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*Insert a '''peripheral venous catheter''' and give IV fluids.<ref name=SURF/>
+Lists
{{Authors|[[User:Mikael Häggström|Mikael Häggström]]}}
[[File:Injection Sites Intramuscular Thigh Adult.png|thumb|Adrenaline injection site.]]{{Nutshell|In a more severe reaction:*'''Adrenaline''', 0.3-0.5mg in adults, given intramuscularly.<ref name=SURF>Unless otherwise specified in lists and table: {{cite web|url=http://www.mastcellssjukdom.se/wp-content/uploads/2015/12/Nationella_rekommendationer_%C3%B6verk%C3%A4nslighetsreaktioner_kontrastmedel__PDF_2014-10-17.pdf|title=Hypersensitivity reactions against contrast media - Swedish Society of Uroradiology [Swedish: Överkänslighetsreaktioner mot kontrastmedel – SURFs kontrastmedelsgrupp] ], 2014-10-17}}</ref>*'''Adrenaline''', 0.3-0.5mg in adults, given intramuscularly.
*Summon an '''anesthesiologist'''
}}<br clear="all">
In case of a '''contrast medium reaction''', anaphylaxis is a more severe allergic reaction whose diagnostic criteria generally include low blood pressure and/or respiratory distress.<ref name="KimFischer2011">{{cite journal|last1=Kim|first1=Harold|last2=Fischer|first2=David|title=Anaphylaxis|journal=Allergy, Asthma & Clinical Immunology|volume=7|issue=Suppl 1|year=2011|pages=S6|issn=1710-1492|doi=10.1186/1710-1492-7-S1-S6}}</ref> In anaphylaxis, intramuscularly administered adrenaline is the most important initial therapy.<ref name=SURF/> Also, an '''anesthesiologist''' or corresponding clinician on duty should be summoned. A '''peripheral venous catheter''' is needed for the administration of IV fluids.<ref name=SURF/> '''Oxygen saturation''', '''pulse''' and '''blood pressure''' are monitored.<ref name=SURF/>
In general in a contrast medium reaction, the patient should be evaluated for the presence of the following symptoms and be medicated accordingly.<ref name=SURF/>
==Evaluation==
Initial evaluation can be done according to an ABCDE approach:<ref name=SURF/>
* Airway: Stridor? Swollen tongue?
* Breathing: Cyanosis? Use pulse oximeter if available.
* Circulation: Palpable pulse over radial, femoral and carotid artery? Heart rate? Blood pressure? Difficulty in taking blood pressure must not delay adrenaline administration.
* Disability: Altered level of consciousness?
* Exposure: Hives?
==In severe hives and progressive angioedema<ref name=SURF/>==
[[File:Angioedema2010.JPG|thumb|Angioedema]]
* 0,3-0,5 mg adrenaline intramuscularly on the anterolateral part of the mid-thigh. It is repeated if needed every
3–5 minutes.
* Corticosteroid (see Table of medications below)
* Observation at least 30 minuter
==Anaphylaxis<ref name=SURF/>==
* 0,3-0,5 mg adrenaline intramuscularly on the anterolateral part of the mid-thigh. It is repeated if needed every
3–5 minutes.
* Summon anesthesiologist or corresponding clinician on duty
* Oxygen, 10 L/min on mask. Attach a pulse oximeter.
* In asthma or bronchospasm: Salbutamol inhalations (see Table of medications below)
* In hypotension: Tilt the table to lower the head of the patient and give volume expander
* Corticosteroid (see Table of medications below)
==Cardiac arrest (unconscious and no breathing)<ref name=SURF/>==
[[File:Chest compressions.gif|thumb|Chest compressions.]]
* Start CPR: 100 chest compressions per minute and ventilate x2 every 30 compressions
* Connect a defibrillator
* If ventricular fibrillation or tachycardia: defibrillate at 200 Joule
* If asystole or pulseless electrical activity (PEA): 1 mg adrenaline 0,1 i.v. bolus
* Continue CPR
==Itching hives==
If ABCDE is otherwise normal:<ref name=SURF/>
* Antihistamine (see Table of medications below)
* Observation at least 30 minutes
==Table of medications==
{|class="wikitable"
!rowspan=2| Symptoms<ref name=SURF/> !!rowspan=2| Medication<ref name=SURF/> !!rowspan=2| Route<ref name=SURF/> !!colspan=2| Dosage<ref name=SURF/> !!rowspan=2| Time to effect<ref name=SURF/> ||rowspan=2| Repeat<ref name=SURF/>
