EMS Medical Emergencies - Excited Delirium

 

Excited delirium is a controversial and complex medical condition that has been associated with certain behaviors and symptoms, often observed in individuals who are agitated, combative, and potentially at risk of harm to themselves and others.

EMS Providers should be aware of the concept of excited delirium and the controversies surrounding its diagnosis in a prehospital setting.

Here are some key points for EMS Providers to consider:

Definition and Presentation: Excited delirium is not officially recognized as a medical diagnosis by all medical authorities. It is typically described as a state of extreme agitation, delirium, and often violent behavior in individuals, which may be associated with drug intoxication, psychiatric conditions, or other underlying medical issues.

The classic presentation may include severe agitation, hyperthermia, combativeness, incoherent speech, hallucinations, increased strength, and a lack of responsiveness to pain.

Controversies: Controversy exists regarding whether excited delirium is a distinct medical entity or if it is a syndrome resulting from other underlying conditions, such as drug intoxication, psychiatric disorders, or medical illness.

Some medical professionals and organizations argue that excited delirium is not a valid diagnosis and is more of a descriptive term for a cluster of symptoms.

Potential Causes: Common causes or contributing factors to the presentation of excited delirium may include substance abuse (especially stimulants like cocaine or methamphetamine), mental health disorders, traumatic brain injury, and medical conditions such as hyperthyroidism.

Management by EMS Providers: EMS providers should prioritize the safety of both the patient and themselves when dealing with individuals who exhibit signs of excited delirium.

The primary goal is to protect the patient from self-harm or harm to others.

Patients may require physical restraint and sedation. However, the use of physical restraints and sedation is a subject of controversy and should be used with caution and in accordance with local protocols and laws.

Immediate Medical Care: Immediate medical attention is essential, and EMS providers should initiate transport to the hospital. These individuals are at risk of severe medical complications, including hyperthermia, cardiac arrhythmias, and rhabdomyolysis.

Documenting Care: Accurate and thorough documentation of the patient's presentation, behavior, interventions performed, and any discussions with law enforcement or other involved parties is crucial for legal and medical reasons.

Legal Considerations: EMS providers should be aware of the legal and ethical issues associated with the management of excited delirium, particularly regarding the use of force, restraint, and sedation.

Ongoing Education: EMS providers should receive ongoing training and education on recognizing and managing agitated and potentially dangerous patients. Additionally, it is important to stay updated on local and regional protocols and guidelines.

EMS providers should prioritize patient safety, provide appropriate care, and be aware of the legal and ethical issues associated with its management.

with law enforcement, mental health professionals, and medical staff is often necessary in these cases.