How do restraints increase the risk for sudden death from cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Restraints have also been implicated as a contributing factor, particularly when the patient is prone. Sudden death occurring during prone restraint of a person in excited delirium appears to be induced by a combination of at least 3 factors that increase oxygen demand and decrease oxygen delivery:

  1. The psychiatric or drug-induced state of agitated delirium coupled with police confrontation places catecholamine stress on the heart.

  2. The hyperactivity associated with excited delirium coupled with struggling against the police and/or restraints increases oxygen demands on the heart and lungs.

  3. A hogtied position impairs breathing by inhibiting chest-wall and diaphragmatic movement.

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