Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-20T13:42:19.888Z Has data issue: false hasContentIssue false

Prehospital resuscitation of a man with excited delirium and cardiopulmonary arrest

Published online by Cambridge University Press:  04 March 2015

Patrick Joseph Maher*
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Washington
Mimi Walsh
Affiliation:
Seattle Police Department, Seattle, WA
Thomas Burns
Affiliation:
Seattle Police Department, Seattle, WA
Jared Strote
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Washington
*
Box 359702, 1CT89, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2499; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Features consistent with the syndrome known as excited delirium (ExDS) have been associated with law enforcement restraint-related death. The pathophysiology and exact causative factors of restraint-related death associated with ExDS remain unclear. We present a case of successful field resuscitation of a man with ExDS who experienced cardiopulmonary arrest while being restrained by law enforcement officers. Despite the presence of a severe lactic acidosis on emergency department admission, the patient recovered following prehospital treatment with advanced cardiac life support measures and intravenous sodium bicarbonate, likely in part due to early recognition of the disease process.

Type
Case Report • Rapport de cas
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1.Vilke, GM, Debard, ML, Chan, TC, et al. Excited delirium syndrome (ExDS): defining based on a review of the literature. J Emerg Med 2012;43:897905, doi:10.1016/j.jemermed.2011.02.017.Google Scholar
2.Hughes, EL.Special Panel review of excited delirium. Weapons & Protective Systems Technologies Center Special Report; 2011.Google Scholar
3.Otahbachi, M, Cevik, C, Bagdure, S, et al. Excited delirium, restraints, and unexpected death: a review of pathogenesis Am J Forensic Med Pathol 2010;31:107–12, doi:10.1097/PAF.0b013e3181d76cdd.CrossRefGoogle Scholar
4.Stratton, SJ, Rogers, C, Brickett, K, et al. Factors associated with sudden death of individuals requiring restraint for excited delirium. Am J Emerg Med 2001;19:187–91, doi:10.1053/ajem.2001.22665.CrossRefGoogle ScholarPubMed
5.Strote, J, Verzemnieks, E, Walsh, M, et al. Use of force by law enforcement: an evaluation of safety and injury. J Trauma 2010;69:1288–93, doi:10.1097/TA.0b013e3181c45302.Google Scholar
6.Debard, ML.White paper report on excited delirium syndrome. Dallas (TX): American College of Emergency Physicians; 2009.Google Scholar
7.Jauchem, JR.Pathophysiologic changes due to TASER(R) devices versus excited delirium: potential relevance to deaths-in-custody? J Forensic Leg Med 2011;18:145–53, doi:10.1016/j.jflm.2011.01.014.CrossRefGoogle Scholar
8.Hick, JL, Smith, SW, Lynch, MT.Metabolic acidosis in restraint-associated cardiac arrest: a case series. Acad Emerg Med 1999;6:239–43, doi:10.1111/j.1553-2712.1999.tb00164.x.CrossRefGoogle ScholarPubMed
9.Brice, JH, Pirrallo, RG, Racht, E, et al. Management of the violent patient. Prehosp Emerg Care 2003;7:4855, doi:10.1080/10903120390937085.CrossRefGoogle ScholarPubMed