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The Participants (alphabetically)

Jeff Lapoint (@lapizity)

Emergency Physician and Medical Toxicologist

Director, Division of Medical Toxicology

Kaiser San Diego

California, USA

John Richards (@JR_Code3)

Emergency Physician

Professor of EM

UC Davis Emergency Medicine

California, USA

The Posts that Got us Here

* John on LitFL

* Jeff on the Tox and the Hound

Steel-Man Rules for this Debate

* Any time you want to contradict the other discussant, you must first restate the views they have just stated and confirm with them that you are understanding correctly. If you can bolster their point even more strongly before contradicting, this is even better. The moderator may prompt you if you forget.

* No ad-hominem attacks (i.e. attacks on the person, not their views. Feel free to politely destroy the views)

* Logical fallacies will be pointed out by the moderator if they have not been by the other discussant

* Try to state whether a viewpoint is based on evidence, and what quality or based on your clinical practice

The Questions

* Should beta-blockers be used in patients with cocaine toxicity?

* How are we defining cocaine toxicity?

* Does Unopposed Alpha phenomena actually exist?

* Are beta-blockers safe in cocaine toxicity?

* Even if they are safe, is there any compelling reason we should use them over other treatments?

* What about the non-floridly toxic patient, for instance: a case of hypertensive, tachycardic, sweaty patient with chest pain. Already received 2 rounds of Ativan and nitro with continuing symptoms, see how each manage

* Do your thoughts on beta-blockers in cocaine toxicity apply to the other stimulants?

* What about patients who admit to taking cocaine in the recent past, but show no signs of toxicity--Is it safe to use beta-blockers in these patients?

* A case: 48 y/o with type I DM, HTN, High Chol. Presents with substernal CP, first trop negative. For some reason nurses obtained a urine drug screen positive for cocaine. When asked, pt states he is an occ. User and last use was 2 days ago. Denies any use today. Pt has been totally forthcoming about all of his drug use and you believe him. Your hospital uses CTCA for this risk category of chest pain to allow immediate discharge for f/u if negative. You order the test, but radiology refuses to do the scan b/c of the requirement for beta-blockers and a drug screen positive for cocaine. Is this justified or not?

Additional Info

* John's extensive publications on cocaine and beta-blockers

* If you don't trust my editing and want an unabridged version, it is here.