ABCD Approach for Contrast Reactions

An easy method for assessing and evaluating the treatment course for various reactions patients may experience when receiving contrast intravenously. 

ABCD Approach for Evaluation and Treatment of Contrast Reactions


Airway, Oxygen

Assessment (severity and category of reaction); blood pressure and pulse (necessary); electrocardiogram monitor may be necessary for evaluation of cardiac rhythm

Assistance (call for it)

Access (venous)-secure/improve intravenous line(s) – peripheral or central


Breathing (begin cardiopulmonary resuscitation [CPR] if necessary); use mouth protective barrier

Bag-valve-mask (e.g., “Ambu” bag) or mouth-mask

Begin full resuscitation efforts (CPR) if necessary; call cardiopulmonary arrest response team

Beware of atypical manifestation (e.g., beta-blockers may prevent tachycardic response)


Circulatory assistance: as appropriate, administer isotonic fluid (e.g., Ringer’s lactate, normal saline), infuse rapidly, and may use pressure bag or forceful infusion

Categorize reaction and patient status, Call cardiopulmonary arrest response team if necessary; CPR; continue to monitor

Common denominators: assess cardiac output; capillary leak (third spacing); decreased venous return, decreased peripheral vascular resistance; pulmonary edema


Drug therapies as appropriate

Do: monitor, assess, and reassure the patient; use correct dose (concentration) and route for drugs; push intravenous fluids and oxygen

Don’t delay (call for help, if you need it); don’t use incorrect dose(s) and drugs


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