Reactions to Intravenous Organic Iodine Compounds and Their Immediate Treatment

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You have just completed the injection for an intravenous urogram and your patient is dying! You have a few minutes to reverse this process! You must be ready with the proper drugs and supportive measures and with a plan of action which is vigorous, yet controlled. These preparations must be made even though most patients suffering a reaction will recover without therapy, while some will die in spite of any treatment. You must plan for those who will recover with help but who will die without it. The sequence of events in such a catastrophic response to the contrast medium is unknown. We are powerless to prevent the primary allergic reaction of the host to the foreign substance. We are equally unable to eliminate the products of this reaction, be they histamine or unidentified compounds. It is necessary, therefore, that oxygenated blood be kept circulating until homeostatic mechanisms are effective. A dangerous reaction involves the cardiovascular, central nervous, or respiratory system, or a combination of these. It may occur without warning and become severe in a matter of seconds. In preparation for such an event you must have the appropriate medications at hand and have a plan of action for yourself, your technician, and available professional assistants. This team must be acquainted with the types of reaction to be anticipated and the methods of treatment, and each must know his role. The following is our plan of treatment, with specific drugs listed so that precise dosages can be stated. In practice these drugs and their dosages are to be selected by the individual who will use them. Cardiovascular Reactions “Cardiovascular collapse,” the most common of the severe reactions following the intravenous injection of an iodine compound, requires immediate therapy before anoxia of the brain and heart proves fatal. The following measures are suggested at the first indication of a fall in blood pressure, to be modified by the severity of the reaction but to be continued until the pressure is maintained in a normal range: Step 1: a. (a) Remove all encumbrances, such as an abdominal compression band, etc. b. (b) Give oxygen, with patient in 10- to 20-degrees head-down position. Make sure the airway is clear. c. (c) Call for assistance by a prearranged signal. d. (d) Record blood pressure at first practical opportunity. Step 2: Give Aramine, 2 to 3 mg. intravenously (0.2 to 0.3 c.c.). A jugular or femoral vein may be used if the antecubital veins are collapsed. If the needle used for the original injection is still within the vein, maintain it there, keep it patent with physiological saline in a large syringe with a rubber tubing adapter.