Treatments for Acute Reactions to Iodinated Contrast

Suction as needed.

Elevate legs.

O2 10L by mask.

IV fluids (NS or LR).

Give Epinephrine 0.3mg 1:1000 IM (Epi-Pen®). Can repeat q5-10 mins.

Call CODE Blue or 911.

For bronchospasm, add Albuterol MDI2-3 puffs.

Administer diphenhydramine 25-50mg IM or IV(may cause or exacerbate hypotension or thicken bronchial secretions)

Administer methylprednisolone 80-125 mg IV

O2 by mask 6 – 10L.

Give Epinephrine 0.3mg 1:1000 IM (Epi-Pen®). Can repeat q5-10 mins.

Call CODE Blue or 911.

O2 by mask 10L.

Albuterol x3 MDI (Give 2-3 puffs and can readminister 2-3 puffs up to 3 times total).

If unresponsive to inhaler, give Epinephrine 0.3mg 1:1000 IM (Epi-Pen®). Can repeat q5-10 mins.

Call CODE Blue or 911.

Elevate legs.

O2 by mask 10L.

IV fluids (rapid NS or LR).

If unresponsive to inhaler, give Epinephrine 0.3mg 1:1000 IM (Epi-Pen®). Can repeat q5-10 mins.

Call CODE Blue or 911.

Elevate legs.

O2 by mask 10L.

IV fluids (NS or LR) wide open.

Atropine: 0.6-1mg IV; repeat every 3-5 minutes as needed up to 3mg.

MILD:Observation. Consider diphenhydramine 25-50mg PO/IM or 25mg IV (may cause or exacerbate hypotension or thicken bronchial secretions)

SEVERE: As above and IV fluids and/or IM epinephrine 0.3mg 1:1000 IM (Epi-Pen®). Can repeat q5-10 mins.  Call CODE Blue or 911.

O2 by mask 10L

IV fluids: (administer slowly)

Nitroglycerin 0.4mg sublingually; may repeat Q 5 min x 3 doses or nitroglycerin ointment one inch strip (wear gloves to rub in)

Morphine 2mg IV

O2 by mask 10L

IV fluids: (administer slowly)

Nitroglycerin 0.4mg sublingually; may repeat Q 5 min x 3 doses or nitroglycerin ointment one inch strip (wear gloves to rub in)

Protect patient

Suction airway

Monitor for obstruction by tongue

O2 by mask if not vomiting

If caused by hypotension or bradycardia, treat per protocol

If uncontrolled, consider anticonvulsant (e.g., diazepam or lorazepam)

O2 by mask 10L

IV fluids (D5W)

Dextrose 50% IV (25gm/50mL)

Oral glucose (orange juice)