Contrast medium reaction - Revision history

Mikael Häggström: /* Evaluation */ Better

2019-11-05T13:59:45Z

Evaluation: Better

Mikael Häggström: /* Documentation */ Specified

2019-02-05T17:05:36Z

Documentation: Specified

Mikael Häggström: title

2019-01-14T11:08:53Z

title

Mikael Häggström: /* Documentation */ Or grading

2019-01-09T17:41:48Z

Documentation: Or grading

Mikael Häggström: /* Evaluation */ +Severity grading

2019-01-09T17:39:40Z

Evaluation: +Severity grading

Mikael Häggström: Linked

2018-12-13T07:04:52Z

Linked

Mikael Häggström: /* Evaluation */ Replaced with CC-BY

2018-12-03T20:38:11Z

Evaluation: Replaced with CC-BY

Mikael Häggström: Border

2018-12-03T20:36:23Z

Border

Mikael Häggström: sized

2018-12-03T20:35:10Z

sized

Mikael Häggström: More anatomically correct

2018-12-03T20:34:48Z

More anatomically correct

@@ Line 13: / Line 13: @@
 ==Evaluation==
-[[File:Hives on back.jpg|thumb|180px|Hives]]
+[[File:Urticaria near navel.jpg|thumb|180px|Hives]]
 Initial evaluation can be done according to an ABCDE approach:<ref name=SURF/>
 * Airway: Stridor? Swollen tongue?

@@ Line 199: / Line 199: @@
 ==Documentation==
-Document where it can easily be seen when planning subsequent exams:
+All allergic reactions should be documented, and anaphylactic reactions should be documented so that it shows clearly when planning subsequent exams:
 *Brand or type of contrast agent.
 *Symptoms and their severity, or overall severity grading and most worrisome symptoms.
 ==Prevention==

@@ Line 23: / Line 23: @@
 ===Severity grading===
 {|class="wikitable"
-! Severity<ref name=sffa>{{cite web|url=http://www.sffa.nu/wp-content/uploads/2015/12/Anafylaxi_sept_2015.pdf|Anafylaxi - svårighetsgradering <nowiki>[</nowiki>Anaphyaxis, severity grading<nowiki>]</nowiki> (Table 1)|website=Swedish Association for Allergology|author=Anaphylaxis group}} 2015</ref> !! Skin<ref name=sffa/> !! Eyes and nose<ref name=sffa/> !! Mouth and GI tract<ref name=sffa/> !! Skin<ref name=sffa/>Airways !! Circulatory<ref name=sffa/> !! Mental<ref name=sffa/>
+! Severity<ref name=sffa>{{cite web|url=http://www.sffa.nu/wp-content/uploads/2015/12/Anafylaxi_sept_2015.pdf|title=Anafylaxi - svårighetsgradering <nowiki>[</nowiki>Anaphyaxis, severity grading<nowiki>]</nowiki> (Table 1)|website=Swedish Association for Allergology|author=Anaphylaxis group}} 2015</ref> !! Skin<ref name=sffa/> !! Eyes and nose<ref name=sffa/> !! Mouth and GI tract<ref name=sffa/> !! Skin<ref name=sffa/>Airways !! Circulatory<ref name=sffa/> !! Mental<ref name=sffa/>
 |-
 ! Non-anaphylactic allergic reaction
@@ Line 205: / Line 205: @@
 ==Prevention==
 {{Main|Prevention of contrast medium reaction}}
-Before a contrast CT of a patient with known allergic-like or unknown-type of contrast reaction to the same class of contrast medium (such as iodinated), the American College of of Radiology recommends premedication with a glucocorticoid, preferably starting 12 or 13 hours before contrast administration.<ref>{{cite web|url=https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf#page=11|Page 9 in: Manual on Contrast Media|website=American College of Radiology, Committee on Drugs and Contrast Media|accessdate=2018-08-25}} Version 10.3. 2018. ACR </ref>
+Before a contrast CT of a patient with known allergic-like or unknown-type of contrast reaction to the same class of contrast medium (such as iodinated), the American College of of Radiology recommends premedication with a glucocorticoid, preferably starting 12 or 13 hours before contrast administration.<ref>{{cite web|url=https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf#page=11|title=Page 9 in: Manual on Contrast Media|website=American College of Radiology, Committee on Drugs and Contrast Media|accessdate=2018-08-25}} Version 10.3. 2018. ACR </ref>
 {{Bottom}}

@@ Line 201: / Line 201: @@
 Document where it can easily be seen when planning subsequent exams:
 *Brand or type of contrast agent.
-*Symptoms and their severity.
+*Symptoms and their severity, or overall severity grading and most worrisome symptoms.
 ==Prevention==

@@ Line 20: / Line 20: @@
 * Disability: Altered level of consciousness?
 * Exposure: Hives?
 ==In severe hives and progressive angioedema<ref name=SURF/>==

@@ Line 8: / Line 8: @@
 *Summon an '''anesthesiologist'''
 }}
-In case of a '''contrast medium reaction''', anaphylaxis is a more severe allergic reaction whose diagnostic criteria generally include low blood pressure and/or respiratory distress.<ref name="KimFischer2011">{{cite journal|last1=Kim|first1=Harold|last2=Fischer|first2=David|title=Anaphylaxis|journal=Allergy, Asthma & Clinical Immunology|volume=7|issue=Suppl 1|year=2011|pages=S6|issn=1710-1492|doi=10.1186/1710-1492-7-S1-S6}}</ref> In anaphylaxis, intramuscularly administered adrenaline is the most important initial therapy.<ref name=SURF/> Also, an '''anesthesiologist''' or corresponding clinician on duty should be summoned. A '''peripheral venous catheter''' is needed for the administration of IV fluids.<ref name=SURF/> '''Oxygen saturation''', '''pulse''' and '''blood pressure''' are monitored.<ref name=SURF/>
+In case of a allergic reaction to '''[[contrast media]]''', anaphylaxis is a more severe allergic reaction whose diagnostic criteria generally include low blood pressure and/or respiratory distress.<ref name="KimFischer2011">{{cite journal|last1=Kim|first1=Harold|last2=Fischer|first2=David|title=Anaphylaxis|journal=Allergy, Asthma & Clinical Immunology|volume=7|issue=Suppl 1|year=2011|pages=S6|issn=1710-1492|doi=10.1186/1710-1492-7-S1-S6}}</ref> In anaphylaxis, intramuscularly administered adrenaline is the most important initial therapy.<ref name=SURF/> Also, an '''anesthesiologist''' or corresponding clinician on duty should be summoned. A '''peripheral venous catheter''' is needed for the administration of IV fluids.<ref name=SURF/> '''Oxygen saturation''', '''pulse''' and '''blood pressure''' are monitored.<ref name=SURF/>
 '''Document''' the incident to avoid repeat reactions.

@@ Line 3: / Line 3: @@
 |author2=
 }}
-[[File:Intramuscular site of adrenaline.jpg|230px|right]]
+[[File:Intramuscular site of adrenaline.jpg|230px|thumb]]
 {{Nutshell|In a more severe reaction:<ref name=SURF>Unless otherwise specified in lists and table: {{cite web|url=http://www.mastcellssjukdom.se/wp-content/uploads/2015/12/Nationella_rekommendationer_%C3%B6verk%C3%A4nslighetsreaktioner_kontrastmedel__PDF_2014-10-17.pdf|title=Hypersensitivity reactions against contrast media - Swedish Society of Uroradiology [Swedish: Överkänslighetsreaktioner mot kontrastmedel – SURFs kontrastmedelsgrupp] ], 2014-10-17}}</ref>
 *'''Adrenaline''' shot, 0.3-0.5mg in adults, given intramuscularly.