Cocaine Chest Pain: Tachy and Shocky

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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glenn b. -

What about benzos for his sympathomimetic toxidrome? Did you avoid because of the low BP?

Stuart S., MD FRCPC -

Glenn - indeed - see below!

Charles T. -

Is there a role for Benzo's in the treatment of this patient? Or is the concern the "sympatho-lysis" the benzo's would cause may tank the patients already tenuous BP?

Stuart S., MD FRCPC -

Charles - thanks for your comment! Absolutely, benzodiazepines are first line in patients like this who are acutely intoxicated with sympathomimetic agents. It was indeed the low blood pressure and concerns about making it worse that made this case so different. Every agent we usually turn to in a patient with cocaine related chest pain: benzos, nitro, calcium channel blockers - all carry a potential risk of hypotension.

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