Mucosal Injuries of the Upper Aerodigestive Tract After Smoking Crack or Freebase Cocaine

The introduction of “crack” and “freebase” cocaine to the United States has resulted in an increased number of patients presenting to emergency rooms with cocaine‐related burns of the upper aerodigestive tract. Because symptoms are nonspecific and histories often unreliable, the emergency room physician must keep a high index of suspicion for cocaine use when confronted with these types of patients. We present seven patients who had burns to the upper aerodigestive tract as a result of smoking crack or freebase cocaine. Two of seven patients underwent an emergency tracheotomy, probably because of delayed diagnosis and inadequate early medical intervention. This article reviews the history behind cocaine use, its different modes of administration, potential complications associated with smoking cocaine, diagnostic workup, and treatment options.