Tuesday, July 14, 2015

Excited Delirium Pneumonic

It can be hard to identify a patient who is experiences excited delirium. However, an emergency physician and medical director, Dr. Michael Curtis, has developed a pneumonic to help emergency providers identify those patients who are suffering from excited delirium - NOT A CRIME.

N - patient is naked
O - violence against objects
T - tough, unstoppable

A - acute, "just happened"

C - confused
R - resistant and won't follow commands
I - incoherent, patient is often loud
M - mental health conditions or makes you feel uncomfortable
E - EMS should transport to ED

Excited Delirium patients are not acting themselves. Excited Delirium is a true medical emergency, and needs to be dealt with accordingly. In order to provide the best possible care to these patients, remember that you still need to treat them as a human being. Do not get "tunnel vision" and just think they are a PSY patient...they are a person who has family and friends, who is just not acting themselves. Remember, it is important to always be professional. 

Depending on your local protocol, EMS providers are allowed to treat patients who are suffering from excited delirium. In my state, our local protocol allows us to administer 10mg Versed IM for a patient who meets the excited delirium protocols outlines signs/symptoms. However, you should always try to talk to your patient BEFORE you move into medication sedation. 

If the person meets the requirements, and the last resort is to administer the Versed, based on my experience, have a NPA/OPA ready, as well as a BVM. Always put your patient on oxygen, and use EtCO2 is able, in order to best monitor their airway. Transport your patient high priority and code them into the ED. 

Versed is a benzodiazepine which means that is it a muscle relaxant. In order for us to breath, we rely on our diaphragm and other respiratory muscles...so if you administer the bento, you are causing these muscle to relax. In some cases, I have had one patient, the patient will stop breathing, and BVM ventilation will need to be performed. 

Remember to always use caution when dealing with patients who are not acting in the right frame on mind. Always watch your back and your partners back. If the scene is not safe, or become unsafe, back away and call for PD. 

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