Recognition and treatment of neuroleptic malignant syndrome

NMS remains a serious and unpredictable reaction to central nervous system dopamine blockade. Use of the more recent, flexible definition of NMS will ensure that patients with this syndrome receive prompt effective diagnosis and treatment. Supportive care, discontinuation of the neuroleptic drug, and administration of bromocriptine are the keys to appropriate management. For patients with hypertension, nifedipine may be a useful alternative or adjunctive treatment. Because these patients may not be able to communicate, the role of the emergency nurse includes not only administration of supportive and pharmacologic care but also reassurance that this frightening disorder is treatable, with improvement likely within 1 day.