ExDS is characterized by extreme agitation and aggression in a patient with altered mental status.
- Recognize excited delirium syndrome (ExDS);
- Describe the pathophysiology of ExDS;
- Know potential causes of ExDS;
- Describe the treatment of ExDS.
1. Vilke GM, DeBard ML, Chan TC, et al. Excited Delirium Syndrome (ExDS): defining based on a review of the literature. J Emerg Med, 2012 Nov; 43(5): 897-905.
2. Lipsedge M. Excited delirium: A psychiatric review. Med Sci Law, 2016; 56(2): 121-7.
3. ACEP Excited Delirium Task Force. White Paper Report on Excited Delirium Syndrome, http://www.fmhac.net/assets/documents/2012/presentations/krelsteinexciteddelirium.pdf.
4. National Highway Traffic Safety Administration. National Emergency Medical Services Education Standards, https://www.ems.gov/pdf/education/EMS-Education-for-the-Future-A-Systems-Approach/National_EMS_Education_Standards.pdf.
5. Jouvenal J. 'Excited delirium' cited in dozens of deaths in police custody. Is it real or a cover for brutality? Washington Post, 2015 May 6; https://www.washingtonpost.com/local/crime/existence-of-excited-delirium-ruling-in-va-womans-death-has-experts-split/2015/05/06/b1cc9499-ddaa-474c-9e8a-9ae89a9ae679_story.html?utm_term=.0ee72d43a05c.
6. Benzer TI, Nejad SH, Flood JG. Case records of the Massachusetts General Hospital. Case 40-2013. A 36-year-old man with agitation and paranoia. N Engl J Med, 2013 Dec 26; 369(26): 2,536-45.
7. Kesha K, Boggs CL, Ripple MG, et al. Methylenedioxypyrovalerone ("bath salts"), related death: case report and review of the literature. J Forensic Sci, 2013 Nov; 58(6): 1,654-9.
8. Ruttenber AJ, Lawler-Heavner J, Yin M, et al. Fatal excited delirium following cocaine use: epidemiologic findings provide new evidence for mechanisms of cocaine toxicity. J Forensic Sci, 1997 Jan; 42(1): 25-31.
9. Schiavone S, Neri M, Mhillaj E, et al. The role of the NADPH oxidase derived brain oxidative stress in the cocaine-related death associated with excited delirium: A literature review. Toxicol Lett, 2016 Sep 6; 258: 29-35.
10. Hick JL, Smith SW, Lynch MT. Metabolic acidosis in restraint-associated cardiac arrest: a case series. Acad Emerg Med, 1999 Mar; 6(3): 239-43.
11. Ruttenber AJ, McAnally HB, Wetli CV. Cocaine-associated rhabdomyolysis and excited delirium: different stages of the same syndrome. Am J Forensic Med Pathol, 1999 Jun; 20(2): 120-7.
12. Takeuchi A, Ahem TL, Henderson SO. Excited Delirium. West J Emerg Med, 2011 Feb; 12(1): 77-83.
13. Chan TC, Vilke GM, Neuman T, Clausen JL. Restraint position and positional asphyxia. Ann Emerg Med, 1997 Nov; 30(5): 578-86.
14. Bozeman WP, Ali K, Winslow JE. Long QT syndrome unmasked in an adult subject presenting with excited delirium. J Emerg Med, 2013 Feb; 44(2): e207-10.
15. Roach B, Echols K, Burnett A. Excited Delirium and the Dual Response: Preventing In-Custody Deaths. FBI, https://leb.fbi.gov/2014/july/excited-delirium-and-the-dual-response-preventing-in-custody-deaths.
16. Richmond JS, Berlin JS, Fishkind AB, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med, 2012 Feb; 13(1): 17-25.
17. Hayes BD. Ketamine for Excited Delirium Syndrome. Academic Life in Emergency Medicine, https://www.aliem.com/2015/ketamine-for-excited-delirium-syndrome/.
18. Scheppke KA, Braghiroli J, Shalaby M, Chait R. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients. West J Emerg Med, 2014 Nov; 15(7): 736-41.
19. Burnett AM, Peterson BK, Stellpflug SJ, et al. The association between ketamine given for prehospital chemical restraint with intubation and hospital admission. Am J Emerg Med, 2015 Jan; 33(1): 76-9.
20. Bellolio MF, Gilani WI, Barrionuevo P, et al. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med, 2016 Feb; 23(2): 119-34.
21. Lulla A, Singh M. The Art of the ED Takedown. emDocs, http://www.emdocs.net/the-art-of-the-ed-takedown/.
22. Vilke GM, Bozeman WP, Dawes DM, Demers G, Wilson MP. Excited delirium syndrome (ExDS): treatment options and considerations. J Forensic Leg Med, 2012 Apr; 19(3): 117-21.
23. Miami-Dade Fire Rescue. Medical Operations Manual, https://mdsceh.miamidade.gov/mobi/moms/Protocol%2039.pdf.
After passing the course, your certificate will be available for download here.