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
CALL FOR HELP STAT:
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