The toxicological exam begins with a quick run-through of the ABCDE's, plus a fingerstick glucose. On secondary survey, one may see patches, bites, punctures, etc. that may suggest a route of introduction.
The history can be especially illuminating, but in severe ingestions/exposures the patient may be too altered to respond, and a surrogate/collateral source of history may not be present. When examining the patient, a thorough heart, lung, abdominal, and neurological exam should be performed at minimum.
Electrocardiogram may reveal abnormalities in cardiac conduction.
CBC, BMP, LFTs, urinalysis, and VBG are often indicated based on symptoms and exam findings alone. If ingestion is suspected, it is appropriate to add APAP, ASA, and alcohol levels. A urine drug screen is often unhelpful or superfluous.
Treatment is typically supportive and based on the clinical picture; if a specific agent or toxidrome is identified, antidotes or reversal agents are sometimes available.