2015 Trumbull Memorial Hospital Demo

Excited Delirium Excited Delirium

Scene Safety Law Enforcement should always be requested

Only restrain the patient if they are threatening the safety of themselves, the crew, or others. Do not attempt to subdue or restrain unless adequate personnel are present and law enforcement is on the scene. Evacuate if they are not.

Clinical Considerations Agitation causes may include:  Excessive heat/cold  Hypoxia  Lack of blood flow to brain  Head injury or stroke  High or low BGL

Universal Patient Assessment

 Metabolic disorders  Neurologic disease

Remove patient from stressful environment

Keep in mind that many accidental needle sticks occur on medical personnel while dealing with violent or agitated patients.

Try to identify and treat the underlying cause of the agitation.

Excited Delirium N-O-T A C-R-I-M-E

 Naked (they strip)  Object (violence against)  Tough (they are strong)  Acute (onset)  Confused  Resistant (to commands)  Incoherent speech  Mental health issues -or- Makes you uneasy  Early request of backup

Paramedics who are not RSI certified may elect to call in for Online Medical Direction to give Ketamine 5mg/kg IM for Excited Delirium

Ketamine 5mg/kg IM

Have suction, BVM, and intubation equipment ready, be prepared to protect the airway, consider extra resources. Monitor SpO2 and ETCO2.

If an IV/IO line is already established: Ketamine 2mg/kg IV/IO

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EMR

EMT

AEMT

Paramedic

Extended