An Unusual Presentation after Crack Cocaine Use

BY ​SEMERE TEDLA, MD; WESLEY EILBERT, MD; & JOSEPH COLLA, MD​A 59-year-old man with a history of frequent crack cocaine use presented with difficulty breathing for four hours. He had no prior medical problems or known allergies. He admitted to smoking crack cocaine four days before his symptoms began. He reported a one-day history of productive cough but denied chest pain, sore throat, and fever.​​He was a well-developed man in mild distress. His temperature was 36.5°C, pulse 90 bpm, blood pressure 188/108 mm Hg, and respiratory rate 20 bpm. His oxygen saturation was 100% on four liters by nasal cannula. Inspiratory stridor was noted with supraclavicular retractions and accessory muscle use. His lungs were otherwise clear to auscultation. His oral cavity and oropharynx were normal in appearance. The remainder of his physical exam was unremarkable.​A chest x-ray was obtained. What should be the next steps in this patient's evaluation and treatment?The patient was diagnosed with crack cocaine-induced subglottic edema. The chest x-ray revealed a “steeple sign” (arrow) indicative of subglottic stenosis, similar to that seen in children with croup. This finding was later confirmed on CT of his chest. Initial treatment with inhaled nebulized albuterol was followed by nebulized racemic epinephrine and 10 mg IV dexamethasone. Flexible fiberoptic laryngoscopy was performed at the bedside by the otolaryngology service, which revealed only bilateral nonobstructive ary...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research