Monday, July 23, 2018

Beta-Blocker for Cocaine Toxicity

EMCrit Wee - July 22, 2018 - By Scott Weingart 
"The Questions
- Should beta-blockers be used in patients with cocaine toxicity?
  • How are we defining cocaine toxicity? 
  • Does Unopposed Alpha phenomena actually exist? 
  • Are beta-blockers safe in cocaine toxicity? 
  • Even if they are safe, is there any compelling reason we should use them over other treatments? 
- What about the non-floridly toxic patient, for instance: a case of hypertensive, tachycardic, sweaty patient with chest pain. Already received 2 rounds of Ativan and nitro with continuing symptoms, see how each manage
- Do your thoughts on beta-blockers in cocaine toxicity apply to the other stimulants? 
- What about patients who admit to taking cocaine in the recent past, but show no signs of toxicity
- Is it safe to use beta-blockers in these patients? 
  • A case: 48 y/o with type I DM, HTN, High Chol. Presents with substernal CP, first trop negative. For some reason nurses obtained a urine drug screen positive for cocaine. When asked, pt states he is an occ. User and last use was 2 days ago. Denies any use today. Pt has been totally forthcoming about all of his drug use and you believe him. Your hospital uses CTCA for this risk category of chest pain to allow immediate discharge for f/u if negative. You order the test, but radiology refuses to do the scan b/c of the requirement for beta-blockers and a drug screen positive for cocaine. Is this justified or not?"