{
"id": "ct-patient-care",
"modality": "CT",
"category": "Patient Care",
"title": "CT Patient Care: Contrast, Reactions and Monitoring",
"minutes": 9,
"slides": [
{
"id": 1,
"diagram": "title",
"heading": "CT Patient Care",
"bullets": [
"21 of 165 scored questions (12.7%)",
"Screening, contrast agents, meds, IV access",
"Reactions, monitoring, consent and infection control"
],
"narration": "Welcome to CT Patient Care. This category is 21 of the 165 scored questions on the CT boards, about 13 percent of the exam. We'll start with screening and lab values, then contrast agents and the medications you'll see in CT. Next comes IV access and power injection, followed by how to recognize and treat contrast reactions. We'll finish with patient monitoring, consent, extravasation and infection control. These are practical questions you already handle every shift, so let's sharpen the details the exam loves.",
"svg": ""
},
{
"id": 2,
"diagram": "screening-checklist",
"heading": "Screening and lab values",
"bullets": [
"Screen: prior reaction, kidneys, metformin, pregnancy",
"eGFR under 30 or acute kidney injury = high risk",
"Biopsy: check PT/INR, PTT and platelets",
"Barium studies after CT; radioactive iodine before contrast"
],
"narration": "Before any IV contrast, screen for a prior contrast reaction, kidney disease, diabetes and metformin use, pregnancy, and thyroid disease. For kidneys, the American College of Radiology, or A C R, prefers the estimated glomerular filtration rate, called e G F R, over creatinine alone. An e G F R under 30, or any acute kidney injury, puts the patient in the high-risk group. Before a biopsy or drain, check bleeding labs: P T and I N R, P T T, and platelets. And scheduling: do CT before barium studies, and do thyroid radioactive iodine work before iodinated contrast.",
"svg": ""
},
{
"id": 3,
"diagram": "osmolality-bars",
"heading": "Contrast agents",
"bullets": [
"Nonionic = lower osmolality, fewer reactions",
"HOCM > LOCM > IOCM; IOCM equals plasma (about 290)",
"Warm to 37 C to lower viscosity",
"Suspected perforation: no barium, use water-soluble"
],
"narration": "Nonionic contrast does not split into charged particles, so it has lower osmolality and fewer side effects than older ionic agents. Rank them: high-osmolar is several times plasma, low-osmolar is about two to three times plasma, and iso-osmolar, iodixanol, matches plasma at about 290 milliosmoles per kilogram. Warming contrast to body temperature, 37 degrees Celsius, lowers viscosity so it flows faster through small catheters. And if bowel perforation is suspected, never give barium. Use water-soluble iodinated contrast instead. Remember, a shellfish allergy is not a specific contraindication.",
"svg": ""
},
{
"id": 4,
"diagram": "medication-table",
"heading": "Medications in CT",
"bullets": [
"Metformin: hold 48 h only if AKI or eGFR under 30",
"Metoprolol slows heart rate for coronary CTA",
"Nitroglycerin dilates coronaries; no with sildenafil",
"tPA only after noncontrast CT excludes a bleed"
],
"narration": "Metformin is a favorite trap. Per A C R, hold it at the time of contrast and for 48 hours after only if the patient has acute kidney injury or an e G F R under 30. Everyone else keeps taking it. For coronary CT angiography, metoprolol, a beta blocker, slows the heart rate, and sublingual nitroglycerin dilates the coronary arteries. Skip nitro with low blood pressure or recent sildenafil or tadalafil. Finally, the clot buster t P A is given for stroke only after a noncontrast head CT rules out hemorrhage.",
"svg": ""
},
{
"id": 5,
"diagram": "iv-gauge",
"heading": "IV access and injectors",
"bullets": [
"18-20 gauge antecubital for 3-5 mL/s",
"Avoid mastectomy side, fistula arm, prior infiltration",
"PICCs and ports only if labeled power-injectable",
"Saline chaser cuts contrast volume and streaks",
"Air embolism: left side down, head down, oxygen"
],
"narration": "For fast injections of three to five milliliters per second, place an 18 or 20 gauge catheter in the antecubital vein. A smaller gauge number means a bigger needle. Avoid the arm on the side of a mastectomy, a dialysis fistula, or a prior infiltration. Never assume a P I C C line or port can take a power injection; it must be labeled power-injectable. A dual-head injector adds a saline chaser, which lowers contrast volume and reduces streak artifact. If you suspect air embolism, turn the patient left side down, head down, and give oxygen.",
"svg": ""
},
{
"id": 6,
"diagram": "reaction-severity",
"heading": "Grading reactions",
"bullets": [
"Mild: limited hives, itching, sneezing",
"Moderate: diffuse hives, bronchospasm, no hypoxia",
"Severe: laryngeal edema, anaphylactic shock, arrest",
"Warmth and metallic taste are physiologic, not allergic"
],
"narration": "A C R grades allergic-like reactions by severity. Mild means limited hives, itching, nasal congestion or sneezing. Moderate means diffuse hives, bronchospasm without low oxygen, or facial swelling without trouble breathing. Severe means laryngeal edema, severe bronchospasm, anaphylactic shock, or cardiopulmonary arrest. Now the trap: a warm flushing feeling, a metallic taste, or brief nausea are physiologic effects, not allergic reactions. They do not need premedication next time. The strongest predictor of a future reaction is a prior reaction to contrast.",
"svg": ""
},
{
"id": 7,
"diagram": "reaction-treatment",
"heading": "Treating reactions",
"bullets": [
"Epinephrine first for severe: 0.3 mg IM of 1 mg/mL",
"Low BP, fast pulse = anaphylactoid: epinephrine",
"Low BP, slow pulse = vasovagal: legs up, atropine",
"Bronchospasm: oxygen and albuterol inhaler",
"Premed: prednisone 50 mg at 13, 7 and 1 h before"
],
"narration": "Epinephrine is first line for severe allergic-like reactions. The adult intramuscular dose is 0.3 milligrams of the 1 milligram per milliliter strength into the outer thigh, and it can be repeated. Low blood pressure with a fast pulse is anaphylactoid, so give epinephrine. Low blood pressure with a slow pulse is vasovagal: elevate the legs, give fluids and oxygen, and atropine if it persists. For bronchospasm, give oxygen and an albuterol inhaler. For a prior reaction, the A C R premed is prednisone 50 milligrams at 13, 7 and 1 hour before, plus diphenhydramine.",
"svg": ""
},
{
"id": 8,
"diagram": "vital-signs",
"heading": "Monitoring the patient",
"bullets": [
"Heart rate 60-100, respirations 12-20",
"SpO2 95-100%; under about 90% needs action",
"Glasgow Coma Scale 3-15; 8 or less is severe",
"Nasal cannula 1-6 L/min, nonrebreather 10-15",
"Keep Foley and chest tube bags below the patient"
],
"narration": "Know your adult normals. Heart rate is 60 to 100 beats per minute, and respirations are 12 to 20 breaths per minute. Oxygen saturation should be 95 to 100 percent; below about 90 percent needs action. The Glasgow Coma Scale runs from 3 to 15, and 8 or less means severe impairment. For oxygen, a nasal cannula delivers about 1 to 6 liters per minute, and a nonrebreather mask about 10 to 15. Keep Foley bags and chest tube drainage below the level of the bladder or chest, and never clamp unless ordered.",
"svg": ""
},
{
"id": 9,
"diagram": "isolation-precautions",
"heading": "Consent, safety and isolation",
"bullets": [
"Provider gets informed consent, not the tech",
"Two identifiers and a time-out before procedures",
"Extravasation: stop, notify, elevate, document",
"Airborne (measles, TB, varicella) = N95",
"C. difficile: soap and water, bleach cleaner"
],
"narration": "Informed consent for a biopsy is obtained by the provider doing the procedure, not by the technologist, and a sedated patient cannot give valid consent. Always use two patient identifiers, like name and date of birth, and hold a time-out before any invasive procedure. For extravasation, stop the injection, notify the radiologist, elevate the arm, and document. For isolation, think M T V for airborne: measles, tuberculosis and varicella need an N 95 respirator. And for C. difficile, alcohol rub fails, so wash with soap and water and clean with bleach.",
"svg": ""
},
{
"id": 10,
"diagram": "summary",
"heading": "Lock these in",
"bullets": [
"eGFR under 30 or AKI = high risk for contrast",
"Hold metformin 48 h only if AKI or eGFR under 30",
"Severe reaction: epinephrine 0.3 mg IM of 1 mg/mL",
"Hypotension + bradycardia = vasovagal: atropine",
"Premed: prednisone 50 mg at 13, 7 and 1 h before"
],
"narration": "Let's lock it in. An e G F R under 30, or acute kidney injury, puts a patient at high risk for contrast-associated kidney injury. Hold metformin for 48 hours only in those same high-risk patients. For a severe allergic-like reaction, give epinephrine first, 0.3 milligrams intramuscular of the 1 milligram per milliliter strength. Low blood pressure with a slow heart rate is vasovagal, so think legs up and atropine. And the A C R premed is prednisone 50 milligrams at 13, 7 and 1 hour before. Now hit Practice this chapter and test yourself.",
"svg": ""
}
]
}