drug but may identify it by a street name Although drug terminology tables are often available in pharmacology or toxicology texts or on the internet, temporal and regional changes in street drug terminology generally make such tables of limited value Additionally, the true substances in the products may not match the substances that the patient believed they were using Your regional poison center can be a useful source of current substance use patterns and regional trends As with any potentially poisoned patient, primary attention is initially paid toward assessment of vital signs and life support as needed to provide a patent, secure airway; to ensure adequate respiratory function; and to treat seizures, shock, or cardiorespiratory arrest Do not overlook temperature Hyperpyrexia is both a poor prognostic indicator for many ingestions and a management target, so accurate measurement with a core temperature is important In the agitated patient, chemical and/or physical restraint may be necessary to both assess the patient and to ensure safety of both the patient and the treating staff Chemical restraint should be used liberally to prevent patients from harming themselves or others Benzodiazepines are the preferred class of agents for most patients The duration of the sedative effects of midazolam are shorter than the other benzodiazepines, allowing for reassessment within an hour Haloperidol may be effective but not be the best first-line agent because it can reduce heatdissipating capability and may lower the seizure threshold Management must also include consideration of the need for GI decontamination With many substances of abuse, several distinct routes of exposure are possible (e.g., ingestion, inhalation, injection, and/or nasal insufflation) Therefore, GI decontamination is not always necessary or appropriate Decontamination should be considered using the same guiding principles regarding toxin and patient characteristics detailed earlier in this chapter If the practitioner is considering decontamination, carefully assess mental status and gag reflex If the potential benefits of decontamination outweigh the risks in a patient with obtundation or a diminished gag reflex, protect the airway by endotracheal intubation before initiating GI decontamination Additional toxin-specific management strategies are discussed in the section that follows Clinical Indications for Discharge or Admission The decision to admit the patient depends on both the clinical severity of the presentation and the anticipated pharmacokinetics of the suspected substance(s) After initial assessment and medical stabilization, subsequent evaluation of any patient presenting in the setting of intentional substance use must include an estimation of the severity of the drug use problem and the risk of suicide or other