Cocaine-related symptoms in patients presenting to an urban emergency department

J A Rich, D E Singer
Annals of Emergency Medicine 1991, 20 (6): 616-21

STUDY OBJECTIVES: Cocaine abuse is a serious social problem that precipitates a significant number of emergency hospital encounters. To determine the nature of cocaine-related symptoms, we studied patients with cocaine use presenting to all adult services of an urban emergency department.

DESIGN: Review of consecutive cases, with analysis of clinical features.

SETTING: All adult EDs of an urban teaching hospital.

TYPE OF PARTICIPANTS: Patients acknowledging recent use of cocaine (within 72 hours) and/or with cocaine detected on a toxicologic screen.

MEASUREMENTS AND MAIN RESULTS: Psychiatric complaints accounted for 44 (30.6%) presentations, followed by neurologic (17.4%), cardiopulmonary (16%), trauma (11.8%), and addiction-related (11.1%) symptoms. Cardiopulmonary symptoms were more frequently associated with intranasal than with IV or smoked cocaine (P = .003). Suicidal intent was the most common psychiatric reason for presentation, occurring in 24 patients (16.6%). Seventeen presented with trauma, including three involved in motor vehicle accidents.

CONCLUSION: Cardiopulmonary symptoms such as chest pain and palpitations may be significantly more frequent in patients who use intranasal cocaine; suicidal intent is common among patients presenting with psychiatric symptoms related to cocaine; and the range of cocaine-related symptoms is varied, including not only psychiatric and cardiopulmonary symptoms but also trauma.

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