Wanted to post this before then couldn’t find the link I saved to my computer. But I found it again online.
Here’s another study going against traditional teaching that I found while researching the post about beta blocker use in heart attacks.
Beta-blockers may actually reduce the risk of MI after cocaine use – despite what ED physicians are routinely taught about NOT giving beta blockers due to the potential for an “unopposed alpha adrenergic effect of cocaine.”
Now what? Do we get dinged by CMS for not giving beta blockers in cocaine users based on some studies or do we give beta blockers to everyone with cocaine chest pain based on other studies?
What a dumbass metric.
Remember that you won’t get “dinged” by CMS in these cases. If you choose not to give beta blockers, whether because it’s a cocaine-related MI, or a bradycardic inferior, or for whatever reason, so long as you document *why* you did not give them, it will be coded as “not given for patient factors,” and will be counted as a compliant case. If you don’t document why you didn’t give them, then they will assume you forgot and it will be counted as noncompliant, a “ding,” if you will.
CMS may be misguided, but they are not dumb, and they do provide a mechanism for provider judgment.
I saw the article you linked to. I was glad to see it, because the whole “unopposed alpha” seemed bogus to me.
Cheers,
SF
I’m being snarkish.
My whole issue is that even with the ability to allow for “provider judgment,” absent a “contraindication” you have to give the medication even if you don’t believe that medical research demonstrates the medication’s effectiveness.
Even worse, CMS forces us to give a medication “early” when a large study shows that giving the medication “early” may cause detriment to our patients.
If the patient comes in with a beta blocker OD, does CMS ding you if you don’t treat the patient by giving cocaine?
Is there a 4 hour window?
Think of how this would affect Press Ganey scores, overcrowding, wait times, and the all around amusement of treating a patient with a beta blocker to counter the stimulant used to counter the original beta blocker OD.