Mrs. K had a history of schizophrenia and bipolar disorder. She was in Italy when she began to withdraw, became noncommunicative and entered a catatonic state. She was admitted to a hospital Intensive Care Unit in Florence, Italy.
As the assigned flight nurse, Karen learned that the attending physicians suspected Neuroleptic Malignant Syndrome (NMS), an uncommon but serious and potentially lethal drug reaction. Mrs. K had been removed from antipsychotic medications as treatment indicates and was being treated with antibiotics, anticoagulants and fluids.
Karen researched NMS and selected a proper course of treatment that would assist in Mrs. K's repatriation. Mrs. K suffered elevations in her CPK, WBC and temperature, which are classic findings with NMS. She developed shortness of breath as a result of hypoxia that required substantive ventilatory intervention. Upon arrival at the Florence hospital, Karen requested additional tests to include a VQ scan, chest X-ray, ABGs and additional venous blood work to determine suitability for travel.
NMS patients are at high risk for cardiac arrest, pulmonary emboli, aspiration pneumonia, renal failure or disseminated intravascular coagulation. Medications that are commonly used for flight such as sedatives (promethazine), pro-peristaltic agents (metoclopramide), antiemetics (prochlorperazine) and anesthetics (droperidol) contain neuroleptic properties and are of concern with these patients.
During the entire transport Mrs. K received oxygen, pulse oximetry and cardiac monitoring. Karen provided a full range of critical care medications and complete airway management including intubation if needed and nursing care with q 15-30 min vital signs, as tachycardia, tachypnea, oscillation of blood pressure and hyperthermia are associated with NMS patients.
Critical care nursing dramatically contributed to Mrs. K's international repatriation, and she is currently living a normal and productive life back home.
