Allergy and Anaphylaxis Protocol

Contrast Pre-Treatment Protocol or for Contrast Reaction

The following treatment is based on our protocol as part of the EVT Care orderset:

Pre-Treatment or Treatment in the Event of Allergy: If patient has an identified contrast allergy or has developed signs and symptoms of a contrast reaction, assess airway, notify Stroke team physician STAT and administer:

  • 1) hydrocortisone 200 mg IV x1 dose STAT

  • 2) diphenhydrAMINE 25-50 mg IV X 1 dose then reassess STAT

  • 3) Notify Resuscitation MD - Speak STAT with ED, ICU, Anesthesia Staff/Fellow

  • 4) Patient should go to a monitored setting, ICU or other, Q1H Vitals, In addition to Q1H Neuro-vitals as applicable



  • On the ward - ICU MD: CALL FOR HELP using STAT Page locating x. 4244

  • In ED - Ask for ED Staff Staff - overhead page ED Staff

  • Don't wait for airway compromise - CALL A CODE - if the patient looks like they are deteriorating or are heading for airway compromise:

    • Call a CODE BLUE, call the Emergency line x. 5555

    • If less than a Code Blue, ask for Rapid Response - Rapid Response can be called via Emergency Line as well, x. 5555 "Code Rapid Response".


  • The key medication that is needed in a true anaphylaxis EPINEPHRINE - This medication requires the presence of a resuscitation MD - Either ED Staff MD, ICU MD Staff/Fellow, or Stroke MD trained in Resuscitation


  • Anaphylaxis can quickly deteriorate into an airway emergency. If there are early signs that this patient is in significant trouble and there is a path towards an impending airway, it is prudent to actually call a code blue to get the maximum help possible as soon as possible.

  • If in the emergency department, obtain a STAT request by the emergency physician to see the patient. If on the ward, STAT request by the Icu Fellow or staff to see the patient immediately.

  • If the situation is deteriorating, definitely evoke a CODE BLUE.

  • STOP Any medications for Blood pressure control as they may exacerbate Hypotension - STOP Labetolol infusion or consider stopping it