IV Contrast induced reactions : MANAGEMENT OF ACUTE REACTIONS:

"Hives" (urticaria)

• Discontinue injection if not completed

• No treatment needed in most cases - reassure the patient

• Consider diphenhydramine PO/IM/IV 25-50 mg

• If severe/widely disseminated: Epinephrine SC (1:1,000) 0.1-0.3 ml (= 0.1-0.3

mg) (if no cardiac contraindications)

Facial or laryngeal edema

• 0.1-0.3 ml epinephrine SC or IM (1:1,000) (= 0.1-0.3 mg) or, if hypotensive, 1  ml epinephrine IV (1:10,000) slowly (= 0.1 mg). Repeat as needed up to 1 mg.

• Give oxygen 6-10 L/min (via mask)

• If not responsive to therapy or if there is obvious acute laryngeal edema, seek

appropriate assistance (e.g., cardiopulmonary arrest response team)

Bronchospasm

• Give oxygen 6-10 L/min (via mask)

• Monitor: ECG, O2 saturation (pulse oximeter), and BP

• Give beta-agonist inhalers, such as metaproterenol, terbutaline, or albuterol

2-3 puffs; repeat as needed

• If unresponsive, epinephrine SC or IM (1:1,000) 0.1-0.3 ml (= 0.1-0.3 mg) or,

if hypotensive, epinephrine (1:10,000) slowly IV 1 ml (= 0.1 mg) - Repeat up

to 1 mg

• Alternatively, give aminophylline 6 mg/kg IV in D5W over 10-20 minutes

(loading dose), then 0.4-1 mg/kg/hr, as needed (caution: hypotension)

• Call for assistance for severe bronchospasm or if O2 saturation <88% persists

Hypotension with tachycardia

• Legs elevated 60 degrees or more (preferred) or Trendelenburg position

• Monitor: ECG, O2 saturation (pulse oximeter), and BP

• Give oxygen 6-10 L/min (via mask)

• Rapid large volumes of IV isotonic Ringer's lactate or normal saline

• If poorly responsive: Epinephrine (1:10,000) slowly IV 1 ml (=0.1 mg) (if no

cardiac contraindications). Repeat as needed up to a maximum of 1 mg

• If still poorly responsive seek appropriate assistance (e.g., arrest team)

Hypotension with bradycardia (vagal reaction)

• Monitor: ECG, O2 saturation (pulse oximeter), and BP

• Legs elevated 60 degrees or more (preferred) or Trendelenburg position

• Secure airway and give oxygen 6-10 L/min (via mask)

• Rapid large volumes of IV isotonic Ringer's lactate or normal saline

• If unresponsive, atropine 0.6-1 mg IV slowly - repeat up to 2-3 mg in adult

• Ensure complete resolution of hypotension and bradycardia prior to discharge.

Severe hypertension

• Give oxygen 6-10 L/min (via mask)

• Monitor: ECG, O2 saturation (pulse oximeter), and BP

• Give nitroglycerine 0.4-mg tablet, sublingual (may repeat x 3)

• Transfer to intensive care unit or emergency department

• For pheochromocytoma−phentolamine 5 mg IV

Unconscious / unresponsive / pulseless / collapsed patient

• CALL CODE (Know the code phone number at your hospital. A code is not the

time to look for the number in a phone book!)

• Institute Basic Life Support

1. Establish airway, head tilt, chin lift

2. Initiate ventilation and external chest compression

3. Continue uninterrupted until help arrives



The ability to see structures or fluids within the body is essential to modern medicine. For example, X-ray examinations would be much more limited without X-ray iodinated contrast media, which provides the ability to look at structures that would otherwise be indistinguishable from nearby tissue.