Search

Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge.Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%).Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain. [West J Emerg Med. 2014;15(2):180–183.]

In support of its role as the Department of Defense (DoD) executive agent for surface transportation and common user ocean terminals, Military Traffic Management Command (MTMC) has established the 'Highways, Rail, and Ports for National Defense' programs, which identify and monitor the capability of the CONUS infrastructure to support mobilization and deployment. This study, Volume I, of the Ports of National Defense (PND) Program contains revised information for selected east coast ports. It provides a comprehensive description of port facilities and an analysis of ship/berth capability. The purpose is to evaluate US east cost commercial port facilities to determine whether they can support a deployment of military units aboard ships. The study provides an assessment of the adequacy of commercial port facilities for the deployment of specific types of units. Identification of terminals that are best suited to support deployments and selection of the best berths. A ready-reference digest of the most significant port characteristics. It also describes port support capabilities for terminal operations.