Excited delirium syndrome in 2013
This topic of excited delirium syndrome has been well covered in the past and I will give you my favourite links to FOAMEd resources in this article.
My intent today is to give an update in 2013 about this condition,particularly as there have been increasing Australian coronial findings using this condition as explanation of sudden death, typically during law enforcement involvement. Also there have been some journal publications in regard to treating this condition in the prehospital setting.
This is the latest Prehospital journal article on the matter:
Professor Anthony Brown ( FACEM , Brisbane) gave this presentation at the 2011 Asia-Pacific Coroners Society meeting
This paper from the St Louis University School of law, highlights the current controversy from a medicolegal framework
This Canadian law Enforcement journal highlights the policing issues in a prehospital setting.
Looking back on my career, I actually recall my first case of Excited delirium syndrome, many years ago. At the time, I diagnosed drug induced psychosis but in reality , looking at the accepted criteria and remembering the case, it was EDS. it was a young man, known to abuse metamphetamines, brought into the ED by police, handcuffed and fighting. I gave him 60 mg IV midazolam total over duration of 15 minutes with virtually no effect. In the end I sedated him with propofol infusion which worked. he got intubated for retrieval. I recall him struggling against the handcuffs and the nurse and I being baffled as to how to manage his agitation, when the midazolam had no effect.
My mate Kane Guthrie gave a good overview along with resources to introduce the topic of EDS to those unfamiliar