Difference between revisions of "Contrast medium reaction"
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==Table of medications== | ==Table of medications== | ||
{|class="wikitable" | {|class="wikitable" | ||
− | !rowspan=2| Symptoms<ref name=SURF/> !! | + | !rowspan=2| Symptoms<ref name=SURF/> !!colspan=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/> |
|- | |- | ||
− | ! Adults !! Children | + | ! Class !! Example !! Adults !! Children |
|- | |- | ||
| | | | ||
Line 54: | Line 54: | ||
*Altered level of consciousness | *Altered level of consciousness | ||
*Severe abdominal pains and vomiting | *Severe abdominal pains and vomiting | ||
− | | Injection of '''adrenaline''' | + | |colspan=2| Injection of '''adrenaline''' |
| Intramuscular in lateral thigh | | Intramuscular in lateral thigh | ||
| 0.3 - 0.5 mg | | 0.3 - 0.5 mg | ||
Line 65: | Line 65: | ||
|- | |- | ||
| Asthma | | Asthma | ||
+ | | '''Bronchodilator''' | ||
| Salbutamol (Ventolin) or own bronchodilator | | Salbutamol (Ventolin) or own bronchodilator | ||
| Inhalation | | Inhalation | ||
Line 76: | Line 77: | ||
|- | |- | ||
| Hypoxia | | Hypoxia | ||
− | | Oxygen | + | |colspan=2| Oxygen |
| Mask | | Mask | ||
|colspan=2| >5 l/min | |colspan=2| >5 l/min | ||
Line 83: | Line 84: | ||
|- | |- | ||
| Altered level of consciousness or hypotension | | Altered level of consciousness or hypotension | ||
− | | Volume expander | + | | Volume expander |
+ | | Ringer's | ||
| IV with pressure | | IV with pressure | ||
|colspan=2| 20mg/kg | |colspan=2| 20mg/kg | ||
Line 89: | Line 91: | ||
| As needed | | As needed | ||
|- | |- | ||
− | | All anaphylaxis cases | + | |rowspan=2| All anaphylaxis cases |
− | | Antihistamine | + | |rowspan=2| '''Antihistamine''' |
+ | | Desloratadine (Clarinex/Aerius) | ||
+ | * | ||
| Oral | | Oral | ||
− | | 10mg | + | | 10mg |
| | | | ||
− | *<6 years: 2.5mg | + | *<6 years: 2.5mg |
− | *6 - 12 years: 5 mg | + | *6 - 12 years: 5 mg |
− | | Within 30-60 minutes | + | |rowspan=2| Within 30-60 minutes |
+ | |rowspan=2| | ||
+ | |- | ||
+ | | Chlorphenamine<ref name="YounkerSoar2010">{{cite journal|last1=Younker|first1=Jackie|last2=Soar|first2=Jasmeet|title=Recognition and treatment of anaphylaxis|journal=Nursing in Critical Care|volume=15|issue=2|year=2010|pages=94–98|issn=13621017|doi=10.1111/j.1478-5153.2010.00366.x}}, citing Resuscitation Council UK</ref> | ||
+ | | IM or slow IV<ref name="YounkerSoar2010"/> | ||
+ | | 10mg<ref name="YounkerSoar2010"/> | ||
| | | | ||
+ | *<6 months: 250μg/kg | ||
+ | *6 months - 6 years: 2.5mg | ||
+ | *6 - 12 years: 5mg<ref name="YounkerSoar2010"/> | ||
|- | |- | ||
|rowspan=2| All anaphylaxis cases | |rowspan=2| All anaphylaxis cases | ||
− | |rowspan=2| Glucocorticoid | + | |rowspan=2| '''Glucocorticoid''' |
+ | | Betamethasone | ||
| Oral or IV | | Oral or IV | ||
| | | | ||
− | *5-8 mg | + | *5-8 mg |
| | | | ||
*<6 years: 3-4 mg | *<6 years: 3-4 mg | ||
*≥6 years: 5-8 mg | *≥6 years: 5-8 mg | ||
|rowspan=2| 2-3 hours | |rowspan=2| 2-3 hours | ||
+ | |rowspan=2| | ||
+ | |- | ||
+ | | Hydrocortisone<ref name="YounkerSoar2010"/> | ||
+ | | IM or slow IV | ||
+ | | 200mg | ||
| | | | ||
− | + | *<6 months: 25mg | |
+ | *6 months - 6 years: 50mg | ||
+ | *6 - 12 years: 100mg<ref name="YounkerSoar2010"/> | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist}} | {{reflist}} |
Revision as of 07:02, 23 May 2018
Author:
[notes 1]
This page in a nutshell: In a more severe reaction:[1]
|
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: 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)[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 |
|
|
2-3 hours | |
Hydrocortisone[3] | IM or slow IV | 200mg |
|
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 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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