Drug-related Coma in the Adolescent

The poisoned and comatose adolescent presents numerous diagnostic and management problems. Often interventions must be performed before a specific diagnosis is made. A history may be impossible to obtain, thus forcing the physician to rely on physical findings, rapid diagnostic testing, and expectant supportive care. The first stage of treatment is stabilization, which involves basic and advanced life support, rapid assessment, presumptive substrate and antidotal therapy, and gastrointestinal decontamination. The second stage, definitive care, requires a careful history, detailed physical examination, and diagnostic studies tailored to narrow the possible etiologies. The authors describe each stage in detail, including evaluation and treatment, as well as discuss common toxic causes of coma in adolescents.