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I narrowed down to two, I already answered but just wanted to see what you might feel is priority. Theres two pt's in the e.r. Waiting room which.one do we assess first? A. A cocaine intoxicated pt with chest pain.

B. An alcoholic patient who is intoxicated and has a history of delirium tremens

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Which one do you think? You start the dialog and we will jump in!

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Well I chose B . Because It was stressed in class how emergency like Delirium tremens was, and it was life threatening. And as I thought about A...I thought cocaine is a central nervous stimulant so yes its expected someones heart rate and bp to be up and pounding I thought thats why they give the beta blocker inderal to treat it.

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My question to you is....is a HISTORY of DTs a higher priority over a person with active Chest pain?

Also, the alcoholic is intoxicated currently. .so how long does it take for DTs to set in?

Stages of alcohol withdrawl?

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I believe 2013SNGrad is correct, even without considering the symptoms, an actually diagnosis takes priority over a risk of diagnosis. While DT can be life threatening, the patient is still intoxicated and not showing signs of DT. Also keep in mind that DT usually take a few days up to a week to show up after the last drink.

Chest pain on the other hand is usually the sign of decreased oxygen profusion to cardiac muscles. Chest pain places ACS and MI as possibilities. Additionally, the risk of MI are the highest within the first hour of cocaine use.

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My question to you is....is a HISTORY of DTs a higher priority over a person with active Chest pain?

Also, the alcoholic is intoxicated currently. .so how long does it take for DTs to set in?

Stages of alcohol withdrawl?

See when you wrote chest pain alone it stands out more, I guess I saw DT's and can still Hear my instructor saying time is.of the essence with dts . But it didnt say a time frame with the question id either had been intoxicated for a while but ABCs make it more clear chest pain is more concerning!

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DTs happen later after withdrawal. If the patient is intoxicated at the time then they havent had time to even think about beginning any withdrawals. It takes a few days and can last week or more

Chest pain is always priority

Think about perfusion, this patient could be having MI and the the cocaine is a factor however anyone with active chest pain is high priority

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
See when you wrote chest pain alone it stands out more, I guess I saw DT's and can still Hear my instructor saying time is.of the essence with dts . But it didnt say a time frame with the question id either had been intoxicated for a while but ABCs make it more clear chest pain is more concerning!
2013SNGrad is right.......The person with a history of DT's is still intoxicated......the DT"s are not an imminent threat...the cocaine intoxicated person is having ACTIVE chest pain....cocaine causes coronary artery spasm which can lead to a MI.

The DT's will be coming if not addresses the cocaine patient is actively having pain. Look up how long it takes for DT's to onset from last drink and look up the effects of cocaine.

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time is definitely of the essence with DTs but just because the pt has a history of DTs doesn't mean he's experiencing it currently. this is one of those questions that's not just testing you on your knowledge (you know about DTs and the treatment for cocaine OD), but testing you on your critical thinking - I hated these questions as well - be sure not to add your own info to them (such as "it's expected someones HR and BP to be up and pounding", I used to have a problem doing that. take only what the question gives you as facts. it said "chest pain," not "elevated HR and BP" - you have to at the very least ASSESS the PQRSTs of the chest pain, right? PQRST Method for Pain Assessment

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Specializes in Emergency Nursing.

The cocaine user with chest pain most likely is experiencing the beginnings of an aortic dissection at best some sort of MI. You are probably going to want to see that patient first because they are going to be dead really soon.

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I researched DT, and I read that this is a condition during alcohol withdrawal. The patient is intoxicated but (I think) is not in acute distress at that very moment. I would definitely consider the cocaine intoxicated patient with chest pain as the priority. Anytime there is chest pain involved (despite cocaine), doctors are going to look into cardiac infarction. Also, cocaine is extremely dangerous to the heart, brain, nervous system, and other parts of the body. In fact, cocaine increases BP and HR. The drug can actually induce MI because it constricts the blood vessels in the body. So the cocaine intoxicated patients could very well be experiencing a heart attack and that is why I would go with choice A. I'm not a nurse yet. I start nursing school in the fall. Thanks for the post! It challenged my thinking!

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