Occasionally, severely agitated patients must be pharmacologically paralyzed and mechanically ventilated to ameliorate acidosis, rhabdomyolysis, or multisystem dysfunction. Phenothiazines lower seizure threshold, and their anticholinergic effects can interfere with cooling thus, they are not preferred for sedation. Hyperthermia can be life threatening and should be managed aggressively with sedation plus evaporative cooling, ice packs, and maintenance of intravascular volume and urine flow with IV normal saline solution. Hypertension that does not respond to benzodiazepines is treated with IV nitrates (eg, nitroprusside) or phentolamine ?-blockers are not recommended because they allow continued ?-adrenergic stimulation. Propofol infusion, with mechanical ventilation, may be used for resistant cases.
High doses and a continuous infusion may be required. Lorazepam 2 to 3 mg IV q 5 min titrated to effect may be used. Benzodiazepines are the preferred initial treatment for most toxic effects, including CNS excitation and seizures, tachycardia, and hypertension. " Treatment of mild cocaine intoxication is generally unnecessary because the drug is extremely short-acting.
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