This document discusses excited delirium syndrome, a medical emergency characterized by bizarre and aggressive behavior accompanied by drug abuse. It presents in males in their 30s with psychiatric illness or nudity. Physiologically, it involves tachycardia, tachypnea, hyperthermia and hypertension. Treatment involves rapid identification, de-escalation if possible, physical restraint and monitoring. Medications like benzodiazepines, antipsychotics and ketamine can be given. Supportive care focuses on treating hyperthermia and metabolic acidosis. Patients are at risk of respiratory depression, acidosis or severe hyperthermia.