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Excited Delirium – Out of Control!

A medical emergency is called in the booking area of a large urban jail. The inmate has ripped off his clothing and is racing about screaming profanities. Custody officers finally subdue him with tazers and have him on the floor securing restraints when he stops breathing. Standard emergency treatment is provided without result. The inmate is pronounced dead on arrival to the local hospital. What just happened?

Excited Delirium (ED) is a rare but deadly condition that can confront nurses working in corrections – particularly jails. Experts differ on the cause or even existence of the condition. However, evidence is mounting in favor of the diagnosis for a variety of unexpected deaths after situations similar to the one described above.

Causes of ED

A prevailing theory is that ED is caused by overstimulation of the brain by dopamine. Cocaine, narcotics or extreme stress can cause an increase in dopamine release. Another biomarker under study is the release of heat shock proteins that leads to problems with body heat. The person’s body temperature rises rapidly without regulation. This combination overpowers the heart and respiratory systems leading to sudden death.

What does ED Look Like?

The challenge of excited delirium in the corrections environment is to quickly identify that we have a medical condition as well as a behavioral issue that needs controlled and treated. An individual in the throes of ED will seem superhumanly strong and intensely hysterical, resisting all attempts at restraint. Often they are pulling off clothing to reduce the overheating. They often seem oblivious to pain and have little response to tazors or pepper spray.

What’s a Nurse to Do?

Correctional medical experts such at Todd Wilcox, MD, Medical Director of Salt Lake County Jail, recommends maximum efforts to subdue the individual to allow immediate medical intervention. This would not be a time for officers to slowly escalate force tactics. Once subdued, benzodiazepines to reduce the agitation is the first treatment of choice.  However, corrections nurses should focus on activities to speed transport to an acute care facility able to effectively manage the condition. Temperature regulation along with oximetry and cardiac monitoring are available in that setting.

Learn more about Excited Delirium
EMS Post: Cocaine, Excited Delirium and Sudden Unexpected Death
Excited delirium: Considerations of selected medical and psychiatric issues

This post originally appeared in CorrectionalNurse.Net

Guest post by Dr. Lorry Schoenly nurse author and educator specializing in the field of correctional health care. She has written 6 continuing education courses especially for the Correctional Healthcare Campus.

Correctional Healthcare Processes
Safety in the Correctional Setting
The Correctional Healthcare Patient and Environment
Medication Administration in the Correctional Setting
Risk and Documentation in the Correctional Setting
Special Issues in Corrections

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Posted: 2/16/2015 9:48:37 AM
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