Emergency Notes

Cocaine Chest Pain, “Answers” | EM Lyceum

Effect on heart: increases plasma levels of dopamine and norepinephrine through central adrenergic stimulation and inhibition of reuptake at the synapse--> sympathetic outflow---> tachycardia, hypertension, and increased myocardial oxygen demand

hypercoaguable state

Chest pain: one minute to four days after cocaine use; half-life of cocaine of thirty to ninety minutes; active metabolites of cocaine detectable for over forty-eight hours after use

greatest risk of MI is within the first few hours after cocaine use. In the first hour, it is estimated that cocaine users are at a full twenty-four-fold increase in risk

Medical management: ASA, ntg, bzd

Avoid b-blocker

Phentolamine could work, but not standard of care

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