Acute Contrast Reaction: Emergency Treatment Card
Quick-reference companion to the reaction documentation form. Adult & paediatric doses harmonised with the ACR Manual on Contrast Media and Resuscitation Council UK (2021); reaction categories follow the ACR classification, which the ESUR Contrast Media Safety Committee Guidelines 2025 endorse.
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ANAPHYLAXIS: act immediatelyOther reactions: quick guideAfter any moderate / severe reactionANAPHYLAXIS: act immediately
Recognise: sudden onset, rapidly progressing Airway (swelling, hoarseness, stridor), Breathing (wheeze, dyspnoea, hypoxia) and/or Circulation (hypotension, collapse) problems, usually with skin changes (urticaria, flushing, angio-oedema).
- Stop the contrast injection. Call the resuscitation team / cardiac-arrest number.
- Airway, Breathing, Circulation. Give high-flow oxygen (15 L/min, non-rebreathe mask).
- Give IM adrenaline 1:1000 into the anterolateral thigh (dose below). Repeat after 5 minutes if no improvement.
- Position: lie flat and raise the legs (sit up if breathing is the main problem; recovery position if unconscious & breathing). Do not stand the patient up.
- Give a rapid IV fluid bolus of crystalloid (dose below) if hypotensive.
- If no response to repeated adrenaline → treat as refractory anaphylaxis: adrenaline infusion by an expert, continued fluids, seek critical-care help.
| Age | IM adrenaline (1:1000) | Volume |
|---|---|---|
| Adult & child >12 yr | 500 micrograms | 0.5 mL |
| Child 6–12 yr | 300 micrograms | 0.3 mL |
| Child 6 mth – 6 yr | 150 micrograms | 0.15 mL |
| Child <6 mth | 100–150 micrograms | 0.1–0.15 mL |
Other reactions: quick guide
Mild urticaria / itching
Usually self-limited. Observe and reassure. Oral / IM H1 antihistamine (e.g. chlorphenamine, adult 10 mg) for symptom relief if troublesome. Watch for progression.
Bronchospasm / wheeze
Call for help. High-flow oxygen. If the wheeze is severe, getting worse, comes with low oxygen or is part of anaphylaxis → IM adrenaline as above. For other wheeze after contrast, guidelines differ: ASCIA 2026 (New Zealand and Australia) and Resuscitation Council UK 2021 treat sudden wheeze as anaphylaxis and give IM adrenaline first; the ACR and ESUR start mild wheeze, with little or no fall in oxygen, on an inhaled bronchodilator and add adrenaline if it does not settle. Salbutamol by nebuliser or inhaler can be added; it never replaces adrenaline in anaphylaxis.
Isolated hypotension + bradycardia (vasovagal)
Lie flat, raise legs. IV crystalloid. Atropine 0.6 mg IV (repeat to max 3 mg) for symptomatic bradycardia. Distinguish from anaphylaxis (which is tachycardic).
Isolated hypertension / chest pain
Monitor, oxygen, IV access, 12-lead ECG. Treat per local cardiac / hypertensive-emergency protocol. Seek medical review.
Nausea / vomiting
Usually transient. Reassure, slow or pause injection. Anti-emetic if protracted. Protect airway if reduced consciousness.
Contrast extravasation
Stop the injection, raise the limb above heart level and apply cold compresses or ice packs (the ACR and ESUR prefer cold to warm); no routine aspiration, hyaluronidase or steroid injection (ACR). Obtain urgent surgical consultation whenever there is concern for a severe extravasation injury, and specifically for any of: progressive swelling or pain; altered tissue perfusion; change in sensation; skin ulceration or blistering; severe pain; worsening passive or active range of motion (ACR Manual on Contrast Media, current edition). Compartment syndrome is the complication not to miss.
After any moderate / severe reaction
Observe (severe reactions can be biphasic), document on the reaction form, inform the supervising radiologist and referrer, advise the patient, record a recommendation for future contrast, and report to your national pharmacovigilance body (New Zealand: CARM / Medsafe; UK: MHRA Yellow Card; Australia: TGA; USA: FDA MedWatch).
Adult & paediatric adrenaline / adjunct doses per Resuscitation Council UK Emergency Treatment of Anaphylaxis (2021); reaction categories per ACR Manual on Contrast Media and the ESUR Contrast Media Safety Committee Guidelines 2025. Doses are typical examples for adults / children. Always follow your current local protocol and formulary.