Case of the Month
October 2003

The case of the weird-looking patient

You, along with paramedics, are called to evaluate a 40-year-old man who complains of “inability to move my head.” When you arrive you find the man with his head cocked to one side and with a grimace on his face. He looks really weird to you and you begin to think “psychiatric case.”

The patient tells you he saw his doctor yesterday for a gastroenteritis and was given compazine suppositories for nausea and vomiting. He had taken 3 so far today.

Vital signs are normal and you decide to code green the paramedics and call a local ambulance for BLS transport for further evaluation at the local hospital emergency department.

Later that evening while you are at the emergency department you ask doctor about the “weird-looking” patient whom you had seen earlier. He tells you that the patient was having a dystonic reaction (abnormal muscle contractions) to the compazine. In the case of compazine, and other phenothiazine type drugs, it is easy to take too much leading to this adverse reaction. This patient took 3 suppositories, which is 75 mg of compazine — a whopping dose.

Dystonic reactions are very uncomfortable and frightening to the patient (especially if he or she has never experienced one before). This reaction is easily treated with intravenous benadryl or cogentin. Had the paramedics not been code greened they could have completely solved this man’s problem.