St. Emlyn´s - April 21, 2014 by Richard Body
"I’m sure we’ve all seen cases like this. A 25 year old lady walks in to the ED complaining of a swollen tongue. She can’t really talk, seems a bit anxious and is quite tearful. The triage nurse notices that the tongue seems a bit prominent and assumes that this is anaphylaxis. The lady is taken straight to Resus where she’s seen by a junior doc, who promptly gives IM adrenaline, IV hydrocortisone and IV chlorphenamine before calling the anaesthetists in a great hurry. Of course, this makes the lady increasingly anxious. When the anaesthetists arrive they realise that the tongue isn’t actually swollen and everyone calms down, appreciating that the lady must actually be having a panic attack. As she fails to calm down with reassurance and a paper bag the belief that she must be crazy strengthens, which of course makes the situation all the worse.
Eventually, somebody will realise that the lady has been taking metoclopramide for morning sickness in early pregnancy and this is not hysteria – it’s an acute dystonia. Suddenly, with the benefit of hindsight, it’s obvious what’s been happening. Everyone relaxes and we can crack on with getting the lady some treatment."
- Why is it so hard to diagnose acute dystonia?
- How does acute dystonia present in the ED?
- How do you avoid misdiagnosis?
- How should we treat acute dystonia?
- What happens next?
- What's status dystonicus?
- What else might I need to bear in mind?
http://stemlynsblog.org/dystonia-emergency-department/