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Chest Pain (Cocaine/Stimulant Ingestion)

Date Last Search Run: Aug 01, 2024
Table last updated: Mar 31, 2023
Data last added: Mar 31, 2023

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)      
3 (weak evidence exists)    


Interventions

12-Lead ECG
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) AMI recognition Process ED-MD Hollander JE., Hoffman RS., Gennis P., Fairweather P., DiSano MJ., Schumb DA., et al. Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group. Acad Emerg Med 1994; 1(4):330-9. Medline
III Supportive (Green) AMI recognition Process ED-MD Wieler J, Mostafa AMT. Reprint of: Cocaine induced chest pain and acute coronary syndrome. Dis Mon 2022; 68(9):101407. Medline

Analgesia (narcotic)
Level Direction Primary Outcome Patient/Process Setting Reference

Benzodiazepines
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Chest pain relief Patient ED-MD Honderick T., Williams D., Seaberg D., Wears R. A prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes. Am J Emerg Med 2003; 21(1):39-42. Medline
III Supportive (Green) Chest pain resolution (measured by visual analog scale) Patient ED-MD Baumann BM., Perrone J., Hornig SE., Shofer FS., Hollander JE. Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Acad Emerg Med 2000; 7(8):878-85. Medline

Beta Blockers
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Reversal of Segment elevation Patient ED-MD Akay S., Ozdemir M. Acute coronary syndrome presenting after pseudoephedrine use and regression with beta-blocker therapy. Can J Cardiol 2008; 24(11):e86-8. Medline

Chest pain prediction tool
Level Direction Primary Outcome Patient/Process Setting Reference
II Opposes (Red) Assessment of 30-day major adverse cardiac event(s) Patient ED-MD Faramand Z, Martin-Gill C, SO F, Callaway C, Al-Zaiti S. The prognostic value of HEART score in patients with cocaine associated chest pain: An age-and-sex matched cohort study. Am J Emerg Med 2021; 45:303–8. Medline

Nitrates
Level Direction Primary Outcome Patient/Process Setting Reference

Securing tube
Level Direction Primary Outcome Patient/Process Setting Reference


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