Fijismo

Cocaine Toxicity in Emergency Medicine Follow-up
Background
The ancient Incas of Peru believed cocaine to be a gift from the gods. However, it is a modern-day curse to the emergency physician.[1] Aside from alcohol (and not including tobacco-related illnesses), cocaine is the most common cause of drug-related ED visits in the United States, accounting for 488,101 ED visits in 2010 , accordingto the Drug Abuse Warning Network (DAWN).[2] Marijuana or hashish constitutes the second leading cause at 461,028 visits. Heroin-related visits accounted for 224,706 visits.
Patients who present to the ED with cocaine toxicity often also have other drugs present; in fact, the combined use of alcohol and cocaine may be the major cause of drug-related deaths.
Across the spectrum of acute andchronic effects, nearly every organ system can be effected. Trauma is often associated with cocaine use. Even the absence of cocaine may precipitate an ED visit due to withdrawal symptoms.
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History of use and abuse
Use of cocaine spans thousands of years, with a duality of effects noted throughout history. Knowledge of its mind-altering function datesto at least 2000 BC. For centuries, indigenous mineworkers in Andean countries have used cocaine derived from the chewing of coca leaves as an endurance-enhancement agent. Spanish physicians reported the first European use of coca for medicinal purposes in 1596. Cocaine was not isolated from coca leaves until 1859. Nevertheless, by 1863, a wine fortified with 6 mg of cocaine alkaloid extract perounce was marketed in France. By 1880, the US pharmaceutical company Parke-Davis sold a fluid extract containing 0.5 mg/mL of crude cocaine.
In 1884, William Stewart Halsted performed the first nerve block using cocaine as the anesthetic. Halsted subsequently became the first cocaine-impaired physician on record. That same year, Sigmund Freud published the essay "Uber Coca," in which he advocatedthe use of cocaine in the treatment of asthma, wasting diseases, and syphilis. As with Halsted, Freud also became dependent on cocaine. In 1885, John Styth Pemberton registered French Wine Cola in the United States. The popular product, which contained 60 mg of cocaine per 8-oz serving, was later renamed Coca-Cola.
By 1893, occasional reports of fatality were associated with cocaine use, and, in1895, The Lancet reported a series of 6 deaths. By 1909, more than 10 tons of cocaine was being imported into the United States each year. Many over-the-counter medical products and elixirs had been created. One product for nasal application, called Dr. Tucker's Asthma Specific, contained 420 mg of cocaine per ounce.
The Harrison Narcotics Act of 1914 banned nonprescription use ofcocaine-containing products. The resulting reduction in the use of cocaine marked the end of the first American cocaine epidemic. In the 1950s, amphetamine gradually replaced cocaine as the most common stimulant of abuse. However, this trend was reversed in the 1970s, with crack ushering in the second epidemic of US cocaine use in 1985.
Crack, which is generally sold in the form of "rocks," may also be sold inlarge pieces called slabs. These are approximately the size and shape of a stick of chewing gum and are sometimes scored to form smaller pieces. Users of cocaine in its crack form tend to be young adults aged 18-30 years who live in the central city and who are from low socioeconomic backgrounds. However, in 1986, the National Office of Drug Control Policy reported that young inner-city drug userswere beginning to disdain crack as a ghetto drug. In Miami, for example, crack use had become unfashionable, and individuals continuing to use it, particularly African Americans, were trying to hide it from their peers.
Cocaine powder is currently marketed to adults from all ethnic backgrounds and socioeconomic groups, predominated by white men older than 30 years who live in the central city....