Prehospital resuscitation of a man with excited delirium and cardiopulmonary arrest

Maher, Patrick; Walsh, Mark; Burns, Thomas G.; Strote, Jared

doi:10.2310/8000.2013.130824

Cited by 11 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other reports of severe agitation document substantially more deranged vital parameters, notably in the setting of confirmed sympathomimetic intoxication 27 . In a larger series of patients who met criteria for excited delirium, 14 only 37% (16) of patients presented with tachycardia in excess of 120 beats per minute, and only 7% (3) were hypertensive on presentation to the ED; 5% (2) were hypotensive. Few displayed serum bicarbonate levels of <10mEq/L (three patients; 7.5% of those with labs drawn) or a pH below 7.20 (two patients; 33% of those with labs drawn).…”

Section: Discussionmentioning

confidence: 99%

“…Profound agitation represents a significant risk to patients and providers alike, and the use of prehospital physical and chemical restraint during transport often is required to maintain the safety of the patient, first responders, and medical staff. [13][14][15] Case reports 16,17 and laboratory data [18][19][20][21][22] suggest that physical restraint of profoundly agitated individuals may decrease venous return, impair physiologic recovery, and decrease chest wall excursion and minute ventilation. Taken together, these changes suggest impairment in physiologic compensation for the metabolic acidosis incurred by persistent agitation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine

Olives

Nystrom

Cole

et al. 2016

Prehosp. Disaster med.

View full text Add to dashboard Cite

BackgroundProfound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear.ObjectiveThe goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol.MethodsThis was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation.ResultsOverall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a high degree of provider-dependent variability.ConclusionsPrehospital ketamine is associated with a high rate of endotracheal intubation in profoundly agitated patients; however, ketamine dosing is not associated with intubation rate when adjusted for potential confounders. It is likely that factors not included in this analysis, including both provider comfort with post-ketamine patients and anticipated clinical course, play a role in the decision to intubate patients who receive prehospital ketamine.OlivesTD, NystromPC, ColeJB, DoddKW, HoJD. Intubation of profoundly agitated patients treated with prehospital ketamine. Prehosp Disaster Med. 2016;31(6):593–602.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine

Olives

Nystrom

Cole

et al. 2016

Prehosp. Disaster med.

View full text Add to dashboard Cite

show abstract

“…Acute hyperactive delirium is potentially fatal 2,3,7,18,20–48 . What was once called a cocaine-induced excited delirium is medically a cocaine-induced acute hyperactive delirium .…”

Section: Not a Medical Diagnosismentioning

confidence: 99%

The Canceling of Excited Delirium

Gill

2024

Am J Forensic Med Pathol

View full text Add to dashboard Cite

“…In two case reports of prone restraint cardiac arrest , loss of consciousness may have been precipitated by a sudden increase in intra-abdominal and intrathoracic pressure. In the first case report, 59 loss of consciousness occurred when the individual (BMI: 23.3 kg/m 2 ) began vomiting. Retching and vomiting may be associated to a substantial increase in intra-abdominal and intrathoracic pressure.…”

Section: Precipitating Factor Of Loss Of Consciousness In Prone Restr...mentioning

confidence: 99%

Prone restraint death: Possible role of the Valsalva maneuver

Michaud¹

2023

Med Sci Law

View full text Add to dashboard Cite

There is an on-going debate about the safety of prone restraint and the exact role of the prone position in physical restraint death. Cardiac arrest in prone restraint death is essentially the end-result of a violent physical altercation wherein a combative individual suddenly loses consciousness while trying to counteract an opposing force. The direct correlations of increased static weight force with decreased inferior vena cava diameter, decreased cardiac output, and decreased stroke volume in prone restraint studies suggest that decreased venous return and decreased cardiac output could have a significant role to play in prone restraint death. Although the degree of changes observed in those studies might not be sufficient to cause cardiac arrest, they could predispose people who instinctively try to free themselves of the restraints to severe complications. The Valsalva maneuver, or forceful expiration against a closed airway, is frequently performed spontaneously in daily activities involving straining and resistance exercise, but has never been considered in restraint death. Pre-existing diminished venous return could increase the risk of major complications in individuals performing the Valsalva maneuver. A substantial decrease in venous return and cardiac output could increase the risk of cerebral hypoperfusion, loss of consciousness, hypoventilation, and sudden death. By increasing the risk of increased intra-abdominal pressure and its negative effect on venous return, high body mass index may be a significant risk factor in prone restraint death. The Valsalva maneuver may have different roles in prone restraint cardiac arrest and might be overlooked in prone restraint death.

show abstract

Prehospital resuscitation of a man with excited delirium and cardiopulmonary arrest

Cited by 11 publications

References 7 publications

Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine

Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine

The Canceling of Excited Delirium

Prone restraint death: Possible role of the Valsalva maneuver

Contact Info

Product

Resources

About