Date Published

November 22, 2013

Updated For

ALS PCS Version ALS PCS Version 5.2

Question:

Question: Regarding Benadryl, in the auxiliary protocol it states that you cannot give Benadryl if the patient has taken a sedative or antihistamine in past 4 hours. This is not, however, indicated in the normal standing order protocol for Benadryl.

I am wondering if this is applicable as well if you arrive on scene with a patient who has taken Benadryl oral prior to your arrival. Do they still meet the protocol to give Benadryl even if they have already taken it? Should I still give it or withhold since they might have an overdose of Benadryl or have both the doses reacting at the same time? Would this also apply to a patient who has taken Gravol prior to EMS arrival as well?

Hope this can be clarified. I feel it's a grey area that most of us don't think about until put in the situation. Thanks.

Answer:

 Great question and thanks for bringing this forward.

Recently the SWORBHP Medical Council has discussed this very topic. Paramedics should not administer Diphenhydramine to a patient who has recently self-administered a dose as you describe above.

Similarly, Dimenhydrinate and Diphenhydramine should not be administered by paramedics to the same patient.

The main concern here would be a cumulative effect from both medications which could result in an anticholinergic excess clinical toxidrome: dry mouth, mild hyperthermia, tachycardia, dilated pupils, CNS changes (confusion/sedation or paradoxical excitation even seizure).

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