chbare Posted May 5, 2006 Author Share Posted May 5, 2006 Dustdevil, I could not have given any better advice. Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted May 5, 2006 Share Posted May 5, 2006 Sorry I did not post earlier, I worked last night and slept in a little. Thanks ERDoc for not giving it away. No Botox injections, he has received Haldol in the past without problems, no Hx. of TCA use, 02 Sat on room air is 86%, BGL-129mg/dl, B/P-80/44, Pulse-110-130 and weak, and a rectal temp is 105.3 F. The nurse is a new grad LPN and stated that about an hour after giving the Haldol injection she found the patient like this, she thought he might have had a seizure and called 911. You insert a nasal airway and begin PPV with a bag valve mask at 15 LPM, you note there is a lot of airway resistance and it is very difficult to bag the patient. Anything else? Take care, chbare. I wouldn't know what else to do other than reposition head or perhaps try a different airway. My guess on what happened is extrapyramidal syndrome as a result of the antipsychotic. The resistance to ventillations might be a result of upper airway muscles tightening. I'm not sure what I could do about it, except increase the O2 concentration and transport. Link to comment Share on other sites More sharing options...
chbare Posted May 6, 2006 Author Share Posted May 6, 2006 AnthonyM83, you notice that in addition to his contracted board like appearance, his chest wall muscles and jaw muscles are contracted and pretty tight as well. You do not insert an OPA because of the clenched jaw. The Nurse also tells you that the patients temp is up to 106 F. You continue bagging after repositioning the airway, but note it is still very difficult to bag the patient. AZCEP, you establish an IV and administer 25 mg of benadryl IVP. You do not note any significant change in the patients condition. On a side note; your transport time to the ER is 30 minutes. Any thing else? Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted May 6, 2006 Share Posted May 6, 2006 On a side note; your transport time to the ER is 30 minutes. Any thing else? Call medical control!! 8) Link to comment Share on other sites More sharing options...
AnthonyM83 Posted May 6, 2006 Share Posted May 6, 2006 Hmmm. I don't think I'll really be able to prevent the root problem, but I can try minimizing the symptoms. Undress patient, ice packs in joint areas, cool towels on forehead. I can't give anything for the fever (I'm a Basic and his airway isn't great). Can't think of how I might unclench his jaw (I'm guessing massaging or ticking him wouldn't work?)... I guess like ERDoc says, call for some help. Are there treatments to reverse this...something the psychiatrist who prescribed the Haldol could give him if he's still in the facility somewhere? Link to comment Share on other sites More sharing options...
ERDoc Posted May 6, 2006 Share Posted May 6, 2006 Anthony, before we start talking treatment, let's talk diagnosis. You are on the right track, but just haven't quite hit the nail on the head. Link to comment Share on other sites More sharing options...
AZCEP Posted May 6, 2006 Share Posted May 6, 2006 Serotonin syndrome? Link to comment Share on other sites More sharing options...
TechMedic05 Posted May 6, 2006 Share Posted May 6, 2006 Sounds like...Neuroleptic Malignant Syndrome? Link to comment Share on other sites More sharing options...
chbare Posted May 6, 2006 Author Share Posted May 6, 2006 TechMedic05, correct you got the diagnosis. NMS is a rare complication of neuroleptic medications such as haldol. (especially haldol) I believe it occurs in up to 1% up people who take neuroleptics. It can occur after the fist dose of medicine or in someone who has been on the medication for several years. The syndrome is thought to be a result of dopamine antagonization of the nigrostriatal pathway. Hyperthermia is thought to be a result of a blockade in the hypothalamus. S/S include muscle rigidity, (lead pipe rigidity) severe hyperthermia, altered mentation, and inability of the autonomic nervous system to adequately regulate hemodynamic status. (B/P, and HR will not be WNL) How will we treat this patient? AnthonyM83, you are doing good, this is a nightmare call for the EMT-B. Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted May 6, 2006 Share Posted May 6, 2006 Anthony, before we start talking treatment, let's talk diagnosis. You are on the right track, but just haven't quite hit the nail on the head.Well, if I had to narrow it down the EPS, I'd say neuroleptic malignant syndrome and acute dystonia...but I still wouldn't know what to do with that. I'm assuming I'm missing something... Was the medication administered properly (mentioned it was a new LVN)? Link to comment Share on other sites More sharing options...
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