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Cocaine toxicity — DipIMC MCQ

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HardMedical EmergenciesCocaine toxicityDipIMC

A 43-year-old man is extremely agitated, sweating and paranoid after cocaine use. He has chest pain, pulse 150, temperature 39.4°C and blood pressure 210/120. What is the most appropriate immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Prioritise safe restraint, benzodiazepine sedation within governance, cooling and urgent transfer

Severe stimulant toxicity with hyperthermia and chest pain is life-threatening and requires coordinated safety, sedation within scope, cooling and hospital assessment. Prone prolonged restraint increases risk of positional asphyxia, especially in excited delirium-like states. Beta-blocker monotherapy is not the immediate pre-hospital priority. The pearl is that agitation, hyperthermia and acidosis can form a lethal spiral.

Reference: JRCALC Guidelines 2025; College of Policing/ambulance restraint principles