The American journal of emergency medicine
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Cocaine is the most commonly abused illegal drug in patients presenting to emergency departments (EDs) because of chest pain and accounts for almost 40% of all drug-related visits. It is not known whether all β-blockers (BB) and β1-selective agents or mixed α1/β-adrenergic antagonists (α1/β-BB) are safe in the acute management of cocaine-associated chest pain, due to concerns of unopposed α-receptor activity resulting in coronary artery spasm and hypertensive urgency. ⋯ Troponin rise is not uncommon in patients with cocaine-associated chest pain and occurred in 11% of the patients. In patients with cocaine-associated chest pain, BBs did not appear to change the incidence of troponin rise. β1-Selective BBs did not appear to worsen troponin levels compared with mixed α1/β-BB.
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Clinical Trial
d-Dimer and simplified pulmonary embolism severity index in relation to right ventricular function.
Right ventricular (RV) involvement in pulmonary embolism (PE) is an ominous sign. The aim of this study was to investigate the extent to which the d-dimer level or simplified PE severity index (sPESI) indicates RV dysfunction in patients with preserved systemic arterial pressure. ⋯ In the acute stage of PE, a d-dimer level 3 mg/L or higher may identify nonmassive PE patients with RV dysfunction and thereby help to determine their risk profile. We found no additional value for sPESI in this context.