In the ED, a client is hallucinating with insects crawling on the skin, tachycardia, and a low respiratory rate; what is a priority assessment to guide treatment?

• A. Determine if recently ingested cocaine
• B. Check for alcohol withdrawal
• C. Assess for infection
• D. Assess for chest pain

Answer: (A)

Recognizing stimulant intoxication is key here, because the combination of hallucinations (like insects crawling on the skin) and tachycardia points toward recent cocaine use. Knowing whether cocaine was ingested recently directly guides treatment decisions: you would prioritize calming the patient and reducing sympathetic overactivity with benzodiazepines, monitor closely for chest pain and arrhythmias, and avoid beta-blockers since they can worsen hypertension and coronary vasospasm in stimulant toxicity. This focus also informs airway management, hydration, and monitoring for complications such as hyperthermia or rhabdomyolysis. Other possibilities like alcohol withdrawal, infection, or just chest pain don’t steer the immediate care plan as specifically toward cocaine-related management.