Benadryl iv push rate

Comment

Author: Admin | 2025-04-28

Have an IV – most headache patients don’t need labs or IV fluids so no reason to start one routinely and a lot of even severe headaches are suitable for fast track. But they just don’t seem to work PO.APAP/NSAIDsI make sure the patient is up to their appropriate daily dosing of acetaminophen or ibuprofen; with appropriate consideration of contraindications, they might make a difference so why not? PO ibuprofen is likely as effective as ketorolac, and getting a shot doesn’t seem to have a placebo effect (if nothing else, this study is worth reading for the amazing design [REF]; summarized in an accompanying editorial on placebos [REF]).SteroidsSteroids don’t fix the headache today but they decrease recurrence in some patients. I don’t give them to everyone, but for patients who get headaches in groups, have been having headaches for a while, or are just miserable enough, I give 10mg of dexamethasone.No diphenhydramineDiphenhydramine doesn’t work for headaches [208 patient RCT, REF].Diphenhydramine doesn’t prevent metoclopramide-associated akathisia [REF; REF] (which in my experience, is much less common than the literature describes). Midazolam has some effect for prophylaxis [REF], but the rate of akathisia is low enough that I don’t think it’s worth the risks (or extending LOS due to zonking out the patient). [n.b. the same for avoiding prophylaxis for ketamine sedations; REF] If the patient gets akathisia [or an emergence reaction], then I give midaz.I’ve heard people suggest diphenhydramine works by knocking out the patient and as any migraine sufferer knows, the best treatment is probably sleep, but the evidence suggests that diphenhydramine just doesn’t add much.That being said, I pick my battles and I don’t knock it our of nurses hands or reprimand the residents every time or even fight with patients if they really think it helps. But never push IV Benadryl – it gets you high [REF].No fluidUnless the patient has been vomiting a lot or has another reason to be volume down, there is little reason to give IV fluids [REF], and in my experience, it locks the patient’s LOS into at least however long the bag takes

Add Comment