Whereas a large percentage of the paramedics recognized classic anaphylaxis, a very small percentage recognized atypical anaphylaxis. Less than half chose epinephrine as the initial drug of choice, and most respondents were unable to identify the correct route/location of administration. This survey identifies a number of areas for improved education.

Skill-based, perception, or judgment errors were observed in more than 1 of 20 cases. No singular strategy was used with 100% accuracy.

A case of prehospital anaphylactic shock that presented atypically, without a known exposure, is discussed. Anaphylaxis is a potentially life-threatening allergic reaction that requires prompt recognition and aggressive treatment. While there is little diagnostic dilemma (specifically used in the conclusion section of this paper) in the recognition and management of "classic" presentations of anaphylaxis there is likely a need for further education of prehospital providers, as well as emergency physicians, on how to recognize atypical cases of anaphylaxis. These cases can be equally severe, with potentially fatal consequences if missed. The diagnosis and management of anaphylaxis are reviewed, as well as barriers that providers encounter in diagnosing uncommon presentations.

This article discusses a case of antipsychotic-induced, focal lingual dystonia causing airway obstruction that was managed completely in the out-of-hospital environment by emergency medical services (EMS) providers. With the ever-increasing use of antipsychotic medications by the general population, it is important for EMS providers and emergency medicine physicians to be aware of rare presentations of dystonic reactions that can sometimes be life-threatening when they involve the lingual, pharyngeal, or laryngeal musculature. This article identifies the medications most likely to induce dystonic reactions, risk factors that predispose individuals to the development of dystonia, and the pathophysiology behind these adverse reactions. It also discusses differential diagnoses to consider, and emergent treatment options.