Difference between revisions of "Contrast medium reaction"
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Initial evaluation can be done according to an ABCDE approach:<ref name=SURF/> | Initial evaluation can be done according to an ABCDE approach:<ref name=SURF/> | ||
* Airway: Stridor? Swollen tongue? | * Airway: Stridor? Swollen tongue? |
Revision as of 14:02, 17 July 2018
Author:
Mikael Häggström [notes 1]
This page in a nutshell: In a more severe reaction:[1]
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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.[2] In anaphylaxis, intramuscularly administered adrenaline is the most important initial therapy.[1] Also, an anesthesiologist or corresponding clinician on duty should be summoned. A peripheral venous catheter is needed for the administration of IV fluids.[1] Oxygen saturation, pulse and blood pressure are monitored.[1]
Contents
Evaluation
Initial evaluation can be done according to an ABCDE approach:[1]
- 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[1]
- 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 minutes
Anaphylaxis[1]
- 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: Inhalations of bronchodilator (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)[1]
- 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:[1]
- Antihistamine (see Table of medications below)
- Observation at least 30 minutes
Table of medications
Symptoms[1] | Medication[1] | Route[1] | Dosage[1] | Time to effect[1] | Repeat[1] | ||
---|---|---|---|---|---|---|---|
Class | Example | Adults | Children | ||||
|
Injection of adrenaline | Intramuscular in lateral thigh | 0.3 - 0.5 mg |
|
Less than 5 min | Every 5-10 min if needed | |
Asthma | Bronchodilator | Salbutamol (Ventolin) or own bronchodilator | Inhalation |
|
|
Less than 5 min | Every 10 mins if needed |
Hypoxia | Oxygen | Mask | >5 l/min | Almost immediate | Continuous | ||
Altered level of consciousness or hypotension | Volume expander | Ringer's | IV with pressure | 20mg/kg | Fast | As needed | |
All anaphylaxis cases | Antihistamine | Desloratadine (Clarinex/Aerius) | Oral | 10mg |
|
Within 30-60 minutes | |
Chlorphenamine[3] | IM or slow IV[3] | 10mg[3] |
| ||||
All anaphylaxis cases | Glucocorticoid | Betamethasone | Oral or IV | 5-8 mg |
|
2-3 hours | |
Hydrocortisone[3] | IM or slow IV[3] | 200mg[3] |
|
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 Unless otherwise specified in lists and table: . Hypersensitivity reactions against contrast media - Swedish Society of Uroradiology [Swedish: Överkänslighetsreaktioner mot kontrastmedel – SURFs kontrastmedelsgrupp ], 2014-10-17].
- ↑ Kim, Harold; Fischer, David (2011). "Anaphylaxis ". Allergy, Asthma & Clinical Immunology 7 (Suppl 1): S6. doi: . ISSN 1710-1492.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Younker, Jackie; Soar, Jasmeet (2010). "Recognition and treatment of anaphylaxis ". Nursing in Critical Care 15 (2): 94–98. doi: . ISSN 13621017., citing Resuscitation Council UK
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