First Things First (assess & treat for the following)
- Assess for life-threatening complications.
- Hypoxia, altered mental status: airway mgt, O2 supplementation
- Hypotension, shock: vascular access, IV fluids
- Arrhythmias: follow ACLS guidelines
- Status epilepticus: IV benzodiazepines, correct structural defects
- Severe hyperthermia: initiate cooling
- Control agitation w/ benzodiazepines IV/IM.
- Focused evaluation for specific complaints
- Available forms of cocaine
- Cocaine hydrochloride: snorted, injected or ingested
- Crack cocaine (alkaloid form): inhaled
- Route of administration determines intensity & duration of action.
- Inhalation has fastest onset & shortest duration.
- Intranasal has slower onset, longer duration.
- Major pathophysiologic effects
- Increases release of catecholamines: primarily norepinephrine, also dopamine & serotonin
- Blocks reuptake of these catecholamines at preganglionic neurons
- Catecholamines lead to profound sympathomimetic effects.
- Local anesthetic effect due to blockade of fast sodium channels
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