Dystonic Reaction

 

History:

 

  • Medication allergy/exposure
  • Past history of reactions
  • Past medical history
  • Medication history
    • Antipsychotics
    • Antiemetics
    • Ace inhibitors

 

Significant Findings:

 

  • Involuntary muscle contractions of the face, neck, chest, back and pelvis
  • Deviated pupils
  • Swollen tongue

 

Differential:

 

  • Acute Extrapyrmadial Reaction
  • Akathisia

 

DO NOT use this order if chest pain is thought to be cardiac in origin

 

Treatment:

 

  • Oxygen
  • 12-Lead EKG
  • Initiate IV

 

*SEE PEARLS*

 

  • Versed 1-2 mg IV/IO; may repeart to a max of 4 mg
          • OR

 

  • Ativan 1-2 mg IV/IO; may repeat to a max of 4mg

 

 

  • Normal Saline up to a 1,000 mL to reverse the signs of hypotension.

 

PEARLS:

 

  • Wait 10-15 mintues after Benadryl before administering Versed or Ativan
  • Patients hemodynamically unstable refractory to IV fluids request an order for  Epinephrine 1:10,000 0.5 - 1 mL/0.05-0.1mg
  • Common medication groups that cause dystonic reactions include:
    • antipsychotics: Zyprexa (Olanzapine), Haloperidol (Haldol), Alprazolam, (Xanax), Fluphenazine (Prolixin), Thorazine (Chlorpromazine), Ziprasidone (Geodon)
    • antimetics: Compazine (Prochlorperazine), Promethazine (Phenergan), Hydroxyzine (Vistaril), Metoclopramide (Reglan).