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Excited delirium syndrome

02 March 2022
Features
02 March 2022
Volume 14 · Issue 3

Abstract

Excited delirium syndrome involves extreme agitation and aggression in a patient with an altered mental status; around one in ten cases ends in cardiac arrest. It has two main triggers: acute drug use and psychiatric illness. Patients display violent behaviour, increased pain tolerance and great strength; they pose significant risks to themselves and those around them. Maintaining safety on scene is paramount, which can be supported by a dual response by paramedics and law enforcement officers, and the patient is likely to need restraining or sedation. Treatment is non-specific and involves managing symptoms and complications such as hyperthermia, acidosis and rhabdomyolysis.

Characterised by extreme agitation and aggression in a patient with an altered mental status, excited delirium syndrome is an increasingly common presentation resulting in a request for paramedic services (Ross, 2017). Excited delirium syndrome is a subcategory of delirium, although the symptoms are generally non-specific and there is no standardised definition of it (Li et al, 2019). Gonin et al (2018) concluded that attempts at defining excited delirium syndrome have generally been syndromic in nature and founded on clinically subjective criteria.

Patients presenting with excited delirium syndrome pose a significant risk, not only to themselves and the paramedics treating them but also to law enforcement and allied health professionals who may be involved.

The triggers for excited delirium syndrome are usually multifactorial in nature. Several medical conditions such as hypoxia, head injury and hypoglycaemia may mimic excited delirium syndrome, and these should not be overlooked because of the distracting nature of the presentation.

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Excited delirium syndrome
Violent behaviour
Extreme agitation
Acute drug use
Restraint
Dual response