Benadryl and Inapsine

Specialties Emergency

Published

So, we've had a physician start working in our ER again (he worked in our ER regularly before I started working there). I have gotten used to his orders, which don't vary much, although they continually confuse me as to what therapy we are providing. One such order is Benadryl and Inapsine which he tends to order the majority of the time.

Migraines, abdominal pain, extremity pain... Really, anything related to pain, they get 50 mg Benadryl and 2.5 mg Inapsine (sans EKG order). Now, I've seen Benadryl and Inapsine work wonders for migraines. It's a very good combo. Although I'm not quite sure I understand the indication for it on abdominal pain or really anything other than migraines or perhaps an allergic reaction. It seems like all we are doing is completely snowing the patient to where they are so heavily sedated they can't feel pain. I'm a fan of relieving pain, not sedating the patient to the point of them not know what year they are in.

Anyone have any thoughts on this? He's a very solid doc and is great to work with, but I really haven't been able to get a straightforward insight into why we are ordering this so much. I understand it on a drug seeker, which we did today. But we also gave it to a vag bleed that recently had a c-section.

Anyway, any thoughts on this would be appreciated. Curious to see what my fellow ER nurses think.

I would just ask the doctor why he's ordering it. Just don't be confrontational about it, obviously. Most doctors love to do teaching and he must have a reason.

I smile and agree that it does make annoying people less annoying. It also tends to curb the appetites of those in withdrawl... Those who are in severe pain will let you know when this doesn't work. At which point you will approach the doctor for further pain medication.

On 8/1/2012 at 2:25 AM, brainkandy87 said:

Well, while I tend to order EKG's behind his back (he thinks it's a waste of an EKG), I think the TDP association with Inapsine is overblown (statistically), as there have been like, what? Nine reported cases ever? With that being said, I've seen the extremely rare Zofran effect of prolonging a QT and throwing someone into v-fib and killing them. Someone in their mid 30's. So I don't risk it.

The doc isn't that old. He's probably in his 40's. And he is much of the school of "it makes annoying people less annoying." I love working with him for that reason, as he gets them in and out and cuts all the BS. I just have my limits to how much annoying-ite I'll administer to someone. The other day, a guy got the Benadryl/Inapsine combo and was freaking out saying he wanted something else before going to CT, to which the doc told me to give him 5 more of Inapsine. I did not comply, LOL.

We don't have a true pain protocol in our ER. The docs are OK with us giving Toradol, Tylenol, Ibuprofen, ASA, but nothing narcotic related without them seeing the pt. A few of the docs trust certain nurses' discretion and let them give, say, 0.5 mg Dilaudid or 50 mcg Fentanyl. Something small but enough to take the edge off until the MD sees them. I think I've seen this doc give narcotic pain meds once.

Anyway, thanks for the input everyone. I've just been curious about it lately.

Wait you don't ever give Zofran because you saw a rare scenario one time where somebody had an adverse reaction to it?

 

Specializes in EM.

From the literature:

Richards 2011 Droperidol for Chronic Pain JEM.pdf (emupdates.com)

Cole 2020 The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department

Search either in Google for some good info.

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