CCASESTUDY
   6 police/security struggling to restrain!   Swearing obscenities, unable to reason with!   Incredibly diaphoretic, &...
   Placed on monitor.   In asystole.   Given 40 mins standard ACLS.   No ROSC!
COD: ExcitedDeliriumSyndrome
 1St documented case 150 years ago   “Fever with Mania”   Around 250 deaths per year in USA   Majority literature/case...
 The term excited delirium, a condition   described as an individual totally out of control, unable to be reasoned with o...
   The typical course of EDS patient involves:     Acute drug intoxication     Hx of mental illness.     Struggle with...
   Males.   Psychostimulant drugs use.   Suspected/known psychiatric illness.   Failure to respond to police.   Unusu...
   Complex & poorly understood.Thought to be from:   Dysregulated dopamine transporters   Elevated heat shock proteins...
   Tachypnea   Tachycardia   Hyperthermia   Hypertension   Acidosis   Rhabdomyolysis
   Dubious reports of taser’s causing death.   Circumstantial evidence only.   Political & social gains would have us t...
   Stop the downward spiral of:     Struggling to exhaustion     Hyperthermia     Acidosis     Cardiac depressionBy a...
   This is a time sensitive disease!It’s both a:  Behavioural emergency!And a  Medical emergency!
P: Psychological issues.R: Recent drug/alcohol use.I: Incoherent thought process.O: Off (taking clothes off) & sweating.R:...
   No “chain of survival”   “Chain of Disaster” – we are the last link!   Team approach     Nurse, Senior Dr, Security...
   Team sport   Enough staff to control individual   Avoid seclusion rooms   Physical restraints till sedation achieve...
 Needs to be prompt and rapid!1ST Line: Benzodiazepines (Midazolam)2ND Line: Antipsychotics (Droperidal) or Ketamine3rd...
Once sedation achieved: Check: Temp, BSL, CK, Lactate and PH. 12 lead ECGHyperthermia (Temp >38.5 risk of MOF): Activel...
   Behavioural & Medical Emergency!   Identify patients at risk!   Require rapid sedation & supportive care for    good...
kaneguthrie@gmail.com
Excited delirium syndrome
Excited delirium syndrome
Excited delirium syndrome
Excited delirium syndrome
Excited delirium syndrome
Excited delirium syndrome
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Excited delirium syndrome

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Presentation to ICEN 2012 on Excited Delirium Syndrome

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  • 28 MALE BIBP
  • Psychostimulant (Amphetamines, Meth, PCP)Failure to respond reflects deliriumNudity related to hyperthermia
  • Excited delirium syndrome

    1. 1. CCASESTUDY
    2. 2.  6 police/security struggling to restrain! Swearing obscenities, unable to reason with! Incredibly diaphoretic, & hot to touch! Unable to do vitals! Given 15 mg IMI Midazalam no effect! 20 mins later still being restrained!Then Stops resisting, quiet, not moving!
    3. 3.  Placed on monitor. In asystole. Given 40 mins standard ACLS. No ROSC!
    4. 4. COD: ExcitedDeliriumSyndrome
    5. 5.  1St documented case 150 years ago “Fever with Mania” Around 250 deaths per year in USA Majority literature/cases – USA Not universally fatal Recognised as a unique syndrome
    6. 6.  The term excited delirium, a condition described as an individual totally out of control, unable to be reasoned with or talkdown, & possessing great feats of strength is somewhat vague & ill defined; but is well known to any police officer, paramedic, or emergency clinician.  Fason, C. & Schneider, G. (2009).
    7. 7.  The typical course of EDS patient involves:  Acute drug intoxication  Hx of mental illness.  Struggle with law enforcement.  Require physical or noxious chemical control measures.  Sudden & unexpected death.  Autopsy fails to reveal cause.  ACEP Excited delirium Taskforce (2009)
    8. 8.  Males. Psychostimulant drugs use. Suspected/known psychiatric illness. Failure to respond to police. Unusual physical strength/stamina. Nudity/inappropriate clothing. Erratic/violent behaviour.
    9. 9.  Complex & poorly understood.Thought to be from: Dysregulated dopamine transporters Elevated heat shock proteins Catecholamine surge Severe acidosis plays a role in cardiovascular collapse.
    10. 10.  Tachypnea Tachycardia Hyperthermia Hypertension Acidosis Rhabdomyolysis
    11. 11.  Dubious reports of taser’s causing death. Circumstantial evidence only. Political & social gains would have us thinking otherwise!Bottom line: Excited delirium causes deathsNot: Taser’s, OC spray or being in custody!
    12. 12.  Stop the downward spiral of:  Struggling to exhaustion  Hyperthermia  Acidosis  Cardiac depressionBy allowing: Gain control – provide sedation/supportive care!
    13. 13.  This is a time sensitive disease!It’s both a:  Behavioural emergency!And a  Medical emergency!
    14. 14. P: Psychological issues.R: Recent drug/alcohol use.I: Incoherent thought process.O: Off (taking clothes off) & sweating.R: Restraint to presence.I: Inanimate objects: violent to-ward shinny or glass objects.T: Tough, unstoppable, superhuman strength.Y: Yelling.
    15. 15.  No “chain of survival” “Chain of Disaster” – we are the last link! Team approach  Nurse, Senior Dr, Security  Monitored area  Rapid sedation is the priority  Use least restrictive restraint method
    16. 16.  Team sport Enough staff to control individual Avoid seclusion rooms Physical restraints till sedation achieved Avoid prone position  Restraint Asphyxia Syndrome
    17. 17.  Needs to be prompt and rapid!1ST Line: Benzodiazepines (Midazolam)2ND Line: Antipsychotics (Droperidal) or Ketamine3rd Line: Rapid Sequence intubationRoutes: IV (preferred), consider IN,IMI, IO
    18. 18. Once sedation achieved: Check: Temp, BSL, CK, Lactate and PH. 12 lead ECGHyperthermia (Temp >38.5 risk of MOF): Actively cool, fluidsRhabdomyolysis: Fluids, IDC.
    19. 19.  Behavioural & Medical Emergency! Identify patients at risk! Require rapid sedation & supportive care for good outcome! Educate your colleagues/EMS/police on EDS!
    20. 20. kaneguthrie@gmail.com
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