Thirty minutes after prochlorperazine 10 mg IM for migraine-… | MyMerci
Medical EmergenciesPA
Question
Thirty minutes after prochlorperazine 10 mg IM for migraine-associated nausea, an adult client develops acute neck stiffness with upward eye deviation. Which is the most appropriate intervention?
1Apply ice to the neck and observe
2Administer diphenhydramine 25-50 mg IV or benztropine 1-2 mg IV/IM for acute dystonia✓ Correct answer
3Administer additional prochlorperazine
4Administer naloxone IV
Explanation
Correct (2): D2 antagonists (prochlorperazine, metoclopramide, antipsychotics) can cause acute dystonia. Treat with IV/IM diphenhydramine 25-50 mg or benztropine 1-2 mg; usually resolves within 15-30 min. (1) Naloxone is for opioid OD. (3) Worsens dystonia. (4) Insufficient — drug treatment needed.
In-depth explanation
Memory Tip Acute dystonia from D2 blockade = first-line diphenhydramine or benztropine. Caution Differentiate from NMS (fever, rigidity, autonomic instability) and TD (chronic).
Clinical scenario
Scenario 26-year-old male received prochlorperazine 10 mg IM in ED for migraine + nausea. 30 min later: torticollis, oculogyric crisis, no fever.