DOCSLIB.ORG

Utilization of Ketamine for Pain, Excited Delirium, and Procedural

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Utilization of Ketamine for Pain, Excited Delirium, and Procedural 6/29/2018 #FSHP2018 Disclosure Utilization of Ketamine for Pain, Excited • I do not have (nor does any immediate family member have): 1. a vested interest in or affiliation with any corporate Delirium, and Procedural Sedation in organization offering financial support or grant monies for this the Emergent Setting continuing education activity 2.any affiliation with an organization whose philosophy could Daniel Yousef, Pharm.D. potentially bias my presentation Emergency Medicine Clinical Specialist Residency Program Director, PGY-2 Emergency Medicine Jackson Memorial Hospital 1 #FSHP2018 2 Objectives Ketamine Mechanism of Action • Describe the use of ketamine for acute pain in the emergency • Dissociative anesthetic department • Structurally similar to phencyclidine (PCP) • Review the use of ketamine for excited delirium in the pre-hospital setting and emergency department • Unique because it provides sedation and analgesia • Discuss the role of ketamine in procedural sedation and rapid • Exerts sedative and analgesic action primarily through NMDA sequence intubation antagonism • Select an appropriate dosing regimen for ketamine based on route • Also has affinity for opioid receptors and indication for use • Identify challenges regarding ketamine administration by non- physicians #FSHP2018 3 #FSHP2018 4 Ketamine Kinetics Ketamine Contraindications • Onset of action • Package insert states not to give in anyone whom a significant • Intravenous: 45-60 seconds increase in blood pressure constitutes a serious hazard • Intramuscular: 3-5 minutes • Absolute contraindications: • Acute chest pain • Duration of action • Acute global eye injury • Intravenous: 5-15 minutes • Schizophrenia • Intramuscular: 30-45 minutes • Infants and children less than 3 months old • Relative contraindications: • Procedures that will stimulate posterior pharynx • Consider not giving to patients with chronic cardiovascular disease such as heart failure, ischemic heart failure • Glaucoma #FSHP2018 5 #FSHP2018 6 1 6/29/2018 Ketamine Side Effects Ketamine Dosing and Administration • Neurologic: for Pain • Dizziness, confusion, hallucinations, nystagmus, blurred vision • Cardiovascular: • Primarily looked at for acute pain but can also be considered for • Hypotension and hypertension chronic pain in patients who do not want opioids • Tachycardia and bradycardia • Idea is to give a sub-dissociative dose of ketamine • Pulmonary: • Laryngospasm • Dose ranges from 0.1 to 0.3 mg/kg • Hypersalivation • Recommend a dose of 0.3 mg/kg • Gastrointestinal • Suggest mixing dose in 50 mL of normal saline and administering • Nausea/vomiting over 20 minutes • One study in pediatrics found reduced vomiting in patients given ondansetron before ketamine Ann Emerg Med. 2008;52:30-34 #FSHP2018 7 #FSHP2018 8 Ketamine Literature for Pain Ketamine for Excited Delirium • Lots of studies ranging from ketamine vs. opioids to ketamine with opioids and need for rescue opioid therapy • Overall literature suggests ketamine will decrease opioid use and in some situations can manage pain just as effectively as opioids alone • Meta-analysis looking at literature published in 2016 • ACEP policy statement • Safe to give using same procedures as opioids • Does not require intensive monitoring • List a wide variety of potential uses PLoS ONE 11(10): e0165461. https://doi.org/10.1371/journal.pone.0165461 http://www.acepnow.com/article/acep-policy-low-dose-ketamine/ #FSHP2018 9 #FSHP2018 10 Excited Delirium Syndrome EMS Use of Ketamine • “Syndrome of uncertain etiology characterized by delirium, agitation, and hyperadrenergic autonomic dysfunction.” Violent patients can be a danger to • Stimulant abuse or other drugs account for majority of cases EMS staff just as much as the ER staff • Bath salts/synthetic cathinones include methylone, ethylone, and alpha-PVP (Flakka) Patients can be difficult to restrain and keep restrained in moving vehicle • Mortality has been reported to be as high as 8% • Causes of death include hyperthermia and cardiovascular collapse EMS has less staff to restrain a patient • Ketamine has become a popular option due to its quick action and side effect profile • Does not lower seizure threshold • Does not impair heat dissipation J Emerg Med. 2012;43(5):897-905. #FSHP2018 11 #FSHP2018 12 2 6/29/2018 Pre-Hospital Ketamine for Delirium Excited Delirium in the ER • Midazolam along with all other benzodiazepines has a slower onset • If no IV access has been established give 3-4 mg/kg IM when given IM • Can be given into deltoid, buttocks, or thigh • Many EMS protocols give 10 mg of midazolam IM • Recommend using the 100 mg/mL concentration for IM and • Anecdotally in acutely agitated patients on sympathomimetic medications the 10 mg/mL concentration for IV onset of action is too slow and often does not work • Good idea to label the drawer in the automated machine for the 100 mg/mL • Effective ketamine dose reported in literature ranges from concentration “IM use only” and adding a pop-up as well 3-5 mg/kg IM • Physicians are typically used to the 10 mg/mL concentration and may draw up the wrong volume in other indications without proper warnings • I recommend 4 mg/kg IM of total body weight and cap off at 500 mg • Doses less than 200 mg have been associated with treatment failure • When IV access is available recommend starting with 0.5 mg/kg and repeating another 0.5 mg/kg in 2-5 minutes • Paramedics are allowed to give so long as the medical director • Not much literature on IV ketamine for excited delirium has written a protocol allowing for its use Ann Emerg Med. 2016;67:581-587. • Can a nurse administer ketamine in this situation? #FSHP2018 13 #FSHP2018 14 Florida Nursing Stance on Ketamine The Joint Commission Statement • Florida nursing board view is based on intent “Individuals who are privileged to administer sedation must be • Intent is different from indication able to rescue patients at whatever level of sedation or • Ketamine is considered an anesthetic and can only be anesthesia is achieved either intentionally or unintentionally, e.g., administered by a person credentialed in anesthesia when the patient slips from moderate into deep sedation or from deep sedation into full anesthesia.” • If intention is to produce an anesthetic state a registered nurse should not administer the medication • For excited delirium it is being given for agitation and we allow our nurses to give ketamine • Currently our institution is re-evaluating this stance https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQId=1639&StandardsFAQChapterId=74&Pr • We do not allow ketamine to be given by a nurse for procedural ogramId=0&ChapterId=0&IsFeatured=False&IsNew=False&Keyword=&print=y sedation #FSHP2018 15 #FSHP2018 16 Cardiovascular Effects of Ketamine Ketamine for Procedural Sedation • Ketamine both enhances and diminishes epinephrine induced arrhythmias • Can cause both bradycardia and tachycardia, hypertension and hypotension • Ketamine induced cardiac vasospasm can lead to severe hypertension and myocardial infarction or sudden cardiac death • We do not routinely recommend treating ketamine induced hypertension or tachycardia with anti-hypertensives • Treat ketamine induced hypertension and tachycardia with midazolam when feasible Clin Ther. 1980;3:28-32. #FSHP2018 17 #FSHP2018 18 3 6/29/2018 Depth of Sedation Making the Case for Ketamine Minimal Sedation (Anxiolysis) is a drug-induced state during which patients • Ketamine is a favorable choice for procedural sedation for its respond normally to verbal commands. respiratory safety profile • Allows for sedation and analgesia without suppressing the Moderate Sedation/Analgesia (“Conscious Sedation”) is a drug-induced respiratory drive depression of consciousness during which patients respond purposefully • Opioids should not be used during the case, can be given before or after to verbal commands, either alone or accompanied by light tactile stimulation. • Few cases in literature of laryngospasm, or patients being intubated due to over sedation Deep Sedation/Analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully • Main concern is with emergence phenomenon following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired As defined by American Society of Anesthesiologists (ASA) #FSHP2018 19 #FSHP2018 20 Emergence Phenomenon Preventing bad delirium • While the medication is active patient is having delirium or • To avoid bad delirium do not dissociation due to confusion between imaginary and real stimuli administer ketamine alone • This reaction is not emergence phenomenon but is very common • Incidence is as high as 10-20% for • Avoid this by telling patient to focus on happy thoughts monotherapy • Administer with propofol (Ketofol) • Give a benzo such as lorazepam or diazepam 30 minutes before procedure • Prefer to give ketamine and propofol (Ketofol) • Real emergence phenomenon happens after the medication • Give in separate syringes • Administration order based on effects subsides and patient has a momentary confusion from their patient’s vitals dream state • Hypotensive patients start with ketamine, and hypertensive patients • Incidence in literature is less with pediatrics, but changes with age get propofol first • Not recommend to pre-treat pediatric patients with benzodiazepines Am J Emerg Med. 2008;26:985–1028. Ann Emerg Med. 2004;460-71. #FSHP2018 21 #FSHP2018 22 Dosing
Load more

Recommended publications
  • Study of Deaths Following Electro Muscular Disruption
    U.S. Department of Justice Office of Justice Programs MAY 2011 National Institute of Justice Special REPORT Study of Deaths Following Electro Muscular Disruption www.nij.gov Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov U.S. Department of Justice Office of Justice Programs 810 Seventh Street N.W. Washington, DC 20531 Eric H. Holder, Jr. Attorney General Laurie O. Robinson Assistant Attorney General John H. Laub Director, National Institute of Justice This and other publications and products of the National Institute of Justice can be found at: National Institute of Justice www.nij.gov Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov MAY 2011 Study of Deaths Following Electro Muscular Disruption NCJ 233432 John H. Laub Director, National Institute of Justice Findings and conclusions of the research reported here are those of the authors and do not reflect the official position and policies of their respective organizations or the U. S. Department of Justice. The products, manufacturers and organizations discussed in this document are presented for informational purposes only and do not constitute product approval or endorsement by the U. S. Department of Justice. The National Institute of Justice is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance; the Bureau of Justice Statistics; the Community Capacity Development Office; the Office for Victims of Crime; the Office of Juvenile Justice and Delinquency Prevention; and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking (SMART). Study of Deaths Following Electro Muscular Disruption ACKNOWLEDGMENTS The National Institute of Justice gratefully acknowledges the following individuals.
    [Show full text]
  • Ketamine As a First-Line Treatment for Severely Agitated
    American Journal of Emergency Medicine 35 (2017) 1000–1004 Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Original Contribution Ketamine as a first-line treatment for severely agitated emergency department patients☆ Jeff Riddell a,⁎, Alexander Tran b, Rimon Bengiamin c, Gregory W. Hendey d, Patil Armenian c a Division of Emergency Medicine, University of Washington, Seattle, WA, USA b St. Louis University School of Medicine, USA c Department of Emergency Medicine, University of California San Francisco – Fresno, Fresno, CA, USA d Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA, USA article info abstract Article history: Objective: Emergency physicians often need to control agitated patients who present a danger to themselves and Received 30 December 2016 hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the Received in revised form 7 February 2017 time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or Accepted 13 February 2017 in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. Keywords: Methods: We conducted a single-center, prospective, observational study examining agitation levels in acutely Sedation agitated emergency department patients between the ages of 18 and 65 who required sedation medication for Ketamine Agitation acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue med- ication dosing, and changes in vital signs.
    [Show full text]
  • Excited Delirium” and Appropriate Medical Management in Out-Of-Hospital Contexts
    APA Official Actions Position Statement on Concerns About Use of the Term “Excited Delirium” and Appropriate Medical Management in Out-of-Hospital Contexts Approved by the Board of Trustees, December 2020 Approved by the Assembly, November 2020 “Policy documents are approved by the APA Assembly and Board of Trustees. These are . position statements that define APA official policy on specific subjects. .” – APA Operations Manual Issue: As noted in the APA’s Position Statement on Police Interactions with Persons with Mental Illness (2017), in a range of crisis situations, law enforcement officers are called as first responders and may find individuals who are agitated, disorganized and/or behaving erratically. Such behaviors may be due to mental illness, intellectual or developmental disabilities, neurocognitive disorders, substance use, or extreme emotional states. Police responses to calls for behavioral health crises have been known to result in tragic outcomes, including injury or death. The concept of “excited delirium” (also referred to as “excited delirium syndrome (ExDs)”) has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody. Although the American College of Emergency Physicians has explicitly recognized excited delirium as a medical condition, the criteria are unclear and to date there have been no rigorous studies validating excited delirium as a medical diagnosis. APA has not recognized excited delirium as a mental disorder, and it is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM- 5). The DSM-5 recognizes Delirium, hyperactive type, but the symptoms of this condition differ in many ways from the symptoms typically attributed to excited delirium (e.g., superhuman strength, impervious to pain, etc.).
    [Show full text]
  • ACEP Recognizes Excited Delirium Syndrome
    EMERGENCY MEDICINE NEWS Exclusively for EMNow’s ACEP Scientific Assembly Edition: October 2009 ACEP Recognizes Excited Delirium Syndrome By Lisa Hoffman syndrome, said Dr. DeBard, a professor of he American College emergency medicine at Tof Emergency Physi- Ohio State University cians formally recog- College of Medicine and nized excited delirium as a past ACEP speaker a unique syndrome on and board member. Sunday, taking an initial The task force step toward identifying called for identifying its causes and preventing those whose deaths the deaths that can occur might be averted with in these patients. early intervention. And Excited Delirium Syn- that starts with identify- drome (ExDS) has long ing the triad of condi- been the sole purview tions that are the hall- of medical examiners, mark of ExDS: delirium, largely because the syn- psychomotor agitation, drome is often only diagnosed on autopsy. But as Mark L. and phy siological excitation. DeBard, MD, the chairman of the ExDS Task Force, said, A typical ExDS patient usually has acute drug intoxica- ACEP’s approval of the task force white paper allows emer- tion, usually from cocaine, or less often has a serious history gency physicians not only to recognize the syndrome and save of mental illness on multiple medications. Because the syn- lives, but to force it into the consciousness of law enforcement drome is marked by aggressive and erratic behavior — being and emergency medical services. extremely combative and ripping off their clothes, for “I want emergency physicians around the country to know instance — the police often become involved and use physi- that most of the time they’re treating these cases successfully, cal or chemical control measures, sometimes a conducted but this allows the medical community to call it by name,” he electrical weapon (CEW).
    [Show full text]
  • Excited Delirium
    UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Excited Delirium Permalink https://escholarship.org/uc/item/8n55r1kj Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 12(1) ISSN 1936-900X Authors Takeuchi, Asia Ahern, Terence L Henderson, Sean O Publication Date 2011 License https://creativecommons.org/licenses/by-nc/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Review Excited Delirium Asia Takeuchi, MD* * University of California, San Diego School of Medicine Terence L. Ahern, BA† † Keck School of Medicine of the University of Southern California Sean O. Henderson, MD‡ ‡ Keck School of Medicine of the University of Southern California, Department of Emergency Medicine and Preventive Medicine Supervising Section Editor: Shahram Lotfipour, MD, MPH Submission history: Submitted June 17, 2009; Revision received January 4, 2010; Accepted April 1, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium.
    [Show full text]
  • LL. EXCITED DELIRIUM SYNDROME (Exds)
    LL. EXCITED DELIRIUM SYNDROME (ExDS) 1. Initiate General Patient Care 2. Presentation: a) Excited delirium syndrome (ExDS) is a potentially life-threatening condition in which a person is in a psychotic and extremely agitated state. Mentally, the sub- ject is unable to process rational thoughts or to focus their attention. Physically, the body’s systems are functioning at such a high rate that they begin to shut down and fail. When these two factors occur at the same time, a person can act erratically enough that they become a danger to self and to the public. b) History of present illness often includes: (1) Ingestion of a stimulant or hallucinogenic drug (2) Drug/alcohol withdrawal (3) Psychiatric patient who is off of medication c) Signs and symptoms: ExDS is characterized as having a minimum of bizarre and aggressive behavior and one of the above history. The more signs and symp- toms the patient exhibits, the more likely the patient is to have ExDS and the higher the risk for complications. (1) Tachycardia (2) Hypertension (3) High body temperature (4) Dilated pupil (5) Incoherent or nonsensical speech (6) Rapid or inconsistent breathing patterns (7) Paranoia (8) Skin changes: (a) Hot/dry skin (in the anticholinergic patient) (b) Profuse sweating (in the cocaine/MDMA/methamphetamine patient) (9) Shivering (10) Inappropriate removal of clothing (11) Patients who present after receiving multiple TASER or other less lethal energy by law enforcement MANY LIFE-THREATENING MEDICAL EMERGENCIES PRESENT WITH SIMILAR SIGNS OF EXDS. EXAMPLES INCLUDE HYPOGLYCEMIA, HYPOXIA, SEIZURES, HEAD INJURIES, AND SEPSIS. EMS PROVIDERS MUST ALWAYS ASSESS FOR THE POSSIBILITY OF OTHER EMERGENCY MEDICAL CAUSES FOR THE PATIENT’S PRESENTATION.
    [Show full text]
  • White Paper Report on Excited Delirium Syndrome ACEP Excited Delirium Task Force
    White Paper Report on Excited Delirium Syndrome ACEP Excited Delirium Task Force September 10, 2009 Report to the Council and Board of Directors on Excited Delirium at the Direction of Amended Resolution 21(08) EXCITED DELIRIUM TASK FORCE _____________________________________________________________________________ TASK FORCE CHAIR Donald Dawes, MD, FACEP Mark L. DeBard, MD, FACEP, Chair Assistant Professor, University of Louisville Professor of Emergency Medicine Department of Physiology and Biophysics Ohio State University College of Medicine Louisville, Kentucky Columbus, Ohio Attending Physician, Lompoc Valley Medical Center Lompoc, California TASK FORCE MEMBERS Police Officer, Santa Barbara Police Department Jason Adler, MD Santa Barbara, California Emergency Medicine Resident University of Maryland Christine Hall, MD, MSc, FRCPC Baltimore, Maryland Clinical Assistant Professor, Faculty of Medicine University of British Columbia William Bozeman, MD, FACEP Victoria, British Columbia Canada Associate Professor of Emergency Medicine Associate Professor, Faculty of Medicine Director of Prehospital Research Department of Community Health Sciences Wake Forest University University of Calgary Winston Salem, North Carolina Calgary, Alberta Canada Theodore Chan, MD, FACEP Joseph Heck, DO, FACOEP, FACEP Professor of Clinical Medicine Adjunct Professor of Emergency Medicine Medical Director, Dept of Emergency Medicine Touro University – Nevada University of California at San Diego Medical Director, Las Vegas Metropolitan Police Dept. San Diego,
    [Show full text]
  • Episode 2 – Excited Delirium Syndrome
    Episode 2 – Excited Delirium Syndrome Prepared by Dr. Lucas Chartier Excited Delirium Syndrome (ExDS) History: 1849: Description of cases of psychiatric patients developing acute onset of agitation, mania and fever, and suddenly collapsing and dying 1980s: “Fatal excited delirium” described in the literature, in the face of rising cocaine consumption in North America, as a combination of: 1. Acute drug intoxication (often cocaine, but also methamphetamine, PCP, LSD) 2. History of mental illness (especially paranoid schizophrenia & bipolar disorder) 3. Struggle with law enforcement (more severe than anyone anticipates, and intense even when a struggle is futile and self mutilation is a result) 4. Physical, chemical or TASER restraint 5. Sudden unexpected death, with autopsy which fails to reveal a definite cause of death (therefore diagnosis of exclusion) 2009: White Paper Report by the American College of Emergency Physicians’ Excited Delirium Taskforce Clinical features: Typical scenario: obese male in mid-30’s displaying destructive/bizarre behavior leading to call to police in setting of psycho-stimulant drug or alcohol intoxication, with prior psychiatric illness Subset of pts eventually enter a quiescent period (for less than a minute) where they suddenly stop struggling followed by a respiratory or cardiac arrest, for an overall incidence of death of 8% This is a medical emergency necessitating cardiac monitoring and rescusitation, not seclusion in a psychiatric room Possible case definition of excited delirium syndrome (based on
    [Show full text]
  • Excited Delirium and Sudden Death: a Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Frontiers - Publisher Connector MINI REVIEW published: 13 October 2016 doi: 10.3389/fphys.2016.00435 Excited Delirium and Sudden Death: A Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum Deborah C. Mash * Department of Neurology and Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, USA Over the past decade, the excited delirium syndrome (ExDS) has raised continued controversy regarding the cause and manner of death of some highly agitated persons held in police custody, restrained or incapacitated by electrical devices. At autopsy, medical examiners have difficulty in identifying an anatomic cause of death, but frequently cite psychostimulant intoxication as a contributing factor. The characteristic symptoms of ExDS include bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Throughout Edited by: Maria Giovanna Trivella, the United States and Canada, these cases are most frequently associated with cocaine, National Research Council, Italy methamphetamine, and designer cathinone abuse. Acute exhaustive mania and sudden Reviewed by: death presents with behavioral symptoms that are identical to what is described for Karie Scrogin, ExDS in psychostimulant abusers. Bell’s mania or acute exhaustive mania was first Loyola University Chicago, USA Satoshi Eifuku, described in the 1850’s by American psychiatrist Luther Bell in institutionalized psychiatric Fukushima Medical University, Japan patients. This rare disorder of violent mania, elevated body temperature and autonomic *Correspondence: collapse continued to be described by others in the psychiatric literature, but with Deborah C.
    [Show full text]
  • Report 2 of the Council on Science and Public Health
    REPORT 2 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (June 2021) Use of Drugs to Chemically Restrain Agitated Individuals Outside of Hospital Settings (Reference Committee E) EXECUTIVE SUMMARY Objective. The term “excited delirium” (ExD) is controversial and lacks a defined set of behavioral signs and symptoms used to identify a person in distress and in need of urgent medical or psychiatric help. Additionally, several media reports have recently highlighted the use of ketamine and other sedative/hypnotic agents by non-medical professionals to chemically incapacitate a person for a law enforcement purpose, and in many cases, ExD is listed as the reason for the use of a sedative/hypnotic agent. The Board of Trustees has requested that the Council on Science and Public Health study the use of ketamine and chemical restraints in the context of “excited delirium” and report back to the House of Delegates. Methods. English-language reports were selected from a PubMed and Google Scholar search using the text terms “excited delirium,” “delirium,” “fatalities excited delirium,” “excited delirium restraint,” “excited delirium sedatives,” “excited delirium ketamine,” “police ketamine,” “EMS ketamine,” and “crisis response team.” Articles were filtered based on relevance. Additional articles were identified by manual review of the references cited in these publications. Searches of selected medical specialty society and international, national, and local government agency websites were conducted to identify clinical guidelines, position statements, and reports. Results. The assessment, diagnosis, and treatment of ExD remains controversial. Despite a lack of scientific evidence, a universally recognized definition, a clear understanding of pathophysiologic mechanisms, or a specific diagnostic test, law enforcement and EMS personnel are taught that ExD is a potentially deadly medical condition.
    [Show full text]
  • Excited Delirium Syndrome and Conducted Electrical Weapons Adam A
    Regis University ePublications at Regis University All Regis University Theses Fall 2014 Excited Delirium Syndrome and Conducted Electrical Weapons Adam A. Nielsen Regis University Follow this and additional works at: https://epublications.regis.edu/theses Part of the Criminology and Criminal Justice Commons Recommended Citation Nielsen, Adam A., "Excited Delirium Syndrome and Conducted Electrical Weapons" (2014). All Regis University Theses. 215. https://epublications.regis.edu/theses/215 This Thesis - Open Access is brought to you for free and open access by ePublications at Regis University. It has been accepted for inclusion in All Regis University Theses by an authorized administrator of ePublications at Regis University. For more information, please contact [email protected]. Regis University College for Professional Studies Graduate Programs Final Project/Thesis Disclaimer Use of the materials available in the Regis University Thesis Collection (“Collection”) is limited and restricted to those users who agree to comply with the following terms of use. Regis University reserves the right to deny access to the Collection to any person who violates these terms of use or who seeks to or does alter, avoid or supersede the functional conditions, restrictions and limitations of the Collection. The site may be used only for lawful purposes. The user is solely responsible for knowing and adhering to any and all applicable laws, rules, and regulations relating or pertaining to use of the Collection. All content in this Collection is owned by and subject to the exclusive control of Regis University and the authors of the materials. It is available only for research purposes and may not be used in violation of copyright laws or for unlawful purposes.
    [Show full text]
  • Ketamine for Excited Delirium Syndrome
    KETAMINE FOR EXCITED DELIRIUM SYNDROME Gary Andolfatto Attending Physician and ED Research Director, Lions Gate Hospital Assistant Professor, UBC Dept of Emergency Medicine Objectives • Describe the Excited Delirium Syndrome • Discuss the use of ketamine for control of Excited Delirium • Discuss practical use considerations and possible complications Disclosure No financial interests to disclose What is “Excited Delirium Syndrome”? ExDS More than just agitation ExDS - Definition • “A syndrome of uncertain etiology characterized by delirium, agitation, and hyperadrenergic autonomic dysfunction.” (American College of Emergency Physicians Task Force 2009) ExDS - Definition • “A syndrome of uncertain etiology characterized by delirium, agitation, and hyperadrenergic autonomic dysfunction.” • American College of Emergency PhysiciansTask force 2009 • Delirium: a state of mental confusion fluctuating in intensity manifested by: • Disorientation, incoherence, memory disturbance • Hallucinations, delusions, ExDS - Definition • “A state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, hostility, exceptional strength, and endurance without apparent fatigue.” • - Morrison 2001 ExDS – Who gets it? • Usually male • Mean age mid-late 30’s • Sudden onset • Often history of mental illness • VERY often history of psycho-stimulant abuse ExDS – What does it look like? • Unable to concentrate • Extremely restless • Cannot remain still • Flailing • Diaphoretic • Flushed skin • Extreme tachycardia • Shedding
    [Show full text]