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ANAPHYLACTOID REACTION

DX: Tachycardia and hypotension

Caution: Is patient on beta or calcium channel blocker?*

 

 

VASOVAGAL REACTION

DX: Bradycardia with / without hypotension

 

 

Treatment:

1. Call for assistance as appropriate!

2. Legs elevated 60o or more or Trendelenberg

3. IV fluids in large volumes (Colloids are best)

4. Oxygen (6-10 L/min via mask)

5. EPINEPHRINE (max. dosage 1.0mg)

(1:1000) 0.2-0.4 ml SQ (mild symptoms)

-or- (1:1000) 0.2-0.4 ml IV dilute & piggyback

-or- (1:10,000) 2.0-4.0 ml IV slowly

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EKG and Intubation; ultimately may require Dopamine 5-10 mcg/kg/min IV.

Treatment:

1. Call for assistance as appropriate!

2. Monitor vitals

3. Legs elevated 60o or more of Trendelenberg

4. Secure airway; Oxygen (6-10L/min via mask)

5. IV fluids in large volumes

6. If inadequate response to above then

... ATROPINE 0.6-1.0 mg IV slowly

(repeat to total of 2-3 mg over 10-15 min.)

 

 

 

 

*Beta- and calcium channel blockers may interfere with treatment. If no response to EPINEPHRINE in patient on beta-blocker then GLUCAGON 2-3 mg IV then slow drip of Glucagon. A patient on beta-blocker may have uncontrolled rise in BP after administration of EPINEPHRINE. Calcium channel blockers decrease response to fluids. PUSH MORE FLUIDS.

 

Withhold GLUCOPHAGE (Metformin) and the newer combination drug GLUCOVANCE (Metformin + Glyburide) 48 hours after elective contrast administration and confirm return to normal renal function with serum creatinine prior to re-instating Glucophage therapy.

 

 

WARNING SIGNS

for possible respiratory compromise: snoring, cough

for possible allergic reaction: sneezing, cough, itching, headache, dizziness, anxiety, pallor, chills, shaking, sweats

 

RESPIRATORY DISTRESS

Treatment:

1. Oxygen (6-10 L/min via mask)

2. Monitor pulse ox, ECG & blood pressure

3. Epinephrine (1:1000) 0.3 mg SQ (may repeat every 15 minutes x 3)

4. Metaproterenol (or other B-agonist) inhaler for prolonged wheezing - 2 puffs from inhaler

If respiratory distress is severe call CODE; begin intubation.

 

 

HIVES or URTICARIA

Treatment:

1. Benadryl 50 mg PO/IV/IM (patient should not drive after administration of Benadryl)

2. If hives are severe: Epinephrine (1:1000) 0.1-0.3 ml SQ and keep IV line open

 

 

PRETREATMENT FOR HISTORY OF PRIOR SERIOUS CONTRAST REACTION

1. 32 mg methylprednisolone PO 12 hours & 2 hours prior to procedure -OR-

2. 50 mg prednisone PO 13 hours, 7 hours & 1 hour prior to procedure, plus 50mg Benadryl PO/IV/IM 1 hour prior

 

REVERSING AGENTS

For Benzodiazepines: Mazicon 0.2 mg (2 ml) IV over 15 seconds; follow-up doses 0.2 mg IV every 60 seconds to maximum of 1 mg until desired level of consciousness achieved. Watch for Mazicon to wear off!

For narcotics: Narcan/naloxone 1 mg IV every 2-3 minutes prn

 

EXTRAVASATION

Consider surgical consult for extravasation >50cc. Immediate surgical consult for increased swelling or pain after 2-4 hours, decreased capillary refill, change in sensation, skin ulceration, blistering.

 

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Special Thanks to Stan Alexander, M.D. for providing this information and format for the web site.