Overdose?

[aclsjax]

It was anxiety. All v/s were good.

 

[systemet]

The symptoms being anxiety / psychogenic has to be considered, but can't be the first assumption. From what you described, dystonia seems a reasonable concern. I think benadryl was probably appropriate.

What was the skin condition? She's taching along at 130 bpm with dilated pupils. Is she diaphoretic? What's the temperature? With the muscle rigidity is there a possibility that we're seeing a presentation of serotonin syndrome?

Or, if the skin's dry, have we considered an anticholinergic overdose? A lot of people get pretty messed up taking meds like gravol (dramamine) in excess.

ECG's narrow right? This isn't an early / mild TCA OD presentation? Because you can see stuttering and ticks with these (I assume due to the anticholinergic properties).

What happened with the patient?

 

[NomadicMedic]

No diaphoresis, skin temp was normal. Narrow sinus tach with no ectopy.

I attempted to follow up with no results.

 

[hyperlyeman1]

I wasn't there so it would be hard to totally judge. Any Hx of illegal drugs, that almost sounds like it could be. Also, from my experience, the two dystonic patients I have had both had their heads turned to the side and were smacking their lips violently. Were confused, alert and oriented to name, age and time but nothing else. Sounds to me like anxiety? possibly HP?h34r:

 

[NomadicMedic]

Could be illicit drugs. I hate to stereotype, but the surroundings would lead me down that path. If she had a hx, nobody was telling me about it.

I've seen a dystonic reaction from haldol, and it was a lot more severe than this presentation.

I am also going down the anxiety road, but again... Without follow up info, which I was unable to obtain, I'm in the dark, too.


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- Sent from my iPhone.

 

[systemet]

C
I am also going down the anxiety road, but again... Without follow up info, which I was unable to obtain, I'm in the dark, too.

This is a huge problem, isn't it? You take a patient to the hospital, you want to know a little bit more about their status, and their clinical course, and yet often no one's willing to give out that information. It's a wasted opportunity to learn. Too bad.

 

[lawndartcatcher]

How 'bout serotonin syndrome?

Could be early onset of Serotonin storm - irritability, jerking movements, anxiety. She's on an SSRI and the benzos could have pushed her down that path. Only thing missing is high temp (later sign). Of course, you need a full lab and hospital to really diagnose that.

 

[abckidsmom]

This is a huge problem, isn't it? You take a patient to the hospital, you want to know a little bit more about their status, and their clinical course, and yet often no one's willing to give out that information. It's a wasted opportunity to learn. Too bad.

I just met a medic who had personal business cards made up at vistaprint.com that she hands out to patients and asks them to contact her and let her know what ever happened.

She's pretty smart and on her game, so I'm thinking it probably helps. And with so many patients having her first and last name and the department phone number, it keeps her customer service skills crisp too. All she has are good write-ups in her personnel file...an odd phenomenon.

 

[the_negro_puppy]

I'd guess at anxiety/emotion mixed with perhaps some drugs/meds shes not mentioning. Either way I would be transporting and a keeping a close eye for any changes. There's nothing we could giver her here.

 

[systemet]

I just met a medic who had personal business cards made up at vistaprint.com that she hands out to patients and asks them to contact her and let her know what ever happened.

She's pretty smart and on her game, so I'm thinking it probably helps. And with so many patients having her first and last name and the department phone number, it keeps her customer service skills crisp too. All she has are good write-ups in her personnel file...an odd phenomenon.

That a great idea, at least, in theory. I think, in practice, I'd be a little too nervous to give out any personal information or encourage my patients to contact me after the event. I've just heard too many bad stories.

 

[Ramathorn90]

All V/s stable, hx of anxiety, recent argument with boyfriend. It appears the lights are shining on anxiety in this case. I would snag etco2, a 12 lead, and monitor her sat while making an attempt at coaching her to relax and calm down.

Sent from my T-Mobile myTouch 3G using Tapatalk

 

[NomadicMedic]

Turned out to dystonia related to her severe anxiety issues. Not an extrapyramidal reaction from her meds.


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