Test 3 - ACR handout Reaction Card

CONTRAST EXTRAVASATION

Elevate arm (heart level), apply cool compress, remove rings. Observe.
Consider surgical consultation for decreased perfusion, sensation, strength, active range of motion, or increasing pain.

HIVES/DIFFUSE ERYTHEMA

1. Observation; monitor vitals q 15 min. Preserve IV access.

2. If associated with hypotension or respiratory distress then considered
   Anaphylaxis:
   - O2 6-10 L/min by face mask
   - IVF 0.9% NS wide open; elevate legs > 60°
   - Epinephrine 0.3 mL of 1mg/mL IM (or auto-
   injector) OR Epinephrine 1 mL of 1mg/10mL
   (0.1 mg/mL) IV with slow flush or IV fluids
   - Call 911 or CODE BLUE

3. If ONLY skin findings but severe or progressive may consider Benadryl 50 mg PO, IM, IV but may cause or worsen
   hypotension.

HYPOTENSION WITH TACHYCARDIA (ANAPHYLAXIS)

1. Preserve IV access, monitor vitals q 15m

2. O2 6-10 L/min by face mask

3. Elevate legs > 60°

4. IVF 0.9% NS wide open

5. Epinephrine 0.3 mL of 1mg/mL IM (or auto-injector) OR Epinephrine 1 mL of 1mg/10mL (0.1 mg/mL) IV with slow flush
   or IV fluids

6. Call 911 or CODE BLUE

HYPOTENSION WITH BRADYCARDIA

1. Preserve IV access; monitor vitals

2. O2 6-10 L/min by face mask

3. Elevate legs > 60

4. IVF 0.9% NS wide open

5. Atropine 0.6-1.0 mg IV if refractory

6. Consider calling 911 or CODE BLUE

LARYNGEAL EDEMA (INSPIRATORY STRIDOR)

1. Preserve IV access, monitor vitals
2. O2 6-10 L/ min by face mask
3. Epinephrine 0.3 mL of 1mg/ mL IM (or
auto-injector) OR Epinephrine 1 mL of
1mg/10mL (0.1 mg/mL) IV with slow flush
or IV fluids
4. Call 911 or CODE BLUE

BRONCHOSPASM (EXPIRATORY WHEEZE)

1. Preserve IV access, monitor vitals
2. O2 6-10 L/min by face mask
3. Beta-2 agonist inhaler 2 puffs; repeat x 3
4. If not responding or severe, then use
Epinephrine 0.3 mL of 1mg/ mL IM (or
auto-injector) OR Epinephrine 1 mL of
1mg/10mL (0.1 mg/mL) IV with slow flush
or IV fluids
5. Call 911 or CODE BLUE