What immediate management steps should be taken for a patient diagnosed with NMS in a primary care setting?

Immediate management of neuroleptic malignant syndrome (NMS) in a primary care setting involves urgent recognition, cessation of all neuroleptic or dopamine antagonist medications, and rapid referral to secondary care for specialist management and monitoring.

Initial steps include stopping the causative agent immediately to prevent progression of the syndrome, as NMS is a life-threatening emergency characterised by hyperthermia, muscle rigidity, autonomic instability, and altered mental status ¹ (Perry and Wilborn, 2012).

Supportive care should be initiated promptly: ensure airway patency, provide oxygen if hypoxic, establish intravenous access for fluid resuscitation to correct dehydration and maintain renal perfusion, and monitor vital signs closely ¹ (Perry and Wilborn, 2012).

Cooling measures to reduce hyperthermia should be started, such as removing excess clothing and applying cooling blankets or fans, but avoid aggressive cooling methods that may cause shivering ¹.

Because NMS can rapidly deteriorate, immediate transfer to hospital is essential for further management including possible intensive care support, administration of specific pharmacological treatments such as dantrolene or bromocriptine, and monitoring for complications like rhabdomyolysis and renal failure ¹ (Perry and Wilborn, 2012).

In summary, the primary care clinician’s role is to recognise NMS early, stop offending drugs, provide initial supportive care, and arrange urgent hospital admission ¹ (Perry and Wilborn, 2012).