Certain underlying medical conditions may be relevant (e.g., glucose-6-phosphate dehydrogenase [G6PD] deficiency for mothball ingestions); thus, any significant medical history should be noted Often, children who are poisoned not come to the ED with a clear history of exposure followed by onset of symptoms Rather, they develop signs and symptoms that mimic other diseases and give no history of toxic exposure Thus, the ED staff must always consider the possibility of ingestion when treating young children General historical features that suggest the possibility of poisoning include (i) acute onset; (ii) age range of to years or adolescence; (iii) history of pica or known exposure to a potential toxicant; (iv) substantial environmental stress, either acute (e.g., arrival of a new baby, serious illness in a parent) or chronic (e.g., marital conflict, parental disability); (v) multiple organ system involvement; (vi) significant alteration in level of consciousness; and (vii) a clinical picture that seems especially puzzling Certain family and social history variables are also important Medications used by other household members, particularly new medications introduced into the home environment by virtue of recent illnesses, or visits from/to grandparents and other relatives, are a common source of ingested drugs Changes in routine and large family gatherings (e.g., holiday parties, moving to a new home) are particularly risky occasions for decreased parental supervision or less carefully guarded potentially toxic medications or household products Although often difficult to obtain, the history of illicit drug use, manufacture, or distribution in the child’s environment (the “drug-endangered child”) significantly increases the risk of serious outcomes from a poison exposure as well Physical Examination The focused physical examination should begin with a reassessment of vital functions and complete recording of vital signs, including core temperature After securing the airway and ensuring adequate cardiorespiratory function, focus on the central and autonomic nervous systems, eye findings, changes in the skin and/or oral and gastrointestinal (GI) mucous membranes, and odors (see Chapter 50 Odor: Unusual ) on the breath or clothing of the patient These features represent those areas most likely affected in toxic syndromes and, when taken together, often form a constellation of signs and symptoms referred to as toxidromes ( Tables 102.5 and 102.6 ) Such toxidromes may be so characteristic as to provide guidance for early therapeutic management before precise historical or laboratory confirmation of a specific exposure is available