Pediatric emergency medicine trisk 3138 3138

FIGURE 102.12 The foxglove plant (Digitalis purpurea ).

Clinical Considerations
Patients may present to the ED in the setting of an unintentional overdose, an
intentional overdose, with sudden alteration of mental status or bizarre behavior,
or as a victim of multiple trauma (e.g., assault, motor vehicle collision). Often,
the history of drug exposure is undeclared and the diagnosis may be delayed. In
such cases, the patient’s mental status can range from combative to fully awake
and responsive to comatose; physical examination may be normal or may show
overt signs of toxicity (e.g., seizures). Table 102.20 provides a summary of the
common drugs of abuse, their typical routes of administration, associated
symptoms, toxic levels, and duration of action.
Initial history from the patient, family, or friends seeks to clarify potentially
ingested substances and estimate the quantity ingested. In the absence of a history
of exposure, it is important to inquire whether the patient has used any
psychoactive drugs in the past. In many cases, the patient may admit to using a