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1 Introduction to Emergency Imaging

• Immediate family history of renal insuciency

• Diabetes, collagen vascular disease, sickle cell disease, multiple myeloma, or gout

• Hypertension requiring medication

• Nephrotoxic medications (metformin,

nonsteroidal anti-inflammatory drugs [NSAIDs])

• Further risk stratification is based on eGFR or serum creatinine.

• Category I: eGFR > 60 or serum creatinine < 1.5: These patients are normal and do not require any treatment beyond oral hydration

• Category II: eGFR 30–60 or serum creatinine 1.5–2.0: Oral or intravenous hydration 500–1,000 mL before and after CT examination. IV contrast dose should be limited to 75 mL

• Category III: eGFR < 30 or serum creatinine > 2.0: If an alternative study is not possible, the increased risk of CIN versus the benefits of intravenous contrast for the individual patient should be discussed with the referring clinician and documented in the medical record.

Diabetic Patients Taking Metformin (Glucophage)

If renal insuciency develops after contrast administration, patients are at increased risk of lactic acidosis. Patients taking met-formin should not take it for 48 hours after intravenous contrast administration.

Chronic Hemodialysis Patients (Renal Failure)

• No need for urgent dialysis

• Limit amount of contrast to reduce osmotic load

Moderate Reaction

• Activate medical response team

• Supplemental oxygen

• Epinephrine 1:1,000 IM 0.3–0.5 ml every 5–15 minutes (begin as promptly as possible)

• Diphenhydramine 50 mg IV

• Metaproterenol or Albuterol inhaler for bronchospasm

Severe Reaction

• Activate medical response team

• Epinephrine 1:1000 IM 0.3-0.5 ml

every 5-15 minutes (begin as promptly as possible)

• If response to IM epinephrine is inadequate, give epinephrine IV infusion, 2-10 micrograms/min

• Supplemental oxygen

• Nebulized Metaproteranol or Albuteral for bronchospasm

• Consider endotracheal intubation for airway edema/respiratory failure

• Normal saline bolus 1-2 liters

Hypotension and Bradycardia

• Trendelenberg

• Normal saline bolus 1-2 liters

• Atropine IV 0.6-1 mg to total dose of

2 mg (adults)

Seizure

• Protect airway

Contrast-Induced Nephropathy (CIN)

Risk Factors

Patients with certain underlying conditions are more likely to suer contrast-induced renal injury and should have estimated glomerular filtration rate (eGFR) or serum creatinine levels prior to receiving intrave-nous contrast in order to better assess their risk. This group includes patients with:

• History of renal disease, prior kidney surgery, transplant, or single kidney