Acute behavioural disturbance and excited delirium presentations

Extreme behavioural emergencies sit at the interface of emergency medicine, toxicology, psychiatry, and — too often — custody. This leaf goes deeper than the general agitation and rapid-tranquillisation ladder: it is about physiology that can kill, language that can mislead, and systems that must put medical care ahead of a forensic label.^[2][3][11]

Meet the patient

A 32-year-old man is brought to the ED by police on a hot summer night. There was a prolonged foot pursuit; he fought four officers and is still struggling against the restraints. He is diaphoretic, incoherent, apparently indifferent to pain, and feels hot to touch. He has not been searched. Paramedics cannot get a set of observations. This is the classic stem — and the wrong word for it will fail the viva.^[4][16]

Two questions dominate the next ten minutes, and the answers must come in the right order. Is this a medical emergency or a behavioural problem? — it is a medical emergency. What will you do in the next few minutes? — secure the airway-ready team, control behaviour quickly, never leave him prone, and start the physiological work-up. Everything below exists to make that sequence automatic.^[2][13]

References18ShowHide

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