I rate Benadryl 19 out of the 33 drugs we carry.
We use Benadryl as an antihistamine in allergic reactions and anaphalaxis. We can give it IV, IM, and since we just got the pediatric syrup, we can give it PO.
An ED doctor told me once, Epi stops the reaction and Benadryl cleans it up. So while Benadryl is a great drug for allergic reactions, it is not the ultimate life-saver epi is. Also, I have found that quite a number of the allergic reactions I do, the patient has already gotten Benadryl either from a family member or a medical person like a doctor or school nurse. Still I would hate to not have Benadryl in my kit. Like Zofran and Morphine, it is a great comfort drug, making the patient feel so much better.
We also use Benadryl for dystonic reactions. Dystonic reactions are something to see. The person’s neck and face and arms get all contorted and jerked up — its a reaction to certain drugs.
I have probably only done five of these calls in all my years.
Here’s one I did a few years ago called Escaped Mental Patient.
A guy escapes from a mental health floor of a local hospital, hitchhikes to his friend’s house, then sits on the porch waiting for the friend to get home. Suddenly, he starts to feel his neck tighten up, and his face and arms. He can’t move them. Panicking, he staggers out into the road, lurching in and out of traffic, trying to get someone to help him. He thinks he is dying.
Finally someone calls 911 and reports a crazy man wandering in and out of traffic who appears sick or deranged.
When we get there he is very scared and anxious. I ask him what meds he is on, and he says he has been on Haldol for the last four days.
That’s the answer right there. Haldol can cause dystonic reactions, which produce symptoms just like the man is having.
I give him 50 mg of Benedryl IV and within minutes he can move his neck and face and arms.
“I thought I was dying,” he says. “I can’t believe no one stopped to help me. Aren’t people supposed to help others in distress.”
“They probably thought you were an escaped mental patient,” I say.
“I thought I was going to die,” he says.
Another indication we used to use Benadryl for (before we carried Haldol), was adding it to Ativan to calm violent psychs. It didn’t work as well as Haldol.
Action: Blocks histamine receptor sites
Indication: Systemic anaphylaxis
Drug induced extrapyramidal reactions
Contraindication: None with emergency use
Side effect: Sedation
Dose: 25 -50mg
Route: IV push, may also be given IM
Pedi Dose: 1mg/kg