Cocaine and the critical care challenge.

Abstract:

OBJECTIVE:Cocaine, which first made its appearance >1,000 yrs ago, is now widely used throughout the world. The physiologic responses to cocaine may cause severe pathologic effects. This review highlights the many critical care challenges resulting from these effects. DESIGN:Historical vignettes, epidemiologic factors, modes of preparation and delivery, and the physiologic and pharmacologic effects of these agents are presented. SETTING:Cocaine causes intense vasoconstriction, which potentially causes damage to all organ systems. Examples of these toxicities are presented. PATIENTS:The adverse multisystem responses to cocaine exposure produce organ failure, which challenges diagnostic accuracy and therapeutic intervention. Organ system failure involves the brain, heart, lung, kidneys, gastrointestinal tract, musculature, and other organs. These harmful effects are additive to preexisting organ dysfunction. INTERVENTION:Recognition of associated cocaine injury alerts the physician that organ dysfunction is more likely to occur and to be more severe. Such anticipation helps plan for therapy in the critical care setting. RESULTS AND CONCLUSIONS:Cocaine use is an expanding health hazard, despite intense governmental efforts to contain its distribution and use. Recognition of the signs and symptoms of cocaine toxicity help anticipate the subsequent organ dysfunction and implement earlier organ system support.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Shanti CM,Lucas CE

doi

10.1097/01.CCM.0000063258.68159.71

subject

Has Abstract

pub_date

2003-06-01 00:00:00

pages

1851-9

issue

6

eissn

0090-3493

issn

1530-0293

journal_volume

31

pub_type

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