What is included in emergency department (ED) care for cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Note the following:

  • Patients with cocaine toxicity should receive initial evaluation and stabilization, including attention to ABCs, oxygen, intravenous access, and cardiac and pulse oximetry monitoring.
  • In hyperthermic patients, temperature may continue to rise due to agitation and potentially to fighting of restraints. Temperature may reach critical levels; thus, close monitoring and early intervention is indicated.
  • Check the nares for residual cocaine, and remove if present.
  • Monitor for hypoglycemia, which may present as any neuropsychiatric abnormality
  • Never base treatment on the results of a drug screen; rely on clinical findings instead.
  • Avoid physical restraints if possible. Benzodiazepines are effective and safe if sedation is required.
  • The prevalence of unrecognized pregnancy is up to 6% in ED patients. Perform routine pregnancy testing for appropriate patients as physiologic changes in pregnancy may increase cocaine toxicity. Cocaine may induce miscarriage, premature labor, placental abruption, or fetal toxicity, and modifications may be necessary for acute management.
  • Provide reassurance. The effects of cocaine are generally short lived. Monitor patients until they are no longer tachycardic and hypertensive and until they are calm and cooperative.

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