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Fri Aug 8 21:59:00 BST 2008

I think I saw one questionable citation on the diagnosis as a cause of death from Texas. 

LNM from Baku, Azerbaijan 
Sent via BlackBerry by AT&T

-----Original Message-----
From: Mike Smertka <medic0947969 at yahoo.com>

Date: Fri, 8 Aug 2008 12:15:48 
To: Trauma & Critical Care mailing list<trauma-list at trauma.org>
Subject: excited delirium

I have actually been doing some research on this, and while I don't have anything publishable at this point, seems to be directly related to toxicology, all the coroners I have spoken with on the subject or who has provided me data, have in common, that it is only listed as a contributing factor in the death, not the cause. Furthermore it appears at first glance there is always toxicology involved in these cases, and are very rare. I have also noticed that all of these are with persons interacting with law enforcement officials. I have also contacted zoologists and a DVMs, who cannot recall any nonhuman animal that can excite itself to death via sympathetic nervous response or other biochemical process. I would be extremely cautious about using this as justification for any protocol or sedation criteria. I ask the forgiveness of the forum members as this is not trauma related, and will confine my comments on list to this message

Mike

--- On Fri, 8/8/08, Jules <jkaymdc at aim.com> wrote:

From: Jules <jkaymdc at aim.com>
Subject: Re: Sedation for combative patients
To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
Date: Friday, August 8, 2008, 8:54 AM

Unfortunately, no, although it is one I'm pushing for. However,
administration and onset of action would still be difficult and fairly long
in this setting. Excited delirium is becoming (or maybe always has been) one
of the biggest scene safety issues for medics, IMO...with the things people
are lacing their recreational drugs with...IS there a chemical restraint
that will be immediately effective? How can it be administered safely...both
for the patient and the medic?

Jules

On Fri, Aug 8, 2008 at 7:32 AM, <msmaltini345 at aol.com> wrote:

> do you carry versed?
>
>
> -----Original Message-----
> From: Jules <jkaymdc at aim.com>
> To: Trauma &amp, Critical Care mailing list
<trauma-list at trauma.org>
> Sent: Thu, 7 Aug 2008 6:24 pm
> Subject: Re: Sedation for combative patients
>
>
>
> i would also be interested in this information. A week ago I was involved
> in
> a call for a "trauma" although the individual had driven the
pick-up into
> the ditch at a slow speed..no damage to the vehicle. However, the person
> was
> showing signs of "meth" use (possible OD), had experienced a
seizure and
> was
> at this time extremely violent, swinging at me and LE each time we
> attempted
> to calm him.
>
> The only medication I had available was Valium...IM of course, which was
> like spitting in the wind.
>
> In the end he was tased 5 times, had received a total of 5 valium IM, 5
> Valium IV, 4 Ativan IV, and 5 Haldol IM (between pre hospital and
hospital)
> before he was controlled.
>
> Suggestions?
>
> Jules
>
> On Thu, Aug 7, 2008 at 4:39 PM, Sarah CAllier <sarah_callier at yahoo.com
> >wrote:
>
>  What is your openion on the sedation of combative patients? I am
>>
> involved
>
>> in a protocal commitie for EMS, We are looking at establishing
>>
> protocals to
>
>> allow the sedation of combative patients. Pt's that would fit into
the
>> catagory for this treatment would be Psychiatric patientswho are
>>
> violent and
>
>> pose a threat to themselves to the Police and to EMS providers. We
>>
> will have
>
>> strict guidelines for the administration of the medications. We are
>>
> looking
>
>> at using Versed Ativan and possibly the use of Droperidol. We are also
>> looking at the possibility of sedation for RSI and for combative
>>
> trauma
>
>> patients. Any openions on what is better?
>>
>>
>>
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excited delirium