When should you ask about cocaine use?
Always ask about recent cocaine use when a younger individual presents to the ED with possible cardiac symptoms, says Pamela Tokarski, RN, an ED nurse at Henry Ford Hospital in Detroit.
"Young patients may not make a connection between cocaine use and the symptoms they are experiencing," she says.
On the other hand, publicity about the consequences of cocaine abuse may raise the fear of cardiac effects or death, prompting the ED visit, she says.
"We have cared for many young patients, several less than 40 years old, who presented to the ED with chest pain and admitted to cocaine use prior to or during the onset of their symptoms," says Tokarski. "Even casual cocaine use should be asked about."
Part of the routine
Questions by triage nurses regarding recent cocaine use have become as routine as asking about hypertension, diabetes, and tobacco use, says Tokarski. Determine when cocaine was last used, because cardiac consequences might occur up to several hours or even days later, she adds.
At Henry Ford Hospital, ED nurses routinely obtain an immediate electrocardiogram (EKG) at triage for any patient 30 years or older who reports chest or epigastric discomfort, dyspnea, diaphoresis, nausea, vomiting, palpitations, or syncope, with the specific intent of identifying ST elevation or left bundle branch block. "If these [EKG] abnormalities are noted, we treat the patient as we would a Level 1 medical or trauma patient, by placing them in our resuscitation room and activating our resuscitation team," says Tokarski.
Cocaine users might present with shortness of breath, headache, hemiparesis, facial asymmetry, abdominal pain, hypertension, or chest pain, either midsternal or radiating through to the back, says Regina L. Wright, MSN, RN, CEN, CNE, clinical nurse specialist for emergency services at Albert Einstein Healthcare Network in Philadelphia. "Acute stroke, seizures, and aortic dissection are also concerns," she says. "These possible complications are compounded if patients have a coexisting condition."
Due to the rapid, simultaneous approach in the ED with oxygen started, intravenous line placed, and chest X-ray being given, patients suddenly become aware of their acuity, says Wright. "They ask, 'Could I really be having a heart attack?' They might report drug use at this time."
Patients often do not connect their drug use with serious consequences, adds Wright. "As always, the ED nurse must be prepared to adjust care as more patient history is obtained," she says.
Always ask about recent cocaine use when a younger individual presents to the ED with possible cardiac symptoms, says Pamela Tokarski, RN, an ED nurse at Henry Ford Hospital in Detroit.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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