The Naked Bike Ride:

The Naked Bike Ride:
Excited Delirium Syndrome
Jeff Beeson DO, RN, EMT-P
Fort Worth, TX
Google Image: Naked Bicycle Rider
Bicycle Share Program?
Question
What are some basic safety measures we
should take on all behavioral emergencies to
ensure our safety?
Excited Delirium
A delirium is characterized by a severe
disturbance in the level of consciousness
and a change in mental status over a
relatively short period of time, manifested by
mental and physiological arousal, agitation,
hostility and heightened sympathetic
stimulation
Psychological
Physiologic
Physical
Paranoid
Tachycardia
Hypervigilence
Hallucinations
Hyperthermia
Extreme Strength
Grandiosity
Hypertension
Incoherent speech
Extreme agitation
Foaming of the
mouth
Shouting
Fear
Mydriasis
Violent behavior
Fornication
Cardiac arrest
Bizarre behavior
Thought disorder
Seizures
Kicking/Thrashing
Dysphoric
Pulmonary
congestion
Running/Hiding
Chest pain
Threat to self/others
Profuse sweating
Aggression
High pain threshold
Restraint History
Restraint History
NAEMSP Position Paper
• NAEMSP.
National
Association of
EMS Physician
Paper, Patient
Restraint for EMS
Systems. Prehosp
Emerg Care.
2002;6(3): 340345.
NAEMSP
• Medical conditions first
– Hypoxia
– Hypoglycemia
• 9% of suffer hypoglycemia
– Acute neurological conditions
– Acute drug or alcohol intoxication
NAEMSP
• Contributing conditions:
–
–
–
–
–
–
Agitated delirium
Drug overdose or intoxication
Comorbid medical conditions
Recent extreme exertion
Fighting against restraints
Inappropriate restraints
NAEMSP
• Protocols for patient restraint
• Person of the same gender during transport
• Overstepping the boundaries of restraint may
be perceived as battery, assault, or false
imprisonment
• Avoid hobble or hogtie
– Handcuffs?
• Restraint must allow for continuous patient
assessment
NAEMSP
• Types of Restraint:
– Verbal deescalation
– Physical restraint
– Chemical sedation
• Anticipate exposure to blood and body fluids
• Law enforcement should be involved
NAEMSP
• Chemical Sedation:
– Goal is to subdue excessive agitation and
struggling against physical restraints.
– Intervention should change the patient’s behavior
without reaching the point of amnesia or altering
the patient’s level of consciousness.
Routes of Administration
•
•
•
•
•
•
Oral
Nasal
IM
IV
IO
PR
When to Sedate
NAEMSP
• Chemical sedation:
– Butyrphenones:
• Haloperidol (Haldol)
• Droperidol (Inapsine)
– Benzodiazepines:
• Diazepam (Valium)
• Lorazepam (Ativan)
• Midazolam (Versed)
– Ketamine
Been there, Got the t-shirt
Chemical Sedation
• Perhaps atypical antipsychotics should be
considered:
– Respiridone (Respiridal)
– Ziprasidone (Geodon)
– Olanzepine (Zyprexia Zydis)
Don’t Forget
• Active Cooling
• Fluid replacement
– Hydration
• Hyperkalemia
• Acidosis
Ideal Restraint
• 4 point restraints
• Anatomical position
• Psych Strap
Package For Transport
Your patient will appear to be
improving for 1 of 2 reasons?
Physical Cues you lost Control
Conclusions
• Protect yourself
• Protect your partner
• Protect the patient
– From Police
• Sedate
– How much?
• Restrain
• Monitor closely
Questions?