Management of Common Contrast Reactions
| Reaction | Etiology | Monitor… | Treatment (28–30) |
|---|---|---|---|
| Anaphylactoid | |||
| Urticaria (skin rash) | Anaphylactoid reaction | Initial size with marking and follow | Usually none; diphenhydramine, 25–50 mg orally/intramuscularly/intravenously; epinephrine (1:1,000), 0.1–0.3 mL subcutaneously/intramuscularly |
| Bronchospasm | Anaphylactoid reaction | Oxygen saturation, pulse, BP | Secure airway; oxygen, 6–10 L/min; metaproterenol/terbutaline inhaler, 2–3 puffs; epinephrine (1:1,000), 0.1–0.3 mL subcutaneously/intramuscularly; epinephrine (1:10,000), 1 mL intravenously (slowly) if hypotensive; call the emergency medical team |
| Facial or laryngeal edema | Anaphylactoid reaction | Oxygen saturation, pulse, BP | Secure airway; oxygen, 6–10 L/min; call the emergency medical team if severe; epinephrine (1:1000), 0.1–0.3 mL subcutaneously/ intramuscularly; epinephrine (1:10,000), 1 mL intravenously (slowly) if hypotensive; call the emergency medical team |
| Hypotension and tachycardia (fast pulse) | Vasodilation | Oxygen saturation, pulse, BP | Elevate legs 60°; oxygen, 6–10 L/min; rapid intravenous fluids; epinephrine (1:10,000), 1 mL intravenously (slowly); call the emergency medical team |
| Hypotension and bradycardia (slow pulse) | Vasovagal response | Oxygen saturation, pulse, BP | Elevate legs 60°; oxygen, 6–10 L/min; atropine, 0.6–1 mg intravenously (slowly); repeat to total of 2–3 mg (0.04 mg/kg) if needed; call the emergency medical team |
| Nonanaphylactoid | |||
| Cardiac arrhythmia | Ionic abnormalities; chemical variations | Oxygen saturation, pulse, BP, ECG | Follow ACLS* protocols; call the emergency medical team |
| Hypertension | Histamine release of catecholamine | Oxygen saturation, pulse, BP, ECG | Nitroglycerine, 0.4 mg sublingually; nitroglycerine; 2% ointment; phentolamine, 5 mg intravenously for pheochromocytoma; call the emergency medical team |
| Seizures | Ionic abnormalities; chemical variations | Oxygen saturation, pulse, BP, ECG | Secure airway; oxygen, 6–10 L/min; diazepam, 5 mg intramuscularly/intravenously; midazolam, 0.5–1 mg intravenously; phenytoin infusion, 15–18 mg/kg at 50 mg/min; call the emergency medical team |
| Pulmonary edema | Osmolar changes, causing large fluid volume shifts | Oxygen saturation, pulse, BP, ECG | Secure airway; oxygen, 6–10 L/min; furosemide, 20–40 mg intravenously (slowly); morphine, 1–3 mg intravenously; call the emergency medical team |
All medications are to be administered under physician supervision. BP = blood pressure; ECG = electrocardiogram; ACLS = advanced cardiovascular life support.