Benadryl or epi?

[beannie]

Pt Senerio: Pt comes to floor from ASU. Within minutes the pt's face becomes severely edemetous, voice sounds like a chipmunk, and pt's pressure is 60/40. The question is, which would be most appropriate, epi or benedryl? I would think benedryl for the histamine release, but would epi be more appropriate b/c it appears to be anaphylactic? I had a similiar situation but BP was stable and we used Benedryl. I am a new nurse and would like some expert advice! :) Thank you.

[Noryn]

Wow from that description it almost sounds as if a code needs to be called if the doctor isnt on the floor. That blood pressure, the facial edema, and high pitched voice really really concern me.

In the ER, we would usually give both. Epi SQ and Benadryl IV although with that blood pressure the Benadryl IV may be contraindicated. I would also expect to give Solu-medrol IV and have some fluids ready.

I definately would keep an eye on the O2 sat, and would have respiratory therapy there. The patient also probably needs moved to a floor or unit where they can be monitored closely after being given those meds.

In that situation you may even be giving that epi IV but to answer your question, I would say both for their specific properties.

[CrunchRN, ADN, RN]

Both! With an H2 blocker chaser. Stat!

[meownsmile, BSN, RN]

Yep,, id say both, epi to support blood pressure and benedryl for histamines. I also would think at that point a code for safety, that far gone and the benedry may not act fast enough to keep her from closing up. Ventilator support may be in order until the airway is less restricted.

[beannie]

thank you all! Very clear now!

[TMPaul]

I'd order Epi, Tagamet IV, Decadron IVP, Benadryl (po), O2 and observation until Sxs abated.

Tina, MSN, APRN-BC

Nurse Practitioner

[leslie :-D]

I'd order Epi, Tagamet IV, Decadron IVP, Benadryl (po), O2 and observation until Sxs abated.

Tina Paul, MSN, APRN-BC

Nurse Practitioner

why po benadryl? i'm just thinking much slower acting.....

[TMPaul]

I've already given the IV/IVP meds and am awaiting results from them so I chose po Benadryl because it would take a bit longer to work and I would also wait about 30 minutes or so to give it. By the time the effects of the Benadryl kick in, I have had sufficient time to evaluate the effects of my other meds. I've found that Benadryl IVP can be very sedating (not that I won't use it if necessary) and most of my patients fall to sleep from it.

I've also used liquid Zyrtec (has both antihistamine and antipuretic properties). :)

Tina