 
  • Rescue
  • Alarm
  • Contain
  • Evacuate/Extinguish
  • Fire Safety Team responds to location
Code BlueSecurity response
  • Security responds to location to provide assistance
Code PinkInfant/Pediatric abduction
  • Security responds to location
  • Initiate access control plan 
Code H.I.C.S.Hospital Incident Command System
  • Hospital Emergency System activated
  • Remain on duty until relieved
Code SilverArmed intruder/Active shooter
  • Avoid intruder
  • "Run, Hide, Fight"
  • Follow instructions from Security & Police 
Code ClearSituation resolved
  • Initiate recovery
  • Resume normal operations