Acute excited states and sudden death

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7166.1154 (Published 24 October 1998) Cite this as: BMJ 1998;317:1154
  1. H G Kennedy, Consultant forensic psychiatrist.,
  2. F R Farnham, Lecturer in forensic psychiatry.
  1. North London Forensic Service, Enfield Community Care NHS Trust, Chase Farm Hospital, Enfield, Middlesex EN2 8JL

    EDITOR —In his letter Pounder1 relies on physiological research by Reay et al2 that has recently been shown to be methodologically incorrect.3 Chan et al showed that even the most extreme (hogtied) restraint positions combined with exercise do not produce hypoxia or any other clinically relevant change in oxygenation or ventilation, provided that correct methods of measurement are used.3 We do not of course recommend hogtying as a form of restraint.


    We thank Karch and Stephens for drawing attention in their letter to the interesting neurochemical associations between cocaine use, hyperthermia, and sudden death. We agree that prudent postmortem management should include neck dissection to rule out neck compression as well as measurements of brain drug concentrations, but as psychiatrists we are more interested in the living than the dead and how to prevent the living becoming the dead.5


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