Drug misuse, intoxication and withdrawal Quiz: Ace Your Exams
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A 65-year-old man comes to the emergency room for evaluation of chest pain and shortness of breath. He endorses using intranasal cocaine daily, and his last use was three hours prior to arrival. Temperature is 100 °F (37.7°C), pulse is 100 bpm, blood pressure is 200/120 mmHg, and SpO2 is 99%. The patient appears agitated and irritable. On physical examination, the pupils are mydriatic, and the patient is sweating profusely. Oral mucosa appears moist, and the nasal mucosa is atrophic. Cardiopulmonary exam is unremarkable. The patient moves all four extremities to command with normal deep tendon reflexes. ECG shows sinus tachycardia with ST depression and T wave inversions in I, avL, V5 and V6. He is treated with IV benzodiazepines and undergoes percutaneous intervention. His blood pressure two hours later is 190/100 mmHg. He complains of blurry vision and an occipital headache. The patient is provided with labetelol and subsequently undergoes ventricular fibrillation cardiac arrest. Which of the following best explains this change in clinical status?
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