Emergency Medicine Cases

Episode 2: Excited Delirium

Mar 9, 2010
Dr. Margaret Thompson, a double-certified emergency physician and toxicology expert, joins Dr. Dan Cass, a regional supervising coroner, to discuss Excited Delirium Syndrome, a critical medical emergency often seen in young, drug-intoxicated males. They delve into its symptoms, such as acute agitation and super-human strength, and the dangers of cardiac dysrhythmias. The conversation emphasizes the importance of collaboration between law enforcement and medical staff in managing these cases and updating treatment protocols for improved outcomes.
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ANECDOTE

Fatal Field Collapse Case

  • A 36-year-old obese man struggled with police, was handcuffed prone, developed severe acidosis and lactate 24, and later died.
  • Postmortem found cardiomegaly with PCP and cocaine but no internal trauma.
INSIGHT

Typical Clinical Presentation

  • Excited delirium presents as acute, violent agitation with superhuman strength and profuse sweating.
  • Many cases involve sympathomimetic drugs and sudden unexplained collapse despite minimal autopsy findings.
INSIGHT

Cluster Of Scene Signs

  • Common collapse predictors include inordinate pain tolerance, tachypnea, sweating, tactile hyperthermia, and failure to tire.
  • Presence of six or more typical features is often used to identify excited delirium.
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