Sztajnkrycer MD, Baez AA
Cocaine, excited delirium and sudden unexpected death.
Emerg Med Serv, Apr 2005, 34(4) p77-81
I've posted this Emergency Medical Services magazine article in PDF file format.
If you don't have an Adobe Acrobat PDF file program, you can download a FREE version HERE.
CHAS REVIEW & NOTES:
This is the BEST excited delirium article I've ever read. These authors came closer than any others to clearly identifying that there has NEVER been a case report published of an "excited delirium" death occurring in the absence of an asphyxial form of restraint application.
After all, in every case of excited delirium ever reported, the description of the victim's behavior clearly indicates that SOME form of restraint was required to initially contain and treat him. But, when an excited delirium case report doesn't even address the fact that the victim was restrained (or doesn't specifically describe the manner of restraint employed), use of an asphyxial form of restraint cannot be ruled-OUT.
Especially considering the fact that asystole is the first dysrhythmia noted 99.9% of the time in excited delirium deaths ... and that initial asystole is a finding consistent with asphyxial deaths, but inconsistent with "cardiac" deaths due to infarctions or excessive catecholamine levels (or the like) ... I remain convinced that there NEVER has been a death documented as being solely due to excited delirium.
(BTW: I sincerely doubt the validity of the 1 case that reported a "ventricular dysrhythmia" being the presenting rhythm. I suspect "victim body jiggle by providers" to be the source of this "ventricular" rhythm on the monitor!)
And, BLESS THESE AUTHORS for correctly noting that "Placing restrained individuals in a prone position has the potential to physically interfere with diaphragm movement." It is not CHEST restriction or compression that causes respiratory arrest in forcefully-prone-restrained individuals. It's BELLY compression.
Again, this is a very well researched and well written article.
WELL DONE, Dr.s Sztajnkrycer and Baez!