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Cocaine-associated chest pain — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseCocaine-associated chest painSCE Acute Medicine

A 51-year-old woman presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show cocaine use with hypertension, chest pain and transient ST depression. What is the most appropriate next step in management?

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Correct answer: A — Give benzodiazepine and nitrate therapy with ACS evaluation

The key discriminator is that cocaine use with hypertension, chest pain and transient ST depression, which makes Give benzodiazepine and nitrate therapy with ACS evaluation the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Provide supportive care and close monitoring are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; NICE NG185