spenac Posted December 11, 2008 Share Posted December 11, 2008 Yup I definitely got this one, but I'll let the basics solve it. Pertinent negatives and positives have confirmed it. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 11, 2008 Author Share Posted December 11, 2008 I am not so sure that you do have it Spenac. It is not that I doubt your skill or ability; the reason I am not sure is that the two questions that would lead you directly to the answer or atleast confirm your hunch, have not been asked yet. From what has been deciphered so far, there are at least two totally diagnosis that this patient could have (and probably one or two more that I never thought of, which I am sure the docs will point out at the end). P.S. This is rarely seen by EMS in the field. In my 20 years, I think I saw it 3 times in the field and 2 more times working part-time in the ER. So if you guys are having a hard time, dont feel bad. Link to comment Share on other sites More sharing options...
ERDoc Posted December 11, 2008 Share Posted December 11, 2008 I might have missed it, but can you tell us any and all medications that she has taken recently? Link to comment Share on other sites More sharing options...
p3medic Posted December 11, 2008 Share Posted December 11, 2008 In addition to the Doctors question, does she have any difficulty with speech, mouth opening, or eye movement? Link to comment Share on other sites More sharing options...
firedoc5 Posted December 11, 2008 Share Posted December 11, 2008 This is one of my problems that forced me out of Fire/EMS. I don't know if it's the same with her, but I'll keep quiet of the two things I'm thinking about. On top of my problem, I did have menengitis in 2000. Talk about bad. Ask whether or not she had ever heard her mother say that it was a difficult birth when she was born. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 11, 2008 Author Share Posted December 11, 2008 She normally only takes birth control pills and a multivitamin. When she went to the infirmary yesterday they gave her a 50mg IM injection of Phenergan, and she was prescribed: Phenergan 25mg tabs PO and Lomotil (her flu symptoms consisted of fever, N&V, general body aches, and diarrhea). She has taken her medications as directed. She denies taking any drug, alcohol, herbal medicines, or stimulants. She in not allergic to any medications. Link to comment Share on other sites More sharing options...
spenac Posted December 11, 2008 Share Posted December 11, 2008 Yes Link to comment Share on other sites More sharing options...
Kaisu Posted December 11, 2008 Share Posted December 11, 2008 distonic reaction to phenergan? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 12, 2008 Share Posted December 12, 2008 total subluxation of c3 and c4 ha ha Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 12, 2008 Author Share Posted December 12, 2008 Go Kaisu go, you are correct. It is a Phenothiazine Reaction. Although the normal reaction involves dystonic and extrapyramidal reactions involving the tongue or facial muscles, it can also affect the neck muscles. Another common reaction is a psychosis where you find the patient with a "wild animal gaze" in their eyes, in a delusional state. Phenergan and Compazine are both phenothiazines, as well as many psych meds (that arent used as much anymore) like Stelazine. It can occur from normal dosage or overdosage. It can be treated with a single dose of Benadryl, but can often require several dosages to resolve all symptoms. If you were guessing Torticollis, that would also be a good guess, but the recent ingestion of a phenothiazine should point you to this diagnosis. http://emedicine.medscape.com/article/814632-overview Link to comment Share on other sites More sharing options...
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