Benadryl contraindicated with a Asthma history?

[NYAEMT-I]

Hey all,

I got a quick question.. Last night we were going over Analphylaxis in AEMT-CC class and the instructor said that benadryl wasn't good for Asthmatics. Can anyone tell me why? Both my kids are asthmatics and have had it before with no problems..

Thanks,

NYAEMT-I [/font:56dcda6054]

[Dustdevil]

Diphenhydramine has anticholinergic properties which can create at least two significant problems in asthmatics. First of all, it can prevent concurrently used beta agonists (salbutamol, etc...) from working properly, which is of especially major concern in those taking maintenance doses. And second, it has an atropine-like drying effect on the patient, resulting in thickened and less manageable secretions, and subsequent congestion. Unless an asthmatic patient is in full blown anaphylaxis and circling the drain, diphenhydramine is just bad ju-ju all around.

[AZCEP]

Unless you want to glue their lungs completely shut, leave the Benadryl alone.

Keep in mind that not everyone will respond the same way to the same drug. Some will have a full blown cholinergic crisis when you give them Benadryl, some will nearly stop breathing from the CNS depression. I would recommend you looking these things up for yourself though. Easier to remember the information if you do some work to get it.

[kevkei]

I'm happy to see others aware of these propeties of Benadryl and how it and Gravol are quite alike :wink:

[firefighter523]

Our region's medical director was in the class one day, and that question came up. He said that " in the event someone is having the "big episode", the benifits outway the contraindications for the short term trip to the ED, and he said to us that we SHOULD give it.

[NYAEMT-I]

Thanks everyone...

My kids have been on benadryl for years for their allergies.. Now that I think about it, they do seem to have more asthma problems when they are on it, but I just attributed it to the allergies..

Thanks,

NYAEMT-I

[Dustdevil]

Our region's medical director was in the class one day, and that question came up. He said that " in the event someone is having the "big episode", the benifits outway the contraindications for the short term trip to the ED, and he said to us that we SHOULD give it.

Absolutely. Unfortunately, it is a dangerous practice in the world of poorly educated paramedics who don't think they need all this "book learnin'" They translate the above comment into meaning everybody with an itch should get Epi, Benadryl, and SoluMedrol like it is some sort of allergy cocktail. They don't take the time or mental effort needed to determine who is having the "big episode" and who is just breaking out in a rash. Consequently, many people end up getting Benadryl inappropriately.

Another reason why you have to make independent clinical decisions about your patient and not just treat symptoms by cookbook protocols.

[firefighter523]

In our region, you must have a HR @120 or greater, along with a pressure @ or below 90, and exibiting signs of allergic reaction, ie.. flushing, edema, resp distress to get the epi and benadryl. We don't carry steriods in the field.

[Nate]

Proper patient assessment should tell you the answers you need to know. If the patient just has a little bit of the hives, however has good PMS/Vitals/ETC..and has asthma...I would be more concerned with making sure they stayed calm so they don't have an asthma attack. Remember the goal of EMS isn't to push a drug every time you turn a wheel, it is to provide the best appropriate care to the patient.

So if you had a patient that was having an allergic reaction you might want to ask them, "have you ever had any reactions to benadryl?" and "have you ever taken benadryl before?" If you do feel that the patient should need it, then you can always start low with 25mg and work your way up to 50mg should the patient need it. Remember you can always add, but you can't subtract drugs from the patient.

[bandaidpatrol]

Consider it's sedative effect also. On a patient that is getting exhausted from their asthmatic episode, sedation is not going to be on your side. May cause the need for intubation.