Excited/Agitated Delirium

[Just Plain Ruff]

Does anyone have a restraint policy or protocol set out in your protocols.

If so please share.

What I am trying to do is to add to our protocols and this is a good one to have set in stone.

Soft restraints first

then further measures and finally

pharmaceutical restraints

Does anyone have in their protocols the use of RSI as a restraint?

[FL_Medic]

Lee County EMS protocols.

http://internet.lee-ems.com/intranet/EMS/p...publication.pdf

[crotchitymedic1986]

Does anyone have a restraint policy or protocol set out in your protocols.

If so please share.

What I am trying to do is to add to our protocols and this is a good one to have set in stone.

Soft restraints first

then further measures and finally

pharmaceutical restraints

Does anyone have in their protocols the use of RSI as a restraint?

Thats good policy. The patient won't do what we want so lets paralyze him and make him ventilator dependent.

[firedoc5]

I was at a seminar where this was one of the topics. It wasn't focused on restraint but on the excessive delirium. Now this was a long time ago, before Tazer, stun gun, etc.

For no bigger than our city was we saw it fairly often.

One thing that stuck in my head was that if severe enough there can be injury to the brain. Not a TIA/CVA, or concussion, but actual injury which is somewhat unexplained. Maybe I missed something about the entire explanation. Has anyone else heard of this?

[FL_Medic]

The brain injury could be from the hyperthermia and seizures. These patients also become acidotic pretty fast. If the seminar was a long time ago than this condition didn't exist. Well it did, but it wasn't recognized and named as it is now. Your local police officers are usually pretty well versed on this condition now. Since the hog tying was killing people.

[crotchitymedic1986]

Actually if you click on the link I provide, it is described in detail. The cause of death is excessive lactic acidosis and hyperventilation, brought on by positioning the patient so that the diaphragm and lungs can not work properly.

Edited March 25, 2009 by crotchitymedic1986

[firedoc5]

Actually if you click on the link I provide, it is described in detail. The cause of death is excessive lactic acidosis and hyperventilation, brought on by positioning the patient so that the diaphragm and lungs can not work properly.

The lactic acidosis does seem familiar now. Thanx for jogging my brain. But there seems to be some other reaction with adrenaline, I believe.

You know that after I stop trying to remember it all this and the thread is deeply buried, I'll remember it or come across my old notes.

[Just Plain Ruff]

Thats good policy. The patient won't do what we want so lets paralyze him and make him ventilator dependent.

I'm not advocating the routine use of RSI, nor am I saying that it's an option for us. But what I am asking for is protocols that may or may not have this in place.

The last thing I want to happen to anyone is to become ventillator dependent but what I am trying to do is to strike some balance into what kind of restraints are out there for our service to utilize and keep both the patient and the medics safe.

[wrmedic82]

These are our protocols

Psychiatric Emergencies (including Excited/Hyperactive Delirium)

Basic Life Support

1. Maintain scene safety. If scene is unsafe, leave and stage for the police department.

2. Consider requesting law enforcement assistance

1. Advise against the utilization of a Taser if Excited Delirium, especially

multiple Taser use.

3. ABCs

4. Oxygen (as indicated)

5. NPO

6. History & physical, vital signs, secondary assessment

7. Measure blood glucose as indicated

8. Provide protection and maintain body temperature or cool patient as needed

9. Reassurance and position of comfort, if hypotensive, elevate feet

10. If patient is spitting, apply an approved spit hood.

Intermediate

1. Airway management as indicated

2. Intravenous access (if possible)

ALS First Responder

1. Cardiac monitor

FRO Advanced / Lead Secondary Paramedic

1. If the patient is violent and a danger to himself/herself or others:

a. Soft, four point physical restraints – utilize properly manufactured soft

restraints on upper and lower extremities

b. Midazolam 5 mg deep IM/slow IVP/IN if needed to protect the patient

and/or crew;

i. As a last resort, you may administer IM through the pants on the

lateral thigh

c. 250ml normal saline IVB, may repeat if necessary

2. 12-lead ECG acquisition and transmission (if available) as indicated

Conditional Primary Paramedic / Primary Paramedic

1. If it is probable that the patient is in full cardiac arrest from a Excited Delirium, refer

to the appropriate ACLS protocol and administer first round of ACLS medicines first,

then administer Sodium Bicarbonate 1 meq/kg IVP.

BSP Orders

1. Additional Midazolam

2. Haloperidol (Haldol) 5-10 mg IM only

3. Benadryl 25 mg IVP/IM for dystonia

4. Further therapy orders

Edited March 30, 2009 by wrmedic82

[mshow00]

"A prophylactic 1 amp sodium bicarbonate is given for acidosis that results from prolonged struggle" from above article

I understand the reason for the bicarb, not the dose. I have been taught that the proper dose of bicarb was 1mEq/kg, and most people I meet are well above 50 kgs that the single amp treats. Is there concern of causing alkolosis with the actual dosing.