Request for Funding

Mentor: Kathleen A. Delaney, M.D.
Department: Surgery, Division of Emergency Medicine
Room number: Parkland Hospital
Mail Code: 8579
Phone number: 214-590-1353
E-mail: Kathleen.Delaney@utsouthwestern.edu
Project title: Prevalence of Cocaine Use in Emergent Department Patients with Severe Hypertension

Human subjects IRB approved project number (where applicable): IRB# 0903-589

Animal subjects IRB approved project number (where applicable): N/A

Project Type Patient Based

Brief Description of Project:

Purpose: In a recent retrospective study of patients with congestive heart failure, we found that 30% of who receive the majority of their care in the emergency department used cocaine regularly. Beta-adrenergic receptor antagonist drugs, standards in the management of severe hypertension in emergency department patients, are contraindicated in persons who have recently used cocaine due to concerns regarding the precipitation of paradoxical hypertension by unopposed alpha-receptor agonist effects. The objective of this study is to document the prevalence of cocaine use among emergency department patients with diastolic blood pressure greater than or equal to 120 mmHg. A waiver of consent for this prospective study was given to us by the IRB.

Summary: This is a prospective study of all patients with a history of hypertension who present to the Parkland Emergency Department with a measured diastolic blood pressure equal to or greater than 120 mmHg. Patients with end stage renal disease, cognitive impairment, pregnancy, age less than 18 years, and terminal illness will be excluded. Patients who cannot provide a spontaneously voided sample of urine will be also excluded. Our data tool records a random study number, categorized complaint, and an age range. The study medical student will review the vital signs recorded in the real time on-line emergency department data base and identify patients in the department who have a blood pressure reading that meets study criteria. The goal is prospective 24 hour a day enrollment of all patients who meet criteria. Following review of the emergency department chart to identify exclusion criteria, the student will enter information from the chart on the randomly numbered data tool, which will also have a numbered sticky label attached to it. Routine evaluation of these patients in the emergency department involves a bedside dipstick test of a spontaneously voided sample of urine, usually conducted by a nurse. The results are written on the chart, and the specimen is thrown away. The student will obtain the urine sample after it has been dipped for blood, apply the study number label and place it in a designated lab collection box for testing the next day.

Benefit to Students Who Participate: The conduct of this study requires a thoughtful, mature approach to the identification of patients, an appreciation of the importance of confidentiality that balances the benefits of the study that may include justification of cost effectiveness of routine drug testing; re-evaluation of the current protocols for management of severe hypertension that include routine use of beta-blockers; and possible re-evaluation of clinic practices and protocols for management of outpatient hypertension. Students will participate in data entry and in the writing and publication of the paper.

Previous Research Activities or Publications with Medical Students:

None

Return to UT Southwestern Homepage

Return to Student Research Projects Index