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Knowledge of appropriate decontamination techniques and timely administration of antidotes coupled with excellent supportive care may positively alter the outcome of poisoned patients.

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A detailed history is essential in the evaluation of a potentially poisoned patient. In the conscious, cooperative person, the specific agent(s), time, route, amount, and intent of exposure need to be documented. In the uncooperative or altered patient, adjunctive information from friends, family, prehospital providers, police, or bystanders may provide more accurate details. Environmental clues such as drug paraphernalia, empty pill bottles, odors, or suicide notes may aid in the diagnosis. If available, review hospital records for recent prescriptions or any history of psychiatric illness. Loose pills with imprint codes may be identified by the pharmacy or poison center.

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A thorough exam begins with a completely disrobed patient. Search clothing and personal possessions, but remain vigilant while doing so as to avoid potential injury from needles or chemicals. Review vital signs and perform a comprehensive physical examination. Focus on the general appearance, level of consciousness, pupil size, mucous membranes, respiratory rate, breath sounds, presence of bowel sounds, skin temperature, and muscle tone as the combination of findings may suggest a specific toxidrome (Table 100-1).

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Table 100-1 Common Toxidromes

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