About two years ago the cops got excited. They discovered something called excited delirium. Rather than us medical geeks putting on training the cops did.
"Tasers don't work!" "Four men can't hold them down" and other comments abounded. The only hope for these patients? Nasal Versed!
WHAT????
How the heck do you expect me to do that? Enter.....the MAD! Mucosa Aerator Device! You connect a syringe to this cone shaped thing and shove it in their nose. Yea.... the delirious, taser-proof, superhuman folks are gonna let me shove this thing in their nose??
Fast forward one month. The cops call us in. They got one! They need us to put her down. I walk in the apartment not sure what to expect. A young woman with flushed cheeks is in a corner, surrounded by cops looking scared. Occasionally she tries to break through them to get away but doesn't. Already I am skeptical. Excited Delirium is supposed to rank up there with PCP. I have dealt with those patients before. Three firefighters, two cops and me sticking them with needles wherever I can find an open patch of skin trying to sedate them to no avail. This just didn't have the same intensity.
My partner and I walk up to her and place our hands on her arms. While talking in a soothing voice we guide her to the gurney. Her face is flushed and dry. Her pupils are HUGE and she is incoherent. But she is not angry. We search her apartment for any signs of drugs. This isn't acting like any drug I have seen. Narcotics make you sleepy and incoherent, but pupils are small and the dry flushed face is abnormal as well.
She isn't tweaking like a mether, with the jerky, picky movements. Nor is her heart about to jump out of her chest. I already described PCP.
We gently push her back onto the gurney and she immediately jumps back up. We go back and forth several times before we let the cops come in and pin her while we restrain her. I always wait as long as I can to do that. It usually just pisses people off. Sure enough the fight is on. She is screaming jibberish and thrashing against her restraints. The cops are jacked up.
"You gotta do the nasal thingy!" one of them yells at me. They are sure this is the real deal. My earlier comments of uncertainty have gone unheeded.
I cave.
I pull out the Versed, a powerful benzodiazepine that is one of the few sedatives that might work, and draw up the dose. I screw on the MAD and now it is game on. The woman has all extremities pinned to the gurney but her head is loose. I try to put the MAD in her nose and she shakes her head violently. One of the firefighters that showed up and I trust completely holds her head and I rest my forearm on her forehead. I fight my conscious with the knowledge that this will calm her down and keep her from dying from a heart attack or overheating. I shove the MAD in and push the plunger. The woman screams and I narrowly miss being spit on. Her words still make no sense as she yells and flails about. I look at my partner. "Just go!"I yell. The excited cops are fighting over who is following us to the hospital as the back doors shut and we take off towards the hospital. The woman fights all the way. The versed had no effect. Her nose is bleeding.
I vowed then never to use that stupid MAD device again. It seemed almost inhumane to me. I would rather stick her with a needle in her arm or butt that do that again. We get to the ER. Two cops and hospital security is waiting for us. She is transferred to the hospital bed and restrained again. The Er doc comes in and looks at her.
"She is having an anticholinergic response," he says matter-of-factly.
Wha???
I nod, tell him what we did for (to) her and leave. I get in the ambulance and look the term up. Almost the exact same signs and symptoms, minus super human strength. One of the most common medications to cause this?? Benadryl. We found an empty bottle at her house. Dangit!!
A Benadryl Overdose? Really? We just practically tortured that woman, accused her of taking drugs, made a scene at her apartments and she took too much Benadryl?
Granted we still would have had to restrain her and get her to the hospital. But the nasal Versed was overkill.
A while later the cops called me to a possible Excited Delirium. I showed up, put the patient on the gurney, told the officer in my face to shove it and drove the man to the hospital. I have never used teh MAD again! And I never will.
http://en.wikipedia.org/wiki/Excited_delerium
http://en.wikipedia.org/wiki/Anticholinergic
- Check out the signs and symptoms for yourself.
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