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