Excited Delirium TRAINING AND EDUCATION FOR FIRST RESPONDERS What is Excited Delirium? A condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature and superhuman strength. Key Terms Bells Mania: A condition that manifests with mania and fever in which the patient becomes exhausted due to mental excitement. Dopamine: A catecholamine neurotransmitter produced in several areas of the brain. Neuroleptic malignant syndrome: A condition that causes delirium and death as a result of abrupt withdrawal from psychiatric medication that blocks dopamine re-uptake. Dissociative agents: Medications that produce a trance-like state by causing interruption of cerebral association pathways between the limbic and cortical systems. History, Where did Excited Delirium Come From? 1849 - Luther Bell MD, described the disease that manifested with mania and fever, which later termed as Bell’s mania. Similarly the term neuroleptic malignant syndrome (NMS), is a condition described in the 1960’s which causes delirium and death as a result of abrupt withdrawal from psychiatric medication. Recent evidence supports a common metabolic derangement that may have a genetic component, which increases the risk for certain patients to suffer from excited delirium. Mental Illness or Excited Delirium? INDICATORS FOR AN EXCITED DELIRIUM PATIENT ARE SIMILAR TO ONES EXHIBITED BY A MENTALLY ILL PERSON OR AN OVERDOSE. Signs of Excited Delirium Inability to Concentrate Extreme Restlessness Inability to remain still Flailing Diaphoresis Flushed skin Extreme Tachycardia Shedding of clothes Attraction to glass windows or mirrors Who is at risk for Excited Delirium? Patient Gender Age Behavior Approx. 91 to 99% of The typical age for the Often follows bizarre excited delirium patients patient is usually 35 to 44. behavior. are male. Has a history of long term substance abuse/illegal drugs. Previous history of psychological issues Pathophysiology The initial understanding of excited delirium came through the accumulation of autopsy results that consistently revealed the presence of stimulant drugs and alcohol in the blood of patients with excited delirium. These drugs include cocaine and methamphetamine. However, people with high levels of these drugs don’t always suffer from excited delirium. Likewise, it can occur in individuals without any stimulants in their system. https://youtu.be/bXo-0iFj8Ys Example of Excited Delirium. Responder Safety In the event of an extremely agitated patient, EMS and law enforcement must approach the call as a team, each playing a very important role. EMS must stage at a safe distance until the scene and the patient have been secured by law enforcement. If needed, law enforcement’s response can be augmented with the use of chemical sedation by EMS personnel. Although some EMS systems have embraced and ultimately changed their protocols for the use of chemical sedation to assist law enforcement with the agitated citizen, it is not common practice on a national level. Conclusion It is important to refer to your local protocols for any information regarding safety and treatments available. .