Page 27 - Radiology Book

contrast allergy Protocols
Pretreatment Regimen #2
Methylprednisolone (Medrol) 32 mg PO 12 hours and 2 hours before contrast media injection. An anti-histamine can also be added to this regimen.
Pretreatment Emergency:
Use the following Prep when you do not have 13 hours: Emergency Regimen #1:
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Methylprednisolone (Solu-Medrol) 40 mg or Hydrocortisone (Solu-Cortef) 200 mg IV q4 hours until contrast study required plus Diphenhydramine (Benedryl) 50 mg IV one hour prior to contrast injection.
Emergency Regimen #2:
Dexamethasone (Decadron) 7.5 mg or Betamethasone 6 mg IV q4 hours until contrast study required plus Diphenhydramine (Benedryl) 50 mg IV one hour prior to contrast injection in patients with known allergy to Methylprednisolone, Aspirin, or non-steroidal anti-in amma- tory drugs, especially if asthmatic.
Emergency Regimen #3:
Omit steroids and give Diphenhydramine (Benedryl) 50 mg IV
Note: IV steroids have not been shown to be effective when given less than 4-6 hours prior to contrast injection.
There is evidence that patients with Asthma, multiple allergies, isch- emic heart disease and those on beta adrenergic blocking agents may be at increased risk for anaphylactoid reations to contast.
Pediatrics with Known Contrast Allergies
Children weighing less than 40 kg only. For children weighing 40 kg or more, use adult dosing.
Prednisone 0.5 mg/kg PO or Methylprednisolone 0.5 mg/kg IV to be given 13 hours, 7 hours, and 1 hour prior to contrast injection plus Diphenhydramine (Benedryl) 1 mg/kg 1 hour prior to contrast injection.
Extravasation of Contrast Media
Extravasated iodinated contrast media is toxic to surrounding tissues and may produce an acute local in ammatory response (peaks 24-48 hours). The most common severe reaction is compartment syndrome with less common skin ulcerations and tissue necrosis occurring within 6 hours of extravasation. There is no clear consensus regarding effective treatments, but surgical consultation should be obtained for severe extravasation injury with one or more of the following signs of symptoms, progressive swelling or pain, altered tissue perfusion, skin ulceration or blistering.
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