Stress Biomarkers Among Patients Undergoing Treatment for Excited Delirium and Severe Pain in the Emergency Department
Stress Biomarkers Among Patients Undergoing Treatment for Excited Delirium and Severe Pain in the Emergency Department
The purpose of this project is to determine the levels of stress biomarkers associated with
 severe pain, agitation from intoxication or psychosis, and excited delirium at various levels
 of the disease in order to compare them to pre-clinical models of law enforcement encounters.
 We hypothesize that the serum catecholamines and markers of metabolic acidosis will worsen
 with the duration and severity of agitation among agitated patients and will not worsen among
 patients with severe pain who are not agitated.

 Specific Aims

 -  To assess the prevalence of patients undergoing treatment for agitation from any cause
 requiring restraint or sedation.

 -  To assess the prevalence of excited delirium in the emergency department.

 -  To determine the difference in serum total catecholamines, serum dopamine, serum
 epinephrine, serum norepinephrine, heart rate, systolic blood pressure, mean arterial
 pressure, mortality, and disposition among patients with agitation requiring restraint,
 including excited delirium and patients with severe pain from extremity fractures.

 -  To describe changes in stress biomarkers among patients with changing levels of
 agitation as determined by the Altered Mental Status scale.
In this study, we propose to study Emergency Department patients under physiologic stress
 from severe pain, agitation, drug overdose, and excited delirium in order to compare markers
 of acidosis in patients at risk for unexplained-in-custody-death (UICD) in order to determine
 the relationship of these markers to what has been found in simulated law enforcement
 encounters. This information will help clarify the levels of stress associated with arrest
 and restraint conditions, allowing us to determine what aspects and levels of stress may be
 associated with the fatal mechanisms of UICD, and to identify markers that would inform death
 investigators of the mechanism of UICD. At the conclusion of this project, we will be able to
 report details explaining the relationship of the physiologic and metabolic effects of stress
 from restraint in excited delirium to other peri-arrest conditions and our previous work in
 simulated law enforcement encounters.
Agitation Group Inclusion Criteria:

 -  Patients with agitation as defined by an Altered Mental Status Score of >1, and who
 are in restraints or are given sedatives for treatment of agitation.

 Agitation Group Exclusion Criteria:

 -  Less than 18 years of age

 -  Suspected or confirmed pregnancy

 Pain Group Inclusion Criteria:

 -  Patients with an extremity fracture who report their pain as severe.

 Pain Group Exclusion Criteria:

 -  Less than 18 years of age

 -  Suspected or confirmed pregnancy

 -  Prisoner