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Sudden cardiac death in excited delirium, and how to prevent it

  • Tina Čakš Golec1
  • Rajko Kavalar1
  • Igor Goričan2
  • Matej Strnad2,3,4

1Department of Pathology, University Medical Centre Maribor, 2000 Maribor, Slovenia

2Emergency Department, University Medical Center Maribor, 2000 Maribor, Slovenia

3Center for Emergency Medicine, Prehospital Unit, Community Healthcare Center, 2000 Maribor, Slovenia

4Department of Emergency Medicine, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia

DOI: 10.22514/sv.2021.222

Submitted: 27 June 2021 Accepted: 06 August 2021

Online publish date: 28 October 2021

*Corresponding Author(s): Tina Čakš Golec E-mail:


The purpose of this study was to review data on restraint related deaths in persons in a state of excited delirium (ExDS) and to propose guidelines for treatment. We analysed three unexpected deaths in persons in a state of ExDS shortly after police restraint. Death which occurs during a police intervention, using physical restraints, may be related to placing the individual in a prone position, the use of neck holds, expert grips, and handcuffs or pepper spray. ExDS results in an altered mental state with agitation, aggression, paranoia, and panic attacks, and is a life-threatening condition. Therefore, before police intervention is initiated, a medical emergency team should be present. In patients with ExDS, physical restraints used by the police should be brief, effective, and include rapid tranquilization (sedation) using benzodiazepines, and antipsychotics.


Cocaine; Dopamine receptors; Delirium; Hyperthermia; Resuscitation

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Tina Čakš Golec,Rajko Kavalar,Igor Goričan,Matej Strnad. Sudden cardiac death in excited delirium, and how to prevent it. Signa Vitae. 2021.doi:10.22514/sv.2021.222.


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