Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘orders’ Category

Contrast Nephropathy

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Acute decline in renal function 24-48 hours after expose to contrast agents. Risk factors:

  • Pre-existing renal insufficiency
  • Diabetes mellitus
  • Decreased effective arterial volume (CHF, dehydration, cirrhosis)
  • Patients receiving nephrotoxic drugs (NSAIDS, diuretics)
  • High volume of contrast

Prophylaxis:

  • IVF 24 hours prior, 12-24 hours post
  • For CHF patients, hold diuretics 24 hours prior
  • For DM patients, hold metformin 24 hours prior, 48 hours post
  • Mucomyst 1200mg IV prior to CT or 600 PO BID before and after scan, or
  • Bicarb 3ml/kg/hr x 1hr prior and 1ml/kg/hr x 6hrs afterwards (mix 3 amps in 1L of D5 water, bolus 500cc prior to ct, then 100cc per hour until its gone)
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Written by lmwong

April 4, 2008 at 3:42 pm

Posted in contrast, orders

Contrast Allergy

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  • Symptoms: hives, respiratory, GI
  • “Shellfish or ‘iodine allergy’ is not a contraindication to use of IV contrast and does not mandate a pretreatment regimen” ~ eMedicine.

Pre-medicate for non-emergent studies:

  • Prednisone 50mg PO 13 hours prior# Prednisone 50mg PO 7 hrs prior# Prednisone 50mg PO + Benadryl 50mg PO/IM 1 hour prior

Emergent studies, administer the following meds and wait 15 minutes.

  • 100 mg of Solumedrol I.V.# 50 mg Benadryl I.V.

Written by lmwong

April 4, 2008 at 3:38 pm

Posted in allergy, contrast, orders

Sedation orders

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  • Versed 1-8mg IV prn adequate sedation
  • monitor vitals during and after procedure per protocol.
  • patient may eat when adequately awake.
  • patient may leave when adequately awake.
  • no driving for the remainder of the day.

Written by lmwong

April 4, 2008 at 3:35 pm

Posted in orders, sedation

Cardiac CT order set

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  • check BP and HR q 5-10 mins
  • if HR >75 bpm, give Metoprolol 150mg IV once
  • if HR 65-75 bpm, give Metoprolol 100mg IV once
  • if HR 60-65 bpm, give Metoprolol 5mg PO once
  • check BP 30 minutes and 60 minutes after metoprolol
  • during contrast scan, give SL nitro once
  • may DC home after procedure

Written by lmwong

April 4, 2008 at 3:33 pm

Posted in cardiac ct, orders