As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.

https://www.youtube.com/watch?v=2krwEbm5hBo

[Video via Larry Mellick’s excellent youtube channel]

Anyone working in any ED for any length of timee will have seen this – either from someone using an illicit substance and appearing at triage or in a poor young woman, 30 mins after your treatment for her migraine.

common with anti-emetics (metoclopramide/prochlorperazine) and anti-psychotics though the full list of potentials is huge.

pathophysiolgy is to do with dopamine in the basal ganglia (blockade of central dopaminergic receptors and some other mechanisms I struggle to follow)

Harwood-Nuss has a nice table of associated agents drugs that might be used illicitly: cocaine/ketamine/bupropion/dextromethorphan bizzarely both diphenhydramine and diazepam, (agents that are often used to treat dystonia) are on the list. Even propofol gets a mention

Tardive dyskinesia is more severe and usually with long term use of anti psychotics

drug or alcohol abuse is thought to be a predisposing factor

Look at the mandible the neck and the eyes – these are the commonest areas affected. Can affect the whole body

reactions can be delayed up to 5 days if starting a new drug

give an antimuscarinic to fix it where I’ve worked this has always been procyclidine elsewhere diphenhydramine and benztropine are commonly suggested agents

IV route seems to be significantly quicker in action than IM.

Harwood-Nuss suggests oral meds for a few days to prevent recurrence

Reference:

Harwood-Nuss 5th Edition, pg 1501

[featured image CC license, Wikimedia Commons, James Heilman, MD]