School is in Session… Torticolls what now?

Some time ago my partner and I received a call for a person with a possible stroke. We responded lights and sirens and found the patient sitting in a chair in his/her kitchen. His/her chief complaint was that of painful, involuntary neck spasms that had started that day following an injection of Haldol approx. two days beforehand.

The patient was warm and diaphoretic, very anxious, and obviously in pain from the visible neck spasms that were pulling his/her head in odd directions. During my assessment, I wasn’t seeing tremulousness or other involuntary motions and the stroke scale and vitals were normal. I didn’t find any other big red flags either, but I pretty much had zeroed in on the diagnosis when my partner called it right out:

“Sir/Ma’am, it looks like you’re having what is called a “Dystonic reaction” to the medicine they gave you the other day. Sometimes this happens and we can treat it for you with a little injection of Benadryl.”

Holy smart medic that partner of mine is! I was impressed. Yes… I *do* know how to diagnose dystonia and I’m pretty much aware of the medications that can cause a dystonic reaction and/or extrapyramidal symptoms and Haldol is one of the most common drugs that cause them. However I was floored when we got the patient in the ambulance and Mr. Smarty-Pants partner pulled out this little gem:

“Why is my neck doing this?? It hurts!” Asked the patient.

“Well Sir/Ma’am, that’s a condition called “Torticollis” and it can be a reaction caused by these medications. The fix is the same.” Mr. Smarty-Pants partner said as he effortlessly sunk the IV.

What? Holy wow! Now I believe that only 10% of medics can make an across-the-room diagnosis of a dystonic reaction and know how to treat it without looking it up, but to actually be able to pull out the word “Torticollis” and be right about it? I’m not pretending that I didn’t have to look it up on my phone once we got to the ED and dropped the patient off. For the patient’s part, their symptoms had all but disappeared with a 25mg injection of diphenhydramine IV. They felt almost 100% better, probably because we caught it early into symptom onset.

I complimented my partner on his apparently immense cranial capacity and he grunted that it ‘twern’t no thing’ at all. He doesn’t believe me that only about 10% of medics would be able to diagnose dystonia and he shrugged off my compliment about the “torticollis” thing entirely.

So now I’m blogging this to take an informal poll. I know that my blog readers are much more well-versed than the general EMS population out there and will probably carry a higher percentage of knowledge on this topic than would a sample of the general EMS population… (Like 90%) but do you think I’m right on my numbers? Leave a comment so I can prove to him I’m right. My pride could use a boost

  • Christopher

    Everybody knows Torticollis is a ring-shaped, filled pasta, traditionally served in a broth; but you can put a cream sauce or a ragu on it…neck spasms…riiiight!

    • Richard

      Tortellini Yum… 🙂

  • Ambulance_Driver

    I ran a call where the fire medic on scene had dismissed the guy as having “a crick in his neck,” when he was obviously so dystonic he looked like he was tying himself in knots.

    I gave the guy 50 mg Benadryl and cleared it right up, and as we were loading the patient, the fire medic, a Captain, asked me, “Now what was it you called that again? Dys-something?”

    I’ll confess I felt a little smug when I told him, “Yeah, a dystonic reaction to Haldol. Technically, he was suffering from kyphosis, torticollis, tardive dyskinesia and oculogyric crisis… but you can just say ‘dystonia’ if all those big words are too hard to remember.”

  • Eliz.

    A common side effect of Haldol.. other side effect is “the Haldol Shuffle,” named for the distinctive shuffling gait, full body shakes and poor muscle control. I actually didn’t 1st learn of this in medic school, but rather in college in one my favorite courses “Psychology of Criminal Behavior,” taught by a visiting professor who had worked at Rikers Island. She said it was a common issue at Rikers and always kind of stuck with me.