Level of consciousness, neuromuscular tone, reflexes Eyes—pupil size/reactivity, extraocular movements, fundi, nystagmus Mouth—corrosive lesions, odors Cardiovascular—rate, rhythm, perfusion Respiratory—rate, chest excursion, air entry GI—motility, corrosive effects Skin—color, bullae or burns, diaphoresis, piloerection Odors Laboratory (individualize) CBC, co-oximetry ABG, serum osmolarity EKG/cardiac monitor Chest radiograph, abdominal radiograph Electrolytes, BUN/creatinine, glucose, calcium, liver function panel Urinalysis Urine screen for common drugs (amphetamine, benzodiazepines, barbiturates, cocaine, marijuana, opiates, phencyclidine) Quantitative toxicology tests (including acetaminophen, aspirin, ethanol) Assessment of severity/diagnosis Clinical findings Laboratory abnormalities (with consideration of anion, osmolar gaps) Toxidromes ( Table 102.6 ) Specific detoxification Reassess ABCDs Institute appropriate GI decontamination (if not already under way) Urgent antidotal therapy Consider excretion enhancement Continue supportive care ABG, arterial blood gas; ETCO2 , end-tidal carbon dioxide; AVPU, A lert, V erbal, P ain, U nresponsive; GCS, Glasgow Coma Scale; ALS, advanced life support; GI, gastrointestinal; CBC, complete blood cell count; EKG, electrocardiogram; BUN, blood urea nitrogen Empiric drug treatment is warranted for most symptomatic poisoned children with altered mental status Administer humidified oxygen and monitor blood oxyhemoglobin saturation by pulse oximetry Assess ventilatory effort by auscultation and continuously by end-tidal CO2 , if available If rapid bedside