HellsBells Posted October 8, 2008 Posted October 8, 2008 I know this guy said that he just said no to drugs, but it sure seems like cocaine all the way, what business does a guy in his 20's have with an AMI anyhow? Don't hurt me too much, I'm still a paramedic student, but would anybody try Midazolam 2.5mg IV? Is anyone even gonna finish this scenario?
ERDoc Posted October 8, 2008 Author Posted October 8, 2008 Oops. Sorry, I had forgotten about this scenario. Instead of dragging it out a few more months I'll just tell you what is going on. This guy is infact having an MI from the bags of cocaine he swallowed when the cops tried to pull him over. One of the bags ruptured and the scuffle with the police only exacerbated the issue. What medication do you want to avoid giving this pt? Why?
towheadedmule Posted October 8, 2008 Posted October 8, 2008 Nitro? The vasodilation speed the transfer of cocaine? treat with versed to control hypertension and hyperthermia
chbare Posted October 8, 2008 Posted October 8, 2008 Think about another class of medications used frequently in the management of MI. Consider what happens if we were only to block specific receptors in the setting of cocaine induced MI. Also consider the cause of the ischemia. Are we dealing with an actual occlusion or vasospasm in some cases? Take care, chbare.
towheadedmule Posted October 8, 2008 Posted October 8, 2008 lidocaine lowers the seizure threshold and can potentiate cocaine toxicity. forgot about this till a VERY recent lit review on eMedicine
chbare Posted October 8, 2008 Posted October 8, 2008 Something to consider; however, think about a class of medications we frequently give to MI patients. In fact, it is considered a core measure for MI management within the hospital. Take care, chbare.
towheadedmule Posted October 8, 2008 Posted October 8, 2008 non selective beta blockers, i.e. Inderal. Reports from ECHOs show that after betablockade the unopposed alpha stimulation can exacerbate tachycardia leading to precipitous hypotension.
chbare Posted October 8, 2008 Posted October 8, 2008 So, just for some additional pharmacology review, which beta blocker could we consider using? Take care, chbare.
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