Creatine phosphokinase elevation in patients presenting to the emergency department with cocaine-related complaints.

The incidence of creatine phosphokinase (CPK) elevation was evaluated in patients presenting to an urban emergency department with any complaint related to cocaine use within the preceeding 24 hours. Patients with obvious causes of CPK elevation (ie, seizure) were excluded. Forty patients were enrolled. CPK values were elevated in 21 patients (53%). The mean CPK value for patients with an elevated CPK was 1,071 IU/L. There was no statistically significant difference between the patient's initial complaint (muculoskeletal, psychiatric, or cardiovascular) and the incidence of CPK elevation (P = .35). Thirty of the 40 patients admitted to using some other drug(s) in addition to cocaine in the preceding 24 hours. Some degree of skeletal muscle injury and CPK elevation appears to be common in patients using cocaine.

Acute asthma.

The number of patients presenting to the emergency department with severe acute asthma exacerbations is increasing. Prompt and aggressive therapy often ameliorates the symptoms and decreases the morbidity and mortality associated with this disease. A directed history and physical examination should be performed, often simultaneously with treatment. The use of inhaled beta-adrenergic agents and the early use of corticosteroids will reverse most attacks. In addition, the use of anticholinergic agents may benefit selected patients. Despite aggressive treatment, some patients will require endotracheal intubation. Controlled intubation with proper sedation and paralysis will decrease the associated morbidity. Complications associated with mechanical ventilation may be prevented by decreasing the amount of auto-PEEP by controlled hypoventilation. Asthma, when incompletely or inadequately treated, can be a rapidly fatal disease process. Conservative approaches to patient admission based on strict objective pulmonary function testing should decrease morbidity and mortality.