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23 Cards in this Set
- Front
- Back
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Contrast extravasation
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Assessment of patient
Assessment of access site, demarcate with pen - distal pulses - paraethesias - neuromuscular defecit Record: - type - volume - encounter note Elevate limb Cold compress Monitor for an hour in department Surgical consult for fasciotomy if severe Send home with instructions to return to ED. Sx should resolve in 2 days. |
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Unresponsive patient in the scanner
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Assess patient
- look - skin - pulses - lungs Vitals - HR - BP - Pulse ox O2 at 6-10 L per minute Establish IV access IF hypotensive and tachycardic: - Trendelenberg - NS bolus - if poorly responsive: epinephrine (1:10,000) slowly IV 1 ml (= 0.1 mg) - repeat as needed up to a maximum of 1 mg If still poorly responsive seek appropriate assistance (e.g., cardiopulmonary arrest response team). IF hypotensive and bradycardic: - Trendelenburg position. - atropine 0.6–1 mg IV slowly if patient does not respond quickly to steps 2–4. - repeat atropine up to a total dose of 0.04 mg/kg (2–3 mg) in adult. - ensure complete resolution of hypotension and bradycardia prior to discharge. |
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Air embolism
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Air embolism
Stop air inflow Left lateral decubitus position Trendelenberg O2 NC at 6-10L NC Fluid support Sheath placement Attempt to aspirate air from RA using flush catheter is possible If poorly responsive: epinephrine (1:10,000) slowly IV 1 ml (= 0.1 mg) Repeat as needed up to a maximum of 1 mg If still poorly responsive seek appropriate assistance (e.g., cardiopulmonary arrest response team). CPR if necessary Hyperbaric O2 |
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Contrast reaction: Urticaria?
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1. Discontinue injection if not completed
2. No treatment needed in most cases 3. Give H1-receptor blocker: diphenhydramine (Benadryl®) PO/IM/IV 25–50 mg. If severe or widely disseminated: give alpha-agonist (arteriolar and venous constriction): epinephrine SC (1:1,000) 0.1–0.3 ml (= 0.1–0.3 mg) (if no cardiac contraindications). |
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Patient seizes while performing myelogram.
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Remove needle
Assess Patient Vitals 1. Give O2 6–10 liters/min (via mask). 2. Consider diazepam (Valium®) 5 mg IV (or more, as appropriate) or midazolam (Versed®) 0.5 to 1 mg IV. 3. If longer effect needed, obtain consultation; consider phenytoin (Dilantin®) infusion — 15–18 mg/kg at 50 mg/min. 4. Careful monitoring of vital signs required, particularly of pO2 because of risk to respiratory depression with benzodiazepine administration. 5. Consider using cardiopulmonary arrest response team for intubation if needed. |
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Patient with GFR of 20 with MRI with contrast for brain metastases.
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DK
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Spill of 20 mCI of 99m-Tc MDP.
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DK
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30 mCi of 131-I administered to wrong patient.
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DK
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Patient found down in waiting room.
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DK
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Patient with remote OSH aneurysm clipping needs an MRI brain for new metastatic disease.
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DK
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Patient with EVAR/coronary stent at OSH needs an MRI spine for cord compression.
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DK
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A radionuclide box arrives wet.
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DK
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A pregnant patient in the PET scanning room.
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DK
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Pneumothorax after lung bx.
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DK
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Diabetic patient with GFR of 35 presenting for contrasted MRI of brain for metastatic disease.
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DK
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Contrast reaction: laryngospasm laryngeal edema
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Vitals
1. Give O2 6–10 liters/min (via mask). 2. Give alpha agonist (arteriolar and venous constriction): epinephrine SC or IM (1:1,000) 0.1–0.3 ml (= 0.1–0.3 mg) or, especially if hypotension evident, epinephrine (1:10,000) slowly IV 1–3 ml (= 0.1–0.3 mg). Repeat as needed up to a maximum of 1 mg. If not responsive to therapy or if there is obvious acute laryngeal edema, seek appropriate assistance (e.g., cardiopulmonary arrest response team). |
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Contrast reaction: bronchospasm
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1. Give O2 6–10 liters/min (via mask).
Monitor: - electrocardiogram - O2 saturation (pulse oximeter) - blood pressure. 2. Give beta-agonist inhalers (bronchiolar dilators, such as metaproterenol [Alupent®], terbutaline [Brethaire®], or albuterol [Proventil® or Ventolin®]) 2 to 3 puffs; repeat as necessary. If unresponsive to inhalers, use SC, IM, or IV epinephrine. 3. Give epinephrine SC or IM (1:1,000) 0.1–0.3 ml (= 0.1–0.3 mg) or, especially if hypotension evident, epi- nephrine (1:10,000) slowly IV 1–3 ml (= 0.1–0.3 mg). Repeat as needed up to a maximum of 1 mg. Call for assistance (e.g., cardiopulmonary arrest response team) for severe bronchospasm or if O2 saturation <88% persists. |
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Contrast reaction: hypotension and tachycardia
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1. Legs elevated 60° or more (preferred) or Trendelenburg position.
2. Monitor: - electrocardiogram - pulse oximeter - blood pressure 3. Give O2 6–10 liters/min (via mask). 4. Rapid intravenous administration of large volumes of Ringer’s lactate or normal saline. If poorly responsive: epinephrine (1:10,000) slowly IV 1 ml (= 0.1 mg) Repeat as needed up to a maximum of 1 mg If still poorly responsive seek appropriate assistance (e.g., cardiopulmonary arrest response team). |
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Contrast reaction: bradycardia and hypotension
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Vitals and assessment
1 Secure airway: give O2 6–10 liters/min (via mask) 2. Monitor vital signs. 3. Legs elevated 60° or more (preferred) or Trendelenburg position. 4. Secure IV access: rapid administration of Ringer’s lactate or normal saline. 5. Give atropine 0.6–1 mg IV slowly if patient does not respond quickly to steps 2–4. 6. Repeat atropine up to a total dose of 0.04 mg/kg (2–3 mg) in adult. 7. Ensure complete resolution of hypotension and bradycardia prior to discharge. |
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Contrast reaction: severe hypertension
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1. Give O2 6–10 liters/min (via mask).
2. Monitor electrocardiogram, pulse oximeter, blood pressure. 3. Give nitroglycerine 0.4-mg tablet, sublingual (may repeat × 3); or, topical 2% ointment, apply 1-inch strip. 4. If no response, consider labetalol 20 mg IV, then 20 to 80 mg IV every 10 minutes up to 300 mg. 5. Transfer to intensive care unit or emergency department. 6. For pheochromocytoma: phentolamine 5 mg IV (may use labetalol if phentolamine is not available). |
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Contrast reaction: seizures or convulsions
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1. Give O2 6–10 liters/min (via mask).
2. Consider diazepam (Valium®) 5 mg IV (or more, as appropriate) or midazolam (Versed®) 0.5 to 1 mg IV. 3. If longer effect needed, obtain consultation; consider phenytoin (Dilantin®) infusion — 15–18 mg/kg at 50 mg/min. 4. Careful monitoring of vital signs required, particularly of pO2 because of risk to respiratory depression with benzodiazepine administration. 5. Consider using cardiopulmonary arrest response team for intubation if needed. |
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Contrast reaction: pulmonary edema
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1. Give O2 6–10 liters/min (via mask).
2. Elevate torso. 3. Give diuretics: furosemide (Lasix®) 20–40 mg IV, slow push. Peds: Give diuretic: furosemide (Lasix®) IV 1–2 mg/kg. 4. Consider giving morphine (1–3 mg IV). 5. Transfer to intensive care unit or emergency department. |
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