Pulmonary Complications From Cocaine

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A concise review of the pulmonary complications of cocaine inhalation
Edward Omron MD, MPH, FCCP
Pulmonary Medicine
Morgan Hill, CA 95037

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Pulmonary Complications From Cocaine

  1. 1. Pulmonary Complications From Cocaine<br />Edward M. Omron MD, MPH, FCCP<br />Pulmonary Medicine<br />Alta Bates Summit<br />
  2. 2. 49 yo male found naked running down the freeway. In ER developed tonic-clonic seizure. He is agitated, diaphoretic, and paranoid Fever to 102.8, HR 120, RR 24, BP 170/98.Audible wheezing at bedside<br />
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  5. 5. Differential Diagnosis<br />Community acquired pneumonia<br />Septic pulmonary embolism<br />Pulmonary edema or hemorrhage<br />Acute interstitial pneumonia<br />Acute pulmonary syndrome from inhalational drug abuse <br />
  6. 6. Which of the following should be initially given?<br />Labetalol<br />Haloperidol<br />Phenytoin<br />Lorazepam<br />Acetaminophen<br />
  7. 7. Sympathomimetic Syndrome Cocaine Intoxication<br />Tachicardia, hypertension, hyperthermia, midriasis, agitation, and psychosis<br />Treatment: <br />IV midazolam or lorazepam for sedation<br />IV Fluids to prevent rhabdomyolysis<br />ECG for myocardial ischemia and ACS markers<br />CT head to r/o intracranial injury<br />Beta Blockers contra-indicated for HTN<br />Unopposed alpha vasoconstrictor effects<br />Labetolol preferred agent<br />Haloperidol contra-indicated<br />
  8. 8. Cocaine<br />Pulmonary complications are a function of<br />Dose Size, method of administration, assoc. substances<br />Extracted from the leaf of Erythroxyloncoca plant<br />South American shrub<br />Four forms <br />Hydrochloride salt “White powder” inhaled<br />Crack: Heat stable, preferred form smoked<br />Bazuco: Extract of coca leaves that is smoked in S.A. <br />
  9. 9. Figure 1.  Photograph illustrates the E coca plant, a shrub that is native to South America and grows in a variety of areas, including Venezuela, Colombia, Ecuador, Peru, Bolivia, Brazil, and northern Argentina.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  10. 10. Pulmonary Complications of Cocaine Abuse<br />
  11. 11. Acute Respiratory Symptoms<br />Cardiorespiratory complaints most common<br />Particle size from Crack Cocaine 2.3 um deposits in alveoli<br />Cough , wheezing, dyspnea, CHEST PAIN<br />Chest Pain 40% after 12 hours<br />Black sputum<br />Acute Chest Syndrome<br />Patchy alveolar infiltrates upper and lower lobes<br />SOB<br />Fever<br />Hypoxia<br />
  12. 12. Barotrauma complication<br />Pneumothorax, pneumomediastinum, pneumopericardium, or subcutaneous emphysema<br />Valsalva maneuvers to TLC<br />Severe cough from inhalation<br />Accomplice blow into their mouths through cardboard tube adding PEEP<br />Injection into internal jugular or subclavian vein lacerating lung apex<br />
  13. 13. Figure 3a.  Pneumomediastinum in a 28-year-old patient who presented with retrosternal chest pain after smoking crack cocaine.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  14. 14. Figure 4.  Spontaneous left-sided pneumothorax in a 33-year-old man who had been smoking crack cocaine.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  15. 15. Asthma<br />Smoked cocaine causes acute bronchospasm in healthy individuals with no history of asthma<br />Bronchospasm can be severe and life threatening<br />Radiographics<br />Patchy parenchymal opacities on CXR<br />GGD on CT chest<br />
  16. 16. Figure 5a.  Crack cocaine–induced asthma in a 38-year-old woman.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  17. 17. Pulmonary Edema and Hemorrhage<br />Cardiogenic and noncardiogenic pulmonary edema<br />80% of cocaine related deaths in autopsy series<br />Increased capillary permeability, leakage<br />Hemoptysis in up 25% of crack users<br />Hemorrhage can be severe and life threatening<br />Edema and hemorrhage have similar appearances on CT Chest<br />Bilateral multifocal opacifications, GGD<br />
  18. 18. Figure 6.  Cardiogenic pulmonary edema in a 36-year-old woman who presented with shortness of breath and chest pain after smoking crack cocaine.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  19. 19. Figure 7.  Acute pulmonary edema in a cocaine abuser.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  20. 20. Eosinophillic Lung Disease<br />“Crack Lung” pulmonary syndrome<br />Inhalation of freebase cocaine<br />Fever, hypoxia, hemoptysis, ARF, and diffuse pulmonary infiltrates<br />Biopsy reveals DAD, alveolar hemorrhage, infiltration with eosinophils and IgE<br />BAL eosinophil rich<br />Corticosteroids are used as treatment<br />
  21. 21. Figure 8a.  Pulmonary eosinophilia in a patient with a history of cocaine abuse.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  22. 22. Figure 8b.  Pulmonary eosinophilia in a patient with a history of cocaine abuse.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  23. 23. Figure 15a.  Advanced emphysema in a relatively young (36-year-old) woman with a history of heavy cocaine abuse and unrelated mitral valve disease.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  24. 24. Figure 15b.  Advanced emphysema in a relatively young (36-year-old) woman with a history of heavy cocaine abuse and unrelated mitral valve disease.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  25. 25. Figure 14a.  Severe pulmonary hypertension in a 43-year-old man with a history of cocaine abuse.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  26. 26. Figure 14b.  Severe pulmonary hypertension in a 43-year-old man with a history of cocaine abuse.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  27. 27. Figure 10a.  Talc granulomatosis in a patient with a history of intravenous cocaine abuse.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  28. 28. Figure 10b.  Talc granulomatosis in a patient with a history of intravenous cocaine abuse.<br />Restrepo C S et al. Radiographics 2007;27:941-956<br />©2007 by Radiological Society of North America<br />
  29. 29. RadioGraphics July 2007 vol. 27 no. 4 941-956<br />Chest 1995; 107: 233–240<br />

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