contrast media and adverse effects

8/6/2019 Contrast Media and Adverse Effects

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CONTRAST MEDIA AND ADVERSECONTRAST MEDIA AND ADVERSE

EFFECTSEFFECTS

Moderator :Moderator : Mr. L.K. GuptaMr. L.K. Gupta

Presenter :Presenter : Vijay KumarVijay KumarB.Sc Final Year StudentB.Sc Final Year Student

Department of Radiodiagnosis, PGIMER, ChandigarhDepartment of Radiodiagnosis, PGIMER, Chandigarh


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INTRODUCTIONINTRODUCTION

Contrast media are those substances which areContrast media are those substances which areusedused

to distinguish between organ and tissues, vesselsto distinguish between organ and tissues, vesselsbyby

introducing different methods. Contrast mediaintroducing different methods. Contrast mediadiffers asdiffers as

the attenuation and absorption of radiation. Contrastthe attenuation and absorption of radiation. Contrast

media having high atomic number and attenuationmedia having high atomic number and attenuationandand

absorption is more so it appears white in theabsorption is more so it appears white in the


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HISTORICAL DEVELOPMENTHISTORICAL DEVELOPMENT

InIn 19231923 firstfirst reportreport ofof opacificationopacification ofof thethe urinaryurinary tracttract byby

renalrenal excretionexcretion byby retrograderetrograde introductionintroduction ofof contrastcontrastagentagent

withwith thethe useuse ofof 1010%% sodiumsodium iodideiodide.. ThisThis waswas followedfollowedbyby

iodineiodine derivativesderivatives ofof pyridonepyridone ee..gg.. ofof thethe firstfirst contrastcontrastmediamedia

waswas uroselectianuroselectian andand diodonediodone (diotrast)(diotrast) whichwhich werewereutilizedutilized

inin urographyurography fromfrom thethe 19301930.. InIn 19501950 thatthat thethe modernmodern

waterwater


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In 1955 a much safer derivative was reported Diatrizoate. ThisIn 1955 a much safer derivative was reported Diatrizoate. This

hadhadon acetamido group. Isomerization of diatrizoate andon acetamido group. Isomerization of diatrizoate and

iothalamateiothalamate

molecule in 1962. The majority of the modern conventionalmolecule in 1962. The majority of the modern conventional

waterwatersoluble contrast media was developed. It contains sodium andsoluble contrast media was developed. It contains sodium and

meglumine. These contrast are Hypertonic with osmolalitis.meglumine. These contrast are Hypertonic with osmolalitis.HyperHyper

osmolality is responsible for many of the adverse effect so lowosmolality is responsible for many of the adverse effect so lowosmolar contrast media was developed which reduce the sideosmolar contrast media was developed which reduce the side

effects. Conventional ionic contrast media have a iodine toeffects. Conventional ionic contrast media have a iodine toparticleparticle

ratio was 3:2. In 1972 a new agent was introduced forratio was 3:2. In 1972 a new agent was introduced for

radiculography. It was iothalamate molecules to form aradiculography. It was iothalamate molecules to form a

HISTORICAL DEVELOPMENT ContdHISTORICAL DEVELOPMENT Contd


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Definition C/MDefinition C/M

The contrast media are the salt of organic iodineThe contrast media are the salt of organic iodinecontainingcontaining

molecules. They are introduced into the body for themolecules. They are introduced into the body for thepurposepurpose

of opacifying structure.of opacifying structure.Properties of C/MProperties of C/M

It must be easily availableIt must be easily available

It must be non toxic / non poisonousIt must be non toxic / non poisonous

Viscosity must be adequateViscosity must be adequate

It should not affect locallyIt should not affect locally It must provide adequate contrast for diagnostic purposeIt must provide adequate contrast for diagnostic purpose

It must provide permanent opacification in theIt must provide permanent opacification in the

radiographradiograph

Intrathecal contrast should be missible in CSFIntrathecal contrast should be missible in CSF


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Types of C/M barium CompoundsTypes of C/M barium Compounds

Bariumsuspensionis made up from pure bariumBariumsuspensionis made up from pure bariumsulphatesulphate

It is morphological studies of GI tractIt is morphological studies of GI tract Barium contrast is used in the form of Ba so4Barium contrast is used in the form of Ba so4

BASO 4BASO 4 :: White crystalline powerWhite crystalline power

Molecular weight = 233Molecular weight = 233

Specific gravity = 4.5Specific gravity = 4.5 Atomic number = 56Atomic number = 56

High density barium usually has particle size 5 to 12High density barium usually has particle size 5 to 12micro metermicro meter

Decreasing the particle size increase viscosity.Decreasing the particle size increase viscosity.

TP1


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Slide 6

TP1 The ParadoX, 7/27/2005


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Varieties of Bariumsuppression is usedVarieties of Bariumsuppression is used

ProprietarynameProprietaryname Density W / VDensity W / V

Baritop 100Baritop 100 100%100%

EE--Z HDZ HD 250%250%

Micro opaque DCMicro opaque DC 100%100%

Micro opaque PowderMicro opaque Powder 76%76%

Polibar RapidPolibar Rapid 100%100%


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IndicationsIndications

Suspected perforationSuspected perforation

To distinguish bowel from otherstructures onTo distinguish bowel from otherstructures onCTCT

LOCM is used if aspiration possiblyLOCM is used if aspiration possibly

In the case of GI tract ofneonates and infantsIn the case of GI tract ofneonates and infants When C/M is likely to enter the lungWhen C/M is likely to enter the lung

Possible leakage of contrast media from the GIPossible leakage of contrast media from the GI

tacttact


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AdvantageAdvantage

Rapid absorption of LOCMRapid absorption of LOCM

No damage to bowel mucosaNo damage to bowel mucosa

Veryslow absorption from gutVeryslow absorption from gut

Resulting in good bowel visualizationResulting in good bowel visualization

Stable in bowel secretionStable in bowel secretion No adverse effects on the lungsNo adverse effects on the lungs


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ComplicationsComplications

Pulmonary oedemaPulmonary oedema

Allergic reactionAllergic reaction

May precipitate in hyper chlorohydric gastricMay precipitate in hyper chlorohydric gastric

acidacid


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Iodine containing watersoluble contrast mediaIodine containing watersoluble contrast media

IonicIonic

NonionicNonionicIonic watersaluble c/m (ionic ) (HOCM)Ionic watersaluble c/m (ionic ) (HOCM)

a.a. Urography 60% (TrazografUrography 60% (Trazograf))

79% Na/ diagrizoate79% Na/ diagrizoate

52% meglumine diatrizoate52% meglumine diatrizoate Iodine content 292 mg/ml 5.14gm (In 20ml Solution)Iodine content 292 mg/ml 5.14gm (In 20ml Solution)

B.B. Urografin 76% (Trazograf) 7.4gm (In 20ml Solution)Urografin 76% (Trazograf) 7.4gm (In 20ml Solution)

10% sodium diatrozoate10% sodium diatrozoate

Iodine content 370mg/mlIodine content 370mg/ml

C.C. Trazogastro (Gastrografin ) ORAL contrastTrazogastro (Gastrografin ) ORAL contrast

10% Sodium diatrizoetec10% Sodium diatrizoetec

66% meglime diatrizoate66% meglime diatrizoate

Iodine content 370mg/mlIodine content 370mg/ml


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Table 1Table 1

Type of Contrast AgentsType of Contrast Agents

Table 2Table 2

Conditions associated with adverse reactions to contrastConditions associated with adverse reactions to contrast

MaterialMaterial

Type AgentType Agent

HighHigh

OsmolalityOsmolality

Ionic Diatrizoate sodiumIonic Diatrizoate sodium

(Hypaque)(Hypaque)

LowLow

OsmolalityOsmolalityIonic LoxaglateIonic Loxaglate

megluminemeglumine

(Hexabrix)(Hexabrix)

Nonionic GadodiamideNonionic Gadodiamide

(Omniscan)(Omniscan)GadoteoridolGadoteoridol

(Pro Hance)(Pro Hance)

Iodixanol (Visipaque)Iodixanol (Visipaque)

Iopamidol (Isovue)Iopamidol (Isovue)

Iopromide (Ultravist)Iopromide (Ultravist)Ioversol (Optiary)Ioversol (Optiary)

Preexisting renal insufficiencyPreexisting renal insufficiency

Previous anaphylactoid reaction to contrast materialPrevious anaphylactoid reaction to contrast material

AsthmaAsthma

Food ormedication allergies, or hayfeverFood ormedication allergies, or hayfever

Multiple medical problem or an underlying disease ( e.g. cardiacMultiple medical problem or an underlying disease ( e.g. cardiac

disease, preexisting azotemia)disease, preexisting azotemia)

Treatment with nephrotoxic agents (e.g. aminoglycosides,Treatment with nephrotoxic agents (e.g. aminoglycosides,nonsteroidal antinonsteroidal anti--inflammatory agents)inflammatory agents)

Advanced ageAdvanced age


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Table 3 Methods ofPreventing ContrastTable 3 Methods ofPreventing Contrast

Material induced renal InsufficiencyMaterial induced renal Insufficiency

General PrincipleGeneral Principle Use the smallest amount of contrast materialUse the smallest amount of contrast materialpossiblepossible

Discontinue othernephrotoxic medications before theDiscontinue othernephrotoxic medications before theprocedureprocedure

Allow two to five days between procedures requiringAllow two to five days between procedures requiring

contrast materialcontrast material

HydrationHydration Oral : 500mL before the procedure and 2,500mL overOral : 500mL before the procedure and 2,500mL overthe 24 hour after the procedurethe 24 hour after the procedure

Intravenous : 0.9% or 0.45% saline 100mL per hourIntravenous : 0.9% or 0.45% saline 100mL per hour

beginning four hours before the procedure andbeginning four hours before the procedure and

continuing for the 24 hourscontinuing for the 24 hours


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Contrast media MRIContrast media MRI

MR contrast media differentiate tissue structure. EitherMR contrast media differentiate tissue structure. Either

increasing signal intensity on T1 weighted image orincreasing signal intensity on T1 weighted image or

decrease. Signal intensityin T2 weight image to do sodecrease. Signal intensityin T2 weight image to do sodifferent Gadolinium based contrast media are used egdifferent Gadolinium based contrast media are used eg--

diethylene triamine penta acetic acid. 1ml magnavistdiethylene triamine penta acetic acid. 1ml magnavist

containcontain

469mg gadiopentetic acid dimeglumine salt in aquous469mg gadiopentetic acid dimeglumine salt in aquous

solution.solution.


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Indication of MRI ContrastIndication of MRI Contrast

Inter cranial lesion with abnormal VascularityInter cranial lesion with abnormal Vascularity Abnormalityin blood brain barrierAbnormalityin blood brain barrier

Gadopentate enhanced MRI help diagnosis andGadopentate enhanced MRI help diagnosis andcharacterization ofneoplastic diseasecharacterization ofneoplastic disease

Acoustic neuromaAcoustic neuroma Inflammatory diseasesInflammatory diseases

Certain vascular abnormalityCertain vascular abnormality

Demyelating abnormalityDemyelating abnormality

eg multiple sclerosiseg multiple sclerosisWhole Body MRI :Whole Body MRI : Evaluation ofsuspected hepatic lesionEvaluation ofsuspected hepatic lesion

Musculoskeletal lesion. Cardiac MR ImagingMusculoskeletal lesion. Cardiac MR Imaging


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Contra IndicationContra Indication

It should not administer pts having hypersensitivityIt should not administer pts having hypersensitivity

Renal failureRenal failure

Sickle cell anemiaSickle cell anemia

PregnancyPregnancy


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Contrast agentsin ultrasoundContrast agentsin ultrasound

Levovist (Schering)Levovist (Schering)

Widely used inmicrobubbles contrast agentWidely used inmicrobubbles contrast agent

Echovist (Schering) bubblesin a glactose soln butEchovist (Schering) bubblesin a glactose soln butlacking the palmating acid coatinglacking the palmating acid coating

Albunex :Albunex : Airmicro bubble used in echocardiographyAirmicro bubble used in echocardiography

Sonvne :Sonvne : Suspension ofstabilized sulpher hexafluorideSuspension ofstabilized sulpher hexafluoride

microbubblesmicrobubbles


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Uses of C/MUses of C/M

It should be used in various places of diagnosticIt should be used in various places of diagnostic

departmentdepartment

IVUIVU

BariumBarium

MRIMRI

CT AngiographyCT Angiography UltrasoundUltrasound


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Preservation of contrast MediaPreservation of contrast Media

Properstorage dark place 15 degree C to 30degree CProperstorage dark place 15 degree C to 30degree C Observation of expiratory dateObservation of expiratory date It should be form 2It should be form 2--3 to3 to

5 years5 years

Examination of the C/M solution before used check theExamination of the C/M solution before used check the

cleanness ofsolution.cleanness ofsolution. Crystallization found insolution then the contrastCrystallization found insolution then the contrast

media which is at low tamp is heated upto 80 degree Cmedia which is at low tamp is heated upto 80 degree C

C/M solution with high viscosity at 37 degree C heatC/M solution with high viscosity at 37 degree C heatreduces the viscosityreduces the viscosity

Risk ofmicrobial contamination for we should not leaveRisk ofmicrobial contamination for we should not leavethe solution open formore than 4 hoursthe solution open formore than 4 hours

Resterlization of the C/M solutionResterlization of the C/M solution do not resterlizationdo not resterlizationthe open containerthe open container

Transfer to the sterile containerTransfer to the sterile container


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Mechanism of contrast media reactionMechanism of contrast media reaction

OverdoseOverdose :: Some kinds of patientsmay be overdose withSome kinds of patientsmay be overdose withC/MC/M

small infants having multiple injection during angio cardiosmall infants having multiple injection during angio cardiographygraphy

and adults with cardiac renal or hepatic failure may be givenand adults with cardiac renal or hepatic failure may be givenexcessive dose the result of hyperosmaler effectexcessive dose the result of hyperosmaler effect

Chemotoxoicity :Chemotoxoicity : Toxic of C/M because ofitsintrinsicToxic of C/M because ofitsintrinsicstructurestructure

the electrical changesin the particle of the HOCM and ofthe electrical changesin the particle of the HOCM and ofhexaberix (sodiummeglumine ioxaglate ) is particularhexaberix (sodiummeglumine ioxaglate ) is particular

importance inintra coronary use the contains are clinicallyimportance inintra coronary use the contains are clinicallymoremore

toxic than anions and sodiumismore toxic thanmegluminetoxic than anions and sodiumismore toxic thanmeglumine


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Anxiety :Anxiety : when C/M reaction as the result of the patientswhen C/M reaction as the result of the patients

fearfear

and apprehension. The high autonomic nervoussystemand apprehension. The high autonomic nervoussystemactivity in an anxious patient will be stimulated furtheractivity in an anxious patient will be stimulated further

whenwhen

the patients experiences the administration of contrastthe patients experiences the administration of contrast

media.media.

When compared with HOCM and LOCM resulted in lessWhen compared with HOCM and LOCM resulted in less

frequent ECG abnormalities and side effects.frequent ECG abnormalities and side effects.

Mechanism of contrast media reaction ContdMechanism of contrast media reaction Contd


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Route of C/M AdministrationRoute of C/M Administration

Intravenous orintra arteriallyIntravenous orintra arterially

ManualManual

Powerinjector e.g. CT, angiographyPowerinjector e.g. CT, angiography

OrallyOrally Barium and TRAZO gastroBarium and TRAZO gastro

Per rectumPer rectum Per vaginalPer vaginal HSGHSG

Directsinto the sinusDirectsinto the sinus


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SafetyPrecautionSafetyPrecaution

Pts history :Pts history : Careful history regarding allergy to iodine anyCareful history regarding allergy to iodine anycontrast agent any drug or food atomcontrast agent any drug or food atom

High risk of ptsHigh risk of pts

Pt with asthma thyroid and cardiac disorderPt with asthma thyroid and cardiac disorder

Pts with chronic seizure , diabetic nephropathy orPts with chronic seizure , diabetic nephropathy ormyelomamyeloma

Hepatic or renal failure impairmentHepatic or renal failure impairment

Pts with metabolic or hematological disorderPts with metabolic or hematological disorder

Unconscious and semi unconscious ptsUnconscious and semi unconscious pts Pts with history of allergy or a previous reaction to aPts with history of allergy or a previous reaction to a

contrast agentcontrast agent

InfantsInfants

Proper hydration of the ptsProper hydration of the pts


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Ptsshould be will hydrated before the administration ofPtsshould be will hydrated before the administration ofC/MC/M

(contrast media)(contrast media)

Emergency equipment :Emergency equipment : emergency resuscitationemergency resuscitationequipmentequipment

and life saving / emergency drug should always beand life saving / emergency drug should always beavailableavailable

during the procedure and in the observation periodduring the procedure and in the observation periodfollowing thefollowing the

exposureexposure

Administration of C/MAdministration of C/M

It is preferable to use glasssyringeIt is preferable to use glasssyringe Pre testing for hypersensitivity reactionismandatoryPre testing for hypersensitivity reactionismandatory

c/mshould always be loaded in the syringe pullingc/mshould always be loaded in the syringe pullingthrough the needle through the rubber cap of the vialthrough the needle through the rubber cap of the vial

One vial to be uses for one pts only repeated use of aOne vial to be uses for one pts only repeated use of asin le vial isnot recommended.sin le vial isnot recommended.


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Total dose and volume should be slowTotal dose and volume should be slow

Select appropriate dosing internal to ensure toSelect appropriate dosing internal to ensure to

complete clearance of contrast media from the bodycomplete clearance of contrast media from the body

Careful observation of pts during and afterCareful observation of pts during and after

administrationadministration The ptsmust be carefully observed during and afterThe ptsmust be carefully observed during and after

administration for at least half an hour asseriousadministration for at least half an hour asserious

delayed adverse reactionmay occurdelayed adverse reactionmay occur

Storage and utilization :Storage and utilization : Should be followed as explainedShould be followed as explainedonon

the pack. Discard the product if there change in colourthe pack. Discard the product if there change in colour


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Advantages of contrast agentAdvantages of contrast agent

Better visualization tissue contrastBetter visualization tissue contrast

Better diagnosis of diseaseBetter diagnosis of disease

Conformation of diagnosisConformation of diagnosis

Disadvantage of C/MDisadvantage of C/M

Discomfort to the pts for contrast introductionDiscomfort to the pts for contrast introduction

Chances of various reactionis possibleChances of various reactionis possible Cost will be additional burden to the patient i.e. costlyCost will be additional burden to the patient i.e. costly


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Advances reaction to contrast mediaAdvances reaction to contrast media

Principles :Principles : Adverse reaction can be reduced for appliedAdverse reaction can be reduced for applied

general principles of all patients. The smallest amount ofgeneral principles of all patients. The smallest amount of

contrast agent possible should be used for each producecontrast agent possible should be used for each produce

allowing at lest 48 hours to elapse between procedureallowing at lest 48 hours to elapse between procedure

AdverseAdverse reactionreaction toto contrastcontrast agentagent rangerange fromfrom aa mildmild

inconvenience,inconvenience, suchsuch asas itchingitching associatedassociated hiveshives toto aa lifelifethreateningthreatening emergencyemergency.. RenalRenal toxicitytoxicity isis wellwell knownknown

adverseadverse

reactionreaction associatedassociated withwith II..VV.. contrastcontrast materialmaterial


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Contrast Media rise to various reactionContrast Media rise to various reaction

Minor reaction :Minor reaction : It includes UTCARIA, sneezing , flushing ,It includes UTCARIA, sneezing , flushing ,

nausia vomiting, tinnitus, violent becomes restlessnessnausia vomiting, tinnitus, violent becomes restlessness

usuallyno treatment is required only to reassure the patientusuallyno treatment is required only to reassure the patientissufficentsissufficents

Intermediate Reaction :Intermediate Reaction : Development of patches all over theDevelopment of patches all over the

body, nausia, vomiting and severe. Patient urge to coughbody, nausia, vomiting and severe. Patient urge to coughbloodblood

pressure raise up a down patients feeds drowsy, patientspressure raise up a down patients feeds drowsy, patients

sweating or feel cold and severingsweating or feel cold and severing

Need:Need: Treatment but no risk to the patientsTreatment but no risk to the patients


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Major Reaction :Major Reaction : Bronchospasm, Laryngeal oedema patient pale,Bronchospasm, Laryngeal oedema patient pale,

sweating thready pulse may loss, consciousness. Respiratorysweating thready pulse may loss, consciousness. Respiratory

failure as the pts can be stop breathing convulsion and coma allfailure as the pts can be stop breathing convulsion and coma all

these required prompt and efficient treatment if to survive thethese required prompt and efficient treatment if to survive the

patientpatient

First line treatment of acute reaction to contrast mediaFirst line treatment of acute reaction to contrast media

Nausia/ vomitingNausia/ vomiting TransientTransient supportive treatmentsupportive treatment

Severe protectedSevere protected Appropriate antiemetic drugsshould beAppropriate antiemetic drugsshould beconsidered.considered.

Urticaria :Urticaria :

Scattered transient : Supportive treatment and observationScattered transient : Supportive treatment and observation

Scattered protected : Appropriate H1 antihistamineScattered protected : Appropriate H1 antihistamineintramuscularly orintravenouslyshould be consideredintramuscularly orintravenouslyshould be considered

Profound : Consider adrenaline (0.1Profound : Consider adrenaline (0.1-- 03mg) Transmuscularly03mg) TransmuscularlyIn adults 0.01mg/kgIn adults 0.01mg/kg


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Bronchospasm :Bronchospasm :

Ox y gen bymark (6Ox y gen bymark (6--10 1/min)10 1/min)

B2 Agoinst metered dose inhaler (2B2 Agoinst metered dose inhaler (2--3 deep3 deepinhalation )inhalation )

AdrenalineAdrenaline

Normal blood pressureNormal blood pressureIntramuscular 2mgIntramuscular 2mg

In pediatric patientsIn pediatric patients 0.01mg/kg upto 0.3mg max0.01mg/kg upto 0.3mg max

Decreased blood pressureDecreased blood pressureIntramuscularIntramuscular 0.5ml adrenaline0.5ml adrenaline

In pediatric patients 0.01mg/kg intramuscularlyIn pediatric patients 0.01mg/kg intramuscularly


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Laryngeal edema :Laryngeal edema :

Oxygen bymask (6Oxygen bymask (6--10 1/min)10 1/min)

Intramuscular adrenaline 0.5ml for adults ; repeat asIntramuscular adrenaline 0.5ml for adults ; repeat as

needed.needed.

Hypotension :Hypotension : Isolated hypotensionIsolated hypotension

Elevate patients legsElevate patients legs

Oxygen bymaskOxygen bymask Intravenous fluidIntravenous fluid rapidlynormal saline or lactated ringersrapidlynormal saline or lactated ringers

solutionsolution

If unresponsiveIf unresponsive adrenaline 0.5ml intramuscularly repeatadrenaline 0.5ml intramuscularly repeat

asneededasneeded Vagal reaction (hypotension and brody cardia)Vagal reaction (hypotension and brody cardia)

Elevate patients legsElevate patients legs

Oxygen bymask ( 6Oxygen bymask ( 6--10 1/min)10 1/min)

Atropine 0.6Atropine 0.6--10mg intravenously repeat ifnecessary after10mg intravenously repeat ifnecessary after33--5 minute to 3m total 0.04 m /k in adults5 minute to 3m total 0.04 m /k in adults


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Pedatric patietns give 0.02 mg/kg i.v. max 0.6mg perPedatric patietns give 0.02 mg/kg i.v. max 0.6mg perdose) repeat necessary to 2mg totaldose) repeat necessary to 2mg total

Intravenous fluidsIntravenous fluids rapidlynormal saline or lactatatedrapidlynormal saline or lactatatedringersolutionringersolution

Generalized anaphylactoid reactionGeneralized anaphylactoid reaction

Call for resuscitation teamCall for resuscitation team

Suction airway asneededSuction airway asneeded

Elevate patients legsif hypotensiveElevate patients legsif hypotensive

Oxygen bymask ( 6Oxygen bymask ( 6--10 1/min)10 1/min)

Intramuscular adrenaline 0.5ml in adults repeat asIntramuscular adrenaline 0.5ml in adults repeat asneeded. In pediatric patients 0.01mg/kg to 0.3mg maxneeded. In pediatric patients 0.01mg/kg to 0.3mg maxdosedose

Intravenous fluids (normal saline, lactated ringers)Intravenous fluids (normal saline, lactated ringers)

HH11 Blocker eg diphendramine 25Blocker eg diphendramine 25--50mg intravenously50mg intravenously


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Treatment guide line ofmajor reactionTreatment guide line ofmajor reaction

Erythema, uticaria and angio neurotic oedemaErythema, uticaria and angio neurotic oedema

It occurin the form of giant urticaria oedema of theIt occurin the form of giant urticaria oedema of thelarynax may occur causing. Respiratory obstructionlarynax may occur causing. Respiratory obstruction

and difficultyin respirationand difficultyin respiration Treatment oxygenshould be administrated in all casesTreatment oxygenshould be administrated in all cases

25mg phenerganis givenintravenouslysupplemented25mg phenerganis givenintravenouslysupplementedby the 0.5ml adriline solutioninsevere cases 100mg ofby the 0.5ml adriline solutioninsevere cases 100mg of

hydrocortisone is given.hydrocortisone is given. Pulmonary oedmaPulmonary oedma Initially patientsis giveInitially patientsis give 02ma in02ma in

addition to hydrocortisone 100mg i.v. (intravenous)addition to hydrocortisone 100mg i.v. (intravenous)given fallowed by 10 to 20ml of aminophylene by slowgiven fallowed by 10 to 20ml of aminophylene by slow

i.e. injectioni.e. injection


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Hypotensive shock :Hypotensive shock : 02 is given theni.v. drip assoon as02 is given theni.v. drip assoon as

possible prednisolone 20 mg or hydrocortisone 100mg ispossible prednisolone 20 mg or hydrocortisone 100mg is

givengiven

i.v.i.v.

Cardiac arrest :Cardiac arrest : The hospital emergency teammust be callThe hospital emergency teammust be call

immediately and the patient ventilated by artificialimmediately and the patient ventilated by artificialrespirationrespiration

with brook airway.with brook airway.

The usual additional measure applied to emergencyThe usual additional measure applied to emergency

teamteam

applied for administration of adrenaline 1.0ml solution 1%applied for administration of adrenaline 1.0ml solution 1%

Sodium bicarbonate drip and 5 to 10ml calcium chloride inSodium bicarbonate drip and 5 to 10ml calcium chloride in

dosedose


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Extravasation of contrast materialExtravasation of contrast material

Tissue damage ismore likely to occur with extravasationTissue damage ismore likely to occur with extravasation

ofof

ionic contrast material then with nonionic content agentsionic contrast material then with nonionic content agentsControl :Control : Applicationice packs and heating pad, andApplicationice packs and heating pad, and

elevation are used to alleviate the symptoms associatedelevation are used to alleviate the symptoms associated

withwith

extravasation of contrast materialextravasation of contrast material


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ConvulsionConvulsion

With the help ofintubations and positive pressureWith the help ofintubations and positive pressurerespirationrespiration

Initially thiopentone tone is administrated byslow i.v.Initially thiopentone tone is administrated byslow i.v.injection.injection.

First line of emergency drugs and instruments whichFirst line of emergency drugs and instruments whichshould be examinationshould be examination

Avil 2ml antihistamineAvil 2ml antihistamine allergic reactionallergic reaction

Hydrcortinsteroid fast actionHydrcortinsteroid fast action-- multipurpose life savingmultipurpose life saving AdrenalineAdrenaline Reduced secretion from bronchial andReduced secretion from bronchial and

salivary glandsalivary gland

DiazopamDiazopam Sedative (anti convulsive)Sedative (anti convulsive)

BuscopanBuscopan AntispasmodicAntispasmodic


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AtropineAtropine

Normal salineNormal saline

Dextrose solutionDextrose solution

Antihistamine H1Antihistamine H1 Suitable forinjectionSuitable forinjection

BitaBita -- 2 against meter dose inhaler2 against meter dose inhaler

i.v. fluidsi.v. fluids normal saline or ringersolutionnormal saline or ringersolution

SphygmomanometerSphygmomanometer

OneOne

Oxygenshould be administrated in all casesOxygenshould be administrated in all cases

StethoscopeStethoscope

Drip standDrip stand

Emergency trollyEmergency trolly

Emergency trollysettingEmergency trollysetting

Ventilator defibrillatorVentilator defibrillator


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contrast media and adverse effects

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