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Signs of an allergic reaction (Mild, Moderate, Severe):

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Signs of an allergic reaction (Mild, Moderate, Severe):

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- Mild: Limited hives, itching, itchy/scratchy throat, nasal congestion, sneezing, runny nose
- Moderate: Diffuse skin redness, hives, itching, facial edema, throat tightness/hoarseness but no dyspnea, wheezing, bronchospasm
- Severe: Diffuse edema, facial edema with dyspnea, erythema with hypotension, laryngeal edema with stridor and/or hypoxia, wheezing, bronchospasm, anaphylactic shock with hypotension and tachycardia.

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- Can be caused by severe allergic-like or physiologic reactions
- Epinephrine
What to look for:
- Sudden loss of responsiveness
- No normal breathing, or patient is only gasping for air
Start CPR
- Make sure patient is unresponsive before starting CPR
- Yell for help
- Hard and fast compressions at center of chest (100-120/min)
- allow chest to fully recoil
- minimize interruptions in compressions
- Alternate compressions with another trained individual to prevent fatigue
- Use an AED device as soon as it becomes available
- Continue administering CPR until someone with more experience arrives

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- People with history of asthma are more prone to bronchospasm or respiratory compromise
- Patient has a pulse but is not breathing
What to do:
- Establish open airway (use an oropharyngeal or nasopharyngeal airway device if available)
- Supply O2 to achieve blood oxygen levels of 94% or higher
- Monitor pulse as patient may enter cardiac arrest at any point and CPR may need to be started.

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- Pull patient into a private room where O2 and suction is available
- Ensure surroundings are clear and safe and patient won't injure themselves in environment
- Turn patient to their side so they do not aspirate
- Preserve IV and monitor vitals until help arrives
- Administer O2 (6-10 L/min if necessary)

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Hypoglycemia:
- Preserve IV
- Administer O2 (6-10 L/min if necessary)
- Give oral glucose to help raise blood sugar (juice, glucose tablet, sugar packets)
Hyperglycemia:
-  Preserve IV
- Assess patient and if unconscious or unresponsive, call for help
- Check for circulation, airway and breathing
- If necessary, perform CPR

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-  Non-iodinated CM such as Barium Sulfate (uncommon)
- Iodinated CM
- Latex allergies (from latex gloves and latex enema tip)

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- Ensure patient is safe
- Assess degree of injury and next steps (whether vitals need monitoring, patient needs to be admitted, etc)
- Write up report per hospital policy including any witnesses and patient report

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Assess Severity
- Monitor vitals
- Monitor patient and their symptoms
- Send to nursing to evaluate and medicate with Benadryl or Allegra

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- Escape of fluid to surrounding tissue during injection of ROCM
- Pain, burning sensation, swelling and discoloration at site.
What to do:
- Stop injection, remove IV and call nurse or MD
- Elevate limb above heart
- Follow site protocol and either apply warm or cold compress
- File incident report
- Patient to be observed for two hours and followed up with in a few days

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- Happens 48hrs after CM administration
- Serum creatinine rises without explanation
- Diabetes, old age, certain drug interactions, and preexisting renal impairment pose a higher risk for incidence
- Best method of prevention is comprehensive patient analysis to determine renal function and, if necessary, pre- and post- IV fluids
Treatment:
- Stop nephrotoxic drugs/IV contrast
- Hydration
- Patient may require dialysis

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- Change in status/general appearance
- Ability to speak and quality of voice (hoarseness)
- Breathing/Wheezing
- Blood Pressure/other vitals
- Skin color
- Frequently ask patient how they are doing