Page 78 - Journal of Special Operations Medicine - Spring 2015

Patients who comply with instructions and who are able etiology of this syndrome and to identify best practices
to sit or lie quietly are less likely to progress to more to threat it.
severe forms of ExDS.
Disclosures
Patients with ExDS are likely dehydrated due to de­
creased fluid intake and increased insensible losses from The authors have nothing to disclose.
high levels of activity, an increased core temperature,
hyperventilation, and diuresis. The administration of IV References
fluids such as normal saline or balanced electrolyte solu­
tions such as lactated Ringer’s, Plasmalyte­A, or Normo­ 1. Sztajnkrycer MD, Baez AA. Cocaine excited delirium and
sol can be used to correct dehydration and may prevent sudden unexpected death. EMS World, April 2005 (updated
or treat underlying electrolyte disorders and rhabdomy­ January 11, 2011).
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West J Emerg Med. 2011;12:77–83.
dium bicarbonate affords any benefit in the treatment 3. Special panel review of excited delirium. National Institute
of this condition or its complications. Intravenous fluids of Justice Cooperative Agreement, No. 2010­IJ­CX­K005.
may be administered at rates of 1 to 1.5mL/hr until re­ https://www.justnet.org/pdf/exds­panel­report­final.pdf. Ac­
suscitated and then no more than to 500mL/hr initially. cessed February 4, 2014.
Patients with ExDS may have a coexisting cardiomy­ 4. Grant JR, Southall PE, Mealey J, et al. Death in custody: a
historical analysis. J Forensic Sci. 2007;52:1177–1181.
opathy and may be at a theoretical risk for fluid over­ 5. Dolinak D, Matshes E, Lew E. Forensic pathology: principles
load and congestive heart failure. Under circumstances and practice. New York, NY: Elsevier Publishing; 2005.
35
where transfer to a medical facility is delayed and urine 6. The Institute for the Prevention of In-Custody Deaths, Inc.
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medical condition that occurs in association with stimu­ 13 April 2011. Rick Wyant and Tom Burns, brief entitled,
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®
pam administered IV. Once sedated, patients should the Standing Committee on Public Safety and National Secu­
undergo a more comprehensive medical assessment and rity. Garry Breitkreuz, MP, Chair. June 2008, 39th Parliament,
when necessary, treatment measures initiated for hyper­ 2nd session. http://www.ecdlaw.info/outlines/06­18­08%20
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treatment facility for further evaluation and treatment. Health Sciences, 2013. The Health Effects of Conducted En­
Further research is needed to better understand the ergy Weapons. Ottawa (ON): The Expert Panel on the Medical

68 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015