1. Screening for Contrast and Reactions Barnes-Jewish Hospital Monica White MBA, RT, R

2. Contrast Media Is a Drug  Drugs Given Over Time Verses a One-Time Bolus  Medication to Treat a Condition Verses to Visualize Structures  IV Medications Isotonic to Plasma Verses Contrast up to 7 Times More Osmolar

3. Typical Reactions to Contrast Media  Nausea and Vomiting  Hives to Urticaria  Hypotension  Anaphylactic Reactions

4. Typical Reactions to Contrast Media  Vagal Reaction  Cardiovascular Collapse- CARDIAC ARREST  Seizures or Convulsions

5. Risk Factors  General Patient Status  History of Severe Allergy  History of Asthma  Renal Disease  Age  Multiple Myeloma  Sickle Cell Anemia

6. Absolutely No Ionic Contrast Should Be Used for Myelograms or Spinal Injections

7. CM-ARF  Pre-Existing Renal Insufficiency  Diabetes Mellitus  Dehydration  Cardiovascular Disease and Diuretics  Advanced Age  Multiple Myeloma  Hypotension  Hyperemia

8. General Patient Preparation  History  Hydration  Handle It  Heads Up

9. Pre Medication  Steroids (Prednisone or Hydrocortisone)  Antihistamines (Benadryl- Diphenhydramine)  Nonionic Contrast

10. Complications and Reactions  Nausea and Vomiting Cool Cloth on Forehead Slow the Rate Compazine  Hives and Urticaria Observe Patients (IV Access Maintained) Benadryl (Diphenhydramine)

11. Complications and Reactions  Bronchospasm Inhaled Bronchodilators Epinephrine Subq or IM 0.1-0.5Ml1:1,000 (Vial) Every 10-15 Minutes IV: 1cc of 1:10,000 (Bristoject) IV Slowly

12. Complications and Reactions  Laryngeal Edema Epinephrine Benadryl or Histamine Blockers True Medical Emergency

13. Complications and Reactions  Hypotension With Tachycardia Check Blood Pressure Elevate Legs IV Fluids Under Physician's Supervision Nurses in Area or Code Team

14. Complications and Reactions  Vasovagal Reaction IV Fluids Atropine (IV Push 0.5-1.0 mg) May Be Repeated up to a Total of 2 mg

15. Complications and Reactions  Anaphylaxis, Circulatory Collapse and Shock Call a Code CPR

16. Being Prepared for an Emergency  Check Procedure Room  Replace Emergency Equipment  Check and Know Where Crash Cart Located  If Unlocked Contents Replaced Immediately  Check Oxygen Tank

17. Being Prepared for an Emergency  Defibrillator Checked Daily  Designated Personnel  Wall Outlets for Oxygen and Suction Checked Daily; Oxygen and Suction Tubing  Know the Code Number 2-2700