Contrast rxn/patient emergencies

Question 1

Facial or laryngeal edema or stridor

Answer 1

oxygen, epi 1:10,000 IV give 1mL, repeat up to 10 mL.

Low threshold for calling a code/intubation

Question 2

hypotension with tachycardia, or shock

Answer 2

Oxygen, trendelenburg, put on monitors, give normal saline IV
If not responsive, give epi 1:10,000 IV up to 10mL
call code if not responding

Question 3

hypotension with bradycardia

Answer 3

oxygen, trendelenburg, place on monitor
IV fluids, atropine 1.0 mg IV push
place pacemaker pads
repeat atropine or give epi 1:10,000 up to 10mL

Question 4

mild-moderate urticaria

Answer 4

benadryl 50mg, watch for 30 minutes, pt should not drive himself home

Question 5

Severe hypertension

Answer 5

place on monitors
Nitroglycerin 0.4mg tab sublingual
transfer to ICU

Question 6

seizure

Answer 6

oxygen, consider valium or versed

get consult, call code if intubation needed

Question 7

pulmonary edema

Answer 7

elevate torso, oxygen, five Lasix 40mg IV

transfer to ICU

Question 8

Pt presents for MRI with gad but has kidney problems - how to proceed?

Answer 8

GFR 60+ good to go
GFR 45-59 low dose/half dose
GFR <30 avoid contrast if possible
if on dialysis, consider using gadovist or eovist and perform right before dialysis

Question 9

Nephrogenic systemic fibrosis - discuss

Answer 9

Rare disease causing fibrosis (scarring) of the skin and other organs caused by gadolinium contrast exposure in patients with poor renal function.

Question 10

How do you deal with metformin and CT contrast?

Answer 10

Stop metformin that day, don’t resume until 48 hours later.

Question 11

Pt has bronchospasm - what do you do?

Answer 11

oxygen, monitors
Beta-agonist inhaled (eg albuterol)
if unresponsive, give epinephrine SC or IM
if severe or persistent, call code team