Contrast Allergies or Extravasation

See ACR contrast manual for additional Information.

Examples of premedication regimens

  • Methylprednisolone 32mg PO 12, 2 hrs prior ± Benadryl 50mg PO 1 hr prior OR
  • Prednisone 50mg PO 13, 7, 1 hr prior ± Benadryl 50mg PO 1 hr prior OR
  • Hydrocortisone 200mg IV 5 hrs and 1 hr and Benadryl 50mg IV 1 hr prior

Regimen by problem

  • Hives/diffuse erythema: Can observe
    • If associated with hypotension or respiratory distress, considered anaphylaxis. Treat with IVF, epinephrine, and supplemental O2
    • If only skin findings but severe and/or progressive, can give Benadryl 50mg PO, IV or IM - Laryngeal edema (inspiratory stridor): epinephrine
  • Bronchospasm: beta-2 agonist inhaler 2 puffs x3, epinephrine if not responsive or severe
  • Hypotension with tachycardia: IVF, epinephrine, supplemental O2
  • Hypotension with bradycardia: IVF, atropine if refractory, supplemental O2
  • Contrast extravasation: elevate arm (heart level), cool compress, remove rings; consider surgical consultation for decreased perfusion, sensation, strength, active ROM, or increasing pain
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