Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

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).