Question

The Emergency room Physician had ordered a CT of the Chest abd. and pelvis on an 35 yr. old Female MVA patient that has recently arrived by EMS. Indication for the exam: chest and Upper abdomen pain, gross hematuria. The ordering Dr. has called you on the phone and is suspecting a liver laceration.  

• The patient has a 24 Gauge Antecubital IV and is on the way to the CT suite.
• Please list which labs (if available) you would review prior to scanning this patient.  
• This is a metformin patient. The patient had taken metformin a few hours earlier. Please list any concerns you may have regarding this drug and any post scan instructions you might give to the patient.
• This female patient had a negative pregnancy test. However, the patient does breastfeed her infant child. What post IV contrast instructions would you give to the patient?
• Should you administer oral contrast for the patient to drink prior to the CT scan?

Answer 1

1. Blood test done prior to Contrast CT scan is Blood urea nitrogen and creatine level in blood.It is done to ensure renal function status for the excretion of contrast.

2.If patient need contrast based CT Metformin drug should be discontinues 48 hours prior to procedure.In IV administation of iodinated contrast ,metfoemin intake can leads to lactic acidosis.Metfoemin excretion primarly taken through kidneys,it it continues after the onset of renal failure result in toxic accumulation of this drug.

3.Do not start breast feeding sufden after the procedure.Wait for 24- 48 hours.Express and dicard the milk during taht period.Drink plenty of fluids for teh excretion of contradt.

4.Before procedur oral contrast is given.If oral contrady ia giving wait for 90 minutes ,since it reaches the abdomen.