Acute behavioural disturbance and excited delirium — structured clinical viva

Terminology. Prefer ABD / hyperactive delirium with severe agitation. Reject excited delirium as a standalone diagnosis or sole cause of death (ACMT 2023). Document physiology and restraint facts.[1]

Medical priorities. ABCDE, glucose, SpO2, temperature; cooling; stop prolonged prone restraint; airway-ready team. Treat as medical emergency, not forensic labelling exercise.[4][5]

Reject proposed combination. Never IM olanzapine with parenteral midazolam — respiratory depression risk.[4]

Safer plan. IM droperidol 5–10 mg as common ANZ ED first-line for undifferentiated ABD with monitoring; midazolam 5–10 mg IM alternative; ketamine rescue (~4–5 mg/kg IM) if refractory under governance. Observations every 15 minutes for ≥1 hour including temperature. Endpoint calm and rousable.[2][3][4]

Capacity/law/disposition. Decision-specific capacity; least-restrictive local law without invented sections; medical observation until stable then psychiatric disposition as indicated.[4]