ABCD Approach for 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

• A

• 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)

• B

• 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

• C

• 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

D