A poorly defined controversial term aka Excited Delirium Generally describes Elevated blood pressure Elevated heart rate Paranoia Hallucinations Violent impulses Associated with drug use mental illness or the two together ID: 161938
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Agitated Delirium
A poorly defined, controversial term
aka Excited DeliriumGenerally describesElevated blood pressureElevated heart rateParanoiaHallucinationsViolent impulsesAssociated with drug use, mental illness, or the two togetherAssociated with catecholamine surgeSlide3
Agitated Delirium
Treatment Goals:
1. Protect yourselfViolent aggressive behavior may result in injury or death2. Prevent patient from self harmSecure flailing extremitiesLaw enforcement applied restraints?Place in position that allows airway & breathing3. Restore patient to calm equilibrium stateReduce violenceReduce physiological extremes
Hypertension
Tachycardia
Environmental misperceptionsSlide4
Treatment option:
Midazolam
(Versed®)May be given IV, IM, IntranasalDose per base orderRecommended dose rangesIV 2-5mgIN/IM 5mgMay repeat x 1 prn with base order Max dose 10mg
Agitated DeliriumSlide5
Patients Who May
Benefit From
MidazolamSlide6
Agitated Delirium
Why give
Midazolam?Counteracts catecholamine surgeDecreases risk of patient deathDecreases psychomotor agitation thus decreasing risk to patient and rescuersDecrease patient discomfort when physical restraints are required for patient’s safetySlide7
Midazolam
is NOT:
A substitute for limb restraintsFor “convenience” of rescuersPunishment for patient behaviorSlide8
Midazolam
is FOR:
Agitated DeliriumThe patient whose psychomotor agitation makes him a threat to himself or to the rescuersThe patient whose psychomotor agitation prevents the rescuer from providing life saving careSlide9
Midazolam
Adverse Reactions
HypoventilationHypotensionParadoxical agitation From disinhibitory effect “the angry drunk”Slide10
Midazolam
Should NOT Be
Used When:Capacity to refuse treatmentHypoxiaHypoglycemiaHypoperfusion (shock)Slide11
Midazolam
used with caution:
Patients with alcohol on boardAdditive effect with alcohol increases risk of respiratory depressionAlcoholics may be more resistant due to unregulated liver enzymesElderly (use lower dose)Slide12
Using
Midazolam
For Agitated DeliriumBase hospital orderMonitoring by paramedic level providerContinuous pulse oximetryBag valve mask and oral airways immediately availableTransport to closest, most medically appropriate receiving hospitalSlide13
TASER
“Thomas A. Swift Electric Rifle”
Less than lethal incapacitating deviceAdministers high frequency alternating current50k to 680k volts at 0.00036 amps (3 milliamps)Amperage killsAdministered for 2-3 secondsCauses pain and skeletal muscle spasmsAdministered by Direct touchDarts connected to wiresSlide14
Post TASER Patients
After
Taser use evaluate patient for:ABCsRestraints may compromise respirationsCardiac dysrhythmiasExtended shocks may cause dysrhythmiasOther injuries sustainedTaser darts?PMs may not remove Taser darts!Outside Scope of Practice
PMs Cannot Medically Clear for Booking!
Transport to ED