If more likely a chronic toxicity, give 4 or 5 vials to start. Will measure both bound and unbound digoxin. Central nervous system including confusion, coma, seizures, headache, fatigue, nausea. May have arrhythmias, cardiac ischemia. Venous carboxyhemoglobin level just as good as arterial.
Oxygen saturation is frequently normal.
Even if the patient seems well when seen or is recovering from the CNS insult, hyperbaric oxygen has been shown to reduce long-term sequelae. Unopposed alpha-adrenergics may worsen problems. For coronary vasospasm, hypertension, or tachycardia, observation is probably adequate, since cocaine has short half-life. If treatment urgent, phentolamine 5 to 10 mg IV probably the drug of choice. MI and CVA may occur up to 72 hours after cocaine use.