Contrast Media Administration & Adverse Reaction Management Flashcards
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According to ACR classification, which clinical presentation defines a SEVERE anaphylactoid contrast reaction?
Answer: Bronchospasm, laryngeal edema, or cardiovascular collapse
Severe anaphylactoid reactions are defined by life-threatening airway compromise (bronchospasm, laryngeal edema) or cardiovascular collapse requiring immediate resuscitative intervention.
What is the FIRST-LINE treatment for a severe anaphylactic reaction occurring during cardiac catheterization?
Answer: IM epinephrine 0.3–0.5 mg (1:1000)
Intramuscular epinephrine (1:1000) in the anterolateral thigh is the gold standard first-line treatment for anaphylaxis due to its rapid alpha and beta-adrenergic effects.
A patient develops diffuse urticaria and mild itching 5 minutes after contrast injection with no respiratory or hemodynamic changes. How is this classified?
Answer: Mild anaphylactoid reaction
Cutaneous symptoms (urticaria, pruritus) without airway involvement or hemodynamic compromise are classified as a mild anaphylactoid reaction under ACR guidelines.
During contrast injection, a patient develops bradycardia to 38 bpm, diaphoresis, and hypotension without urticaria or bronchospasm. What is the MOST likely reaction type?
Answer: Vasovagal reaction
Bradycardia with diaphoresis and hypotension in the absence of cutaneous or respiratory symptoms is characteristic of a vasovagal reaction triggered by pain, anxiety, or vagal stimulation.
What is the appropriate treatment for a vasovagal reaction with persistent bradycardia and hypotension during a catheterization procedure?
Answer: Atropine IV and IV fluid bolus
Vasovagal reactions are treated with atropine to reverse vagally-mediated bradycardia and IV fluids to restore preload and blood pressure.
Which patient factor is the STRONGEST predictor of a repeat adverse contrast reaction?
Answer: History of a prior moderate or severe contrast reaction
A prior moderate or severe reaction to iodinated contrast media is the strongest risk factor for recurrence, with repeat reaction rates significantly higher than in the general population.
Which ACR-recommended premedication regimen is used for ELECTIVE contrast studies in patients with a prior contrast reaction?
Answer: Prednisone 50 mg PO at 13, 7, and 1 hour before contrast plus diphenhydramine 50 mg PO 1 hour before
The ACR elective premedication protocol is prednisone 50 mg PO at 13, 7, and 1 hour before contrast plus diphenhydramine 50 mg PO 1 hour before to reduce reaction risk.