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JRCERT Update

Stephenson

activate emergency medical response when Once the adverse reaction is identified, early initial
appropriate management is initiated. Early management includes
keep the patient alive until emergency responders keeping the patient comfortable, calm, and reas-
assume care or the patient is released sured, and, whenever possible, moving him or her to
advise patients regarding future contrast exposure a sufficiently equipped treatment area. For patients
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In the acute setting, a crucial, first goal in manag- undergoing computed tomography or magnetic
ing a reaction to contrast is recognizing that a reaction resonance imaging, this often means moving the
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has occurred. Because radiologic technologists and patient out of the imaging suite and connecting him
students often are present when a reaction initially is or her to a pulse oximeter, a blood pressure monitor,
revealed, they must be able to identify and classify con- or other such monitoring devices. If patients have
trast reactions confidently and efficiently. Symptoms IV access for their scan, the radiologic technologist
and signs can include a change in the patient’s appear- should preserve this access until the responsible
ance or behavior, and frequently the patient will report provider indicates it can be discontinued. Although
the symptoms he or she is experiencing. However, signs additional IV access lines can be obtained, the ini-
and symptoms can develop insidiously or be obscured; tial line might represent the only or easiest route to
for example, the patient’s mental status might render administer lifesaving IV medications.
him or her unable to report symptoms. In some cases Treatment areas should include access to:
innocuous or nonspecific symptoms can progress to oxygen
a life-threatening reaction. In these situations, noting suction
and characterizing the evolution of signs and symptoms IV supplies
quickly and correctly are key to identifying reactions crash cart
and life threats. In addition, noting the lack of progres- contrast reaction kit
sion or abatement of symptoms also can be a reassuring phone and relevant phone numbers
sign of stable or improving patient status. Ease and immediacy of access to these items are criti-
The second goal is to notify the responsible pro- cal, as is having a clear and shared understanding of the
vider that a reaction has occurred. The responsible thresholds requiring activation of the emergency medi-
provider serves as the leader of the early response team cal system or a rapid response or code team alert.
and supervises the management of such emergencies.
Depending on local guidelines and regulations, this Acute Adverse Reactions
individual can be a: Acute adverse reactions are labeled as mild, mod-
physician erate, or severe based on their risk of progression
nurse practitioner and death, and each type could further be labeled as
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physician assistant anaphylactic or physiologic. Anaphylactic reactions
technologist include the initiation of the acute hypersensitivity
designated staff member who is available cascade. This initiation is different from a typical
The responsible provider must be immediately on allergic reaction in that an anaphylactic response
site and given all critical information relevant to has no contrast-molecule–related allergen-anti-
2,13
determining the identification, cause, and treatment body interaction. Nevertheless, an anaphylactic
of a reaction, including the: response results in the release of the same chemical
nature of the response mediators from immune cells and can appear the
timing of symptomatology same clinically. Physiologic reactions are related to
patient’s general condition the toxic effects of contrast molecules on human
other relevant demographic and clinical organ systems and include hypertension, arrhythmia,
patient details seizure, and vasovagal response.

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