Poisoning is the leading cause of death due to unintentional injury in the United States. Each year, between 2,000,000 and 4,000,000 US poison exposures occur. Poison control centers (PCCs), health departments, and family physicians work at different levels of the health care system to identify, manage, and prevent poisoning. PCCs provide assistance to the public and to clinicians and health care facilities, with expert consultation in identification, diagnosis, and treatment of poison exposures. They also provide education for clinicians and support primary prevention activities. State, tribal, and local health departments have been established by law to address public health in their jurisdictions. For patients exposed to a poison, family physicians are often the first point of contact with the health care system. Patients who present with undifferentiated symptoms, such as headache, rash, or respiratory symptoms, may have had an unknown exposure. A comprehensive history, including detailed occupational and social histories, and physical examination are often the first steps in identifying an exposure. Family physicians performing an initial assessment of symptoms can call the PCC if they suspect a toxic exposure or are unable to identify a cause.

Case 1. You are working in the emergency department when a family is brought in for exposure to carbon monoxide. The family consists of two parents, a teenager, and two children. Most of the family members were sleeping in the home when the teenager, who was awake working on homework, developed a headache, nausea, and dizziness. She alerted her parents, who checked on the children in their shared bedroom over the garage. They were weak and dizzy. The parents called 911 and all family members were transported to the hospital for evaluation. The first responders noted that a car was running in the garage with its doors closed. They think the car’s remote start was accidentally activated.