All doses stated are for adults.

CONTRAST EXTRAVASATION
Immediately stop administration of the contrast. If the contrast was administered through a peripheral IV line, remove the IV cannula. Elevate the affected extremity above the heart. Apply intermittent warm or cool packs to the affected area. Monitor closely for signs of tissue necrosis or compartment syndrome for at least 2 hours(increase swelling or pain over time, blistering, ulceration, induration or other skin changes and altered tissue perfusion and/or changes in sensation.) Surgical consultation may be necessary if a large volume of contrast extravasation occurred(such as 100 cc or more). Instruct the patient to notify staff if there are signs of tissue necrosis or compartment syndrome. Notify the doctor requesting the exam. Follow up the patient in the next few days until resolution of local edema.

HIVES/URTICARIA
Asymptomatic: No treatment. Observe until resolving.
Symptomatic: Secure IV access. Benadryl(Diphenhydramine) 25-50 mg IM/IV over 2 minutes.

DIFFUSE ERYTHEMA
Secure IV access. IV fluids 0.9% Normal Saline or Lactated Ringer 1-2 L rapidly IV.
Mild: Benadryl(Diphenhydramine) 25-50 mg IM/IV over 2 minutes.
Moderate: Methylprednisolone 40-60 mg IV over 2 minutes.
Severe: Epinephrine 0.1 mg/mL(1:10,000) 0.1 mg(1 mL) slowly IV, repeat 0.1 mg(1 mL) IV as needed, up to 1 mg(10 mL) total dose. Call emergency response team.

LARYNGEAL EDEMA
Oxygen by mask at 10 L/min. Secure IV access. Epinephrine 0.1 mg/mL(1:10,000) 0.1 mg(1 mL) slowly IV, repeat 0.1 mg(1 mL) IV as needed, up to 1 mg(10 mL) total dose. Call emergency response team. Methylprednisolone 40-60 mg IV over 2 minutes.

BRONCHOSPASM
Oxygen by mask at 10 L/min. Secure IV access.
Mild: Albuterol (90 microgram/puff), 2 puffs and inhale.
Moderate: Epinephrine 1 mg/mL(1:1,000) up to 0.3 mg(0.3 mL) SQ, repeat 0.3 mg(0.3 mL) SQ as needed, up to 1 mg (1 mL) total dose.
Severe: Epinephrine 0.1 mg/mL(1:10,000) 0.1 mg(1 mL) slowly IV, repeat 0.1 mg(1 mL) IV as needed, up to 1 mg(10 mL) total dose. Call emergency response team.

PULMONARY EDEMA
Call emergency response team. Oxygen by mask at 10 L/min. Secure IV access. Elevate head of bed. Furosemide (Lasix) IV 10 mg/mL 10-40 mg (1-4 mL) IV over 2 minutes. Morphine 1-3 mg IV slowly, repeat every 5-10 minutes as needed. Naloxone(Narcan) 0.4 mg/mL IV 0.4-2.0 mg(1-5 mL) IV if hypotension or respiratory depression occur. Methylprednisolone 40-60 mg IV over 2 minutes.

HYPOTENSION AND BRADYCARDIA
Call emergency response team. Oxygen by mask at 10 L/min. Secure IV access. Elevate legs. IV fluids 0.9% Normal Saline or Lactated Ringer 1-2 L rapidly IV. Atropine 0.1 mg/mL 0.5-1.0 mg(5-10 mL) IV slowly, repeat 0.5-1.0 mg(5-10 mL) as needed, up to 3 mg(30 mL) total dose.

HYPOTENSION AND TACHYCARDIA
Call emergency response team. Oxygen by mask at 10 L/min. Secure IV access. Elevate legs. IV fluids 0.9% Normal Saline or Lactated Ringer 1-2 L rapidly IV. Epinephrine 0.1 mg/mL(1:10,000) 0.1 mg(1 mL) slowly IV, repeat 0.1 mg(1 mL) IV as needed, up to 1 mg(10 mL) total dose.

HYPERTENSIVE CRISIS
Call emergency response team. Oxygen by mask at 10 L/min. Secure IV access. If pulmonary edema, Furosemide (Lasix) IV 10 mg/mL 40 mg (4 mL) IV over 2 minutes.

CARDIAC ARREST
Call emergency response team. Begin CPR. Airway, Breathing, Circulation, Defibrillation.

DIABETIC HYPOGLYCEMIA
Patient is ABLE to swallow safely: Oxygen by mask at 10 L/minute. Secure IV access. Administer oral glucose 2 sugar packets or 15 g glucose tablet/gel or 1/2 cup (4 oz) of fruit juice.
Patient is UNABLE to swallow safely: Oxygen by mask at 10 L/minute. Secure IV access. Dextrose 50% IV D50W 1/2 ampule (12.5 g) IV over 2 minutes. If no IV access, Glucagon 1 mg/mL 1 mg(1 mL) IM/SQ.

SEIZURES
Oxygen by mask at 10 L/minute. Secure IV access. Turn patient on side to help prevent aspiration. Observe, supportive care, protect patient from falling or injury to self. Lorazepam(Ativan) IV 2 mg/mL 2-4 mg(1-2 mL) slowly IV as needed, up to 8 mg(4 mL) total dose.

PANIC ATTACK
Reassure patient. Monitor patient. If necessary, Lorazepam(Ativan) IV 2 mg/mL 0.5-2 mg(0.25-1 mL) slowly IV.

Mayo clinic suggested treatment regimens for contrast reactions.