Acute cocaine intoxication is an ever increasing problem in the United Kingdom. Aggressive resuscitation linked to early diagnosis is essential in preventing death. Three cases of severe cocaine toxicity are presented to highlight certain diagnostic indicators in recognising the condition in patients presenting in a collapsed state to the accident and emergency departnent. Acidosis was a striking feature. The acute management of such patients is supportive and should involve methods to minimise continuing absorption.(_Accid EmergMed 1996;13:261-263)

The use of central venous catheters (CVCs) remains standard of care for delivering vasopressors in patients with shock though it is associated with mechanical and infectious complications. In an initiative to reduce central line days, a multidisciplinary team devised a protocol for the administration of vasopressors via peripheral IV (PIV). In February 2019, the protocol was implemented in the 9-bed medical intensive care unit (MICU) of the Michael E. DeBakey VA Medical Center (MEDVAMC), a 349-bed teaching hospital. We hypothesized that central line days would be reduced with initiation of this protocol. METHODS: A retrospective chart review was conducted on all veterans in the MICU that received vasopressors peripherally at the MEDVAMC between Feb 1st, 2019 till October 26th, 2019. The primary end point evaluated was central line days. Additional data collected included PIV site, vasopressor medication choice, duration and dosage, as well as escalation from PIV to central venous catheter (CVC). Extravasation events were monitored.