Benadryl

benadryl

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.

***

dystonia

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.

***

Diphenhydramine (Benadryl)

Class: Antihistamine
H1 blocker

Action: Blocks histamine receptor sites

Indication: Systemic anaphylaxis
Drug induced extrapyramidal reactions

Contraindication: None with emergency use

Precaution: Asthma

Side effect: Sedation
Hypotension

Dose: 25 -50mg

Route: IV push, may also be given IM

Pedi Dose: 1mg/kg

1 Comment

  • It’s also handy when you’re giving morphine to that patient with an iffy, borderline blood pressure, or perhaps a bit dehydrated.

    The vasodilation that results from morphine administration is a pure histamine reaction, and you can blunt the potential hypotension pretty effectively with Benadryl.

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Peter Canning

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  • Comments
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30
    Joseph Eriksen
    The Ideal Medic
    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
    2015-03-24 19:37:25
    Shawn McCormick
    The Ideal Medic
    I totally agree. To me those make great paramedics. I work as a Operation Supervisor and encourage teamwork/backup whenever the situation calls for it. I encourage feedback from a difficult call my crews responded to. 1) they have the chance to recall the events that took place and they may self evaluate the call. 2)…
    2015-03-24 17:14:14
    Sean Fitch
    The Ideal Medic
    Totally agree Peter, For too long I had the same interpretation and like you now, I would by far take your current description.
    2015-03-24 17:05:33
    tom combs - ER doc/author
    The Ideal Medic
    Twenty-five years as an ER doc in level one trauma centers has me in total agreement. I Interestingly what you say regarding paramedics also, in many ways, applies to ER docs. "Tries to learn from each call...puts the patient first." A great post. I salute to your wisdom!
    2015-03-24 17:04:06

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