Contrast Reaction Note (Imaging)

Note Information

(Do not infer facts not observed or reported. For safety-critical fields—agent, dose, onset time, treatments—enter "Unknown/Not documented" if unavailable. Use 24-hour time throughout.)

Date/Time of Note: [date and time]

Author: [name, credentials]

Location: [imaging modality area]

Patient: [per system standard]

Study/Exam: [name and accession if available]

Supervising Radiologist: [name] – [present / contacted remotely]

Event Summary

[2–4 sentence narrative summary including: contrast type and route; timing of symptom onset relative to injection; top 2–4 manifestations; severity classification; reaction phenotype; key interventions; outcome/disposition]

Contrast Exposure

Agent: [name, class, concentration] (If unknown, enter "Unknown – see contrast log/MAR.")

Route/Dose: [IV / IA / other]; [volume administered] (If contrast was not administered, document "Contrast not administered" and state reason.)

Administration Time: [start time]

Premedication: [yes / no] (If yes, list agents and timing.)

Relevant History: [prior contrast reactions, asthma/atopy if known at time of exam]

Reaction Assessment

Onset Time: [absolute time] ([interval post-injection])

Classification: [Allergic-like / Physiologic / Mixed/Unclear] – [Mild / Moderate / Severe] (Assign only when supporting findings are documented.)

Key Findings: [specific signs and symptoms supporting classification; relevant negatives; patient quotes for subjective symptoms; progression: improving / stable / worsening]

Anaphylaxis Criteria: [clinical features prompting designation] (Include only if labeled or treated as anaphylaxis; otherwise omit.)

Alternate Etiologies: [brief differential] (Include only if plausible alternatives such as vasovagal, anxiety, or aspiration; otherwise omit.)

Vitals & Monitoring

• At recognition: [time] – BP [value], HR [value], RR [value], SpO2 [value], O2 delivery [method]
• After intervention: [time] – BP [value], HR [value], RR [value], SpO2 [value], O2 delivery [method]
• At disposition: [time] – BP [value], HR [value], RR [value], SpO2 [value], O2 delivery [method]

(If vitals were not obtained, state "Vitals not obtained" with reason.)

Interventions & Response

• [time] – [medication/treatment], [dose], [route]; [immediate response]
• [time] – [non-medication intervention]; [immediate response]

(List each intervention on a separate line. Include non-medication measures such as positioning, oxygen, IV access, or code activation. If no medications administered, state "No medications administered.")

Response & Course: [symptom trajectory: improved / resolved / persisted]; [time to improvement]; [recurrence during observation: yes / no]; [imaging exam: completed / modified / aborted]

Disposition & Future Precautions

Disposition: [discharged home / sent to ED / admitted / returned to complete exam]

Observation Duration/Location: [duration and location]

Condition at Handoff: [stable / symptom-free / ongoing symptoms / oxygen requirement]

Handoff To: [receiving clinician/team] (If transferred; otherwise omit.)

EHR Allergy Update: [agent added to allergy list with reaction type and severity] (Use agent-specific entry; avoid generic labels such as "iodine allergy.")

Future Contrast Recommendations: [For allergic-like: recommend avoidance of culprit agent, consider allergy referral for moderate/severe. For physiologic: note premedication generally not indicated, document technique modifications if any. Reference institutional protocol if premedication recommended. Note if extended observation or IV access maintenance recommended.]

Ordering Provider Notified: [yes / no]

Safety Event Report Filed: [yes / no]

Author Signature: [electronic signature per system standard]