Behavioral Emergencies
Excited Delirium Syndrome
• Medical emergency-combination of delirium, psychomotor agitation,
anxiety, hallucinations, speech disturbances, disorientation, violent
behavior, insensitivity to pain, hyperthermia, and increased strength.
• Potentially life threatening, and associated with the use of physical
control measures including restraints, TASER, or similar device.
• Most common in male subjects with a history of serious mental illness
and/or
acute or chronic drug abuse, particularly stimulants.
Scene Safety
General Adult Assessment
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Consider medical causes for the
patient’s behavior:
1. Hypoxia
2. Intoxication / Overdose
3. Hypoglycemia / Electrolytes
4. Head Injury
5. Post-ictal State
6. Excited Delirium
Suspected Excited Delirium?
Yes
KETAMINE
2.0mg/kg IV/IO
OR
2-4mg/kg IM
Consider behavioral
restraints;
No prone position
Consider Law
Enforcement escort
Transport
No
Implement the
S.A.F.E.R. model
Threatened or acted in a way that suggests threat to self or others?
Yes
Yes
No
Treatened to
harm SELF
Treatened to
harm OTHERS
No threats to
self or others
2-point restraints;
consider law
enforcement escort; or
4-point restraints if
nedded
Consider a flight risk
Transport
4-point restraints; hood
if indicated; NO PRONE
POSITION
Persistent risk
Transport
MIDAZOLAM
0.1 mg/kg IN/IM/IV;
may repeat q 5 min at
0.05 mg/kg
OR
DIAZEPAM
5.0 mg IV; may
repeat q 5 min
OR
DROPERIDOL
1.25 mg IM/IV/IO followed
by a saline flush or bolus;
may repeat dose q 5 min
OR
KETAMINE
2.0 mg/kg IV/IO OR
4.0 mg/kg IM
Cardiac monitor
Continue General Adult
Assessment
Continue Assessment
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