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Catheter‐assisted Intubation
Author(s) -
Zink Brian J.
Publication year - 1995
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1995.tb03209.x
Subject(s) - medicine , intubation , catheter , anesthesia , surgery
To the Editor:-The majority of previously reported patients with cocaine-associated myocardial infarctions (MIS) were cigarette smokers.' Coronary artery vasoconstriction occurs both after the nasal insufflation of cocaine hydrochloride' and after cigarette smoking.' Therefore, we had previously hypothesized that the use of cocaine in temporal proximity to cigarette smoking may play a role in the pathogenesis of myocardial ischemia.' Recently, Moliterno et a].' showed that the effects of cocaine on myocardial O2 demand are exacerbated by concomitant cigarette smoking. This combination of toxins increased the metabolic requirement of the heart for 02, while simultaneously decreasing the diameter of diseased coronary artery segments. As a result of their investigation, we reanalyzed data from the cocaine-associated chest pain (COCHPA) trial.> During the prospective study of 246 patients who presented to the ED with cocaine-associated chest discomfort, we collected data describing the time of last cocaine use, the duration of time between cocaine use and the onset of chest discomfort, and the time of the patient's last use of tobacco (if it was in the last 12 hours). Patients were eliminated from this analysis if their last use of cocaine was more than 12 hours prior to arrival; or if the patient continued to smoke tobacco after the onset of chest pain. We could not establish the relationship between the onset of chest pain and most proximate tobacco use for patients who continued to smoke after the onset of chest pain, because we recorded only the patients' last use of tobacco. Analysis of the 51 patients who had used both cocaine and tobacco in the 12 hours prior to presentation revealed that the time between cocaine use and tobacco use was related to the onset of chest pain (r = 0.62, p < 0.0001). As the time interval between tobacco use and cocaine use shortened, the development of chest pain occurred more rapidly (Fig. 1). The concurrent use of tobacco with cocaine may shorten the interval prior to onset of chest pain. While it remains unknown whether concurrent use of cocaine and tobacco increases the likeli-