A 48-year-old male presents to the emergency department complaining of bilateral hand numbness and tingling over the past few months. The patient has also noticed a mild swelling of bilateral lower extremities, worse at the end of the day and improved with leg elevation. He has no significant past medical history and takes no medications.

The patient is a 38-year-old African American male with a past medical history of schizoaffective and bipolar disorder who presented to the ED with altered mental status and chest pain. The patient had been issued a day / evening pass to leave the psychiatric facility where he currently resides and spent the evening at home with family.

A 68-year-old male presents to the emergency department for evaluation of weakness. According to the patient’s daughter, he has been increasingly confused over the past 24 hours and has been vomiting “constantly” for the past 48 hours. The patient appears lethargic, but adds that he has been experiencing severe stomach cramping as well as several episodes of diarrhea.

A 17-year-old male with no significant past medical history is brought into the ED by his parents with altered mental status after an evening spent with some friends. The patient is awake but anxious and unable to provide a detailed history. His heart rate is 132 bpm, blood pressure is 162/85 mmHg, respiratory rate 32 breaths per minute, and temperature is 99°F.

Paramedics are called to a college fraternity Halloween party where a large cauldron of “green witches brew” was being served. Several students are found intoxicated with altered mental status and hallucinations. Two male freshman students suffer generalized tonic-clonic seizures en route to the ED.

Annually, more than 3,000 patients seek care in the United States following envenomation by poisonous snakes. Many of these envenomations are from Crotalinae such as rattlesnakes, cottonmouths, and copperheads, which mainly cause local tissue injury as opposed to a minority of bites from the Elapidae or coral snake which causes neuromuscular weakness leading to respiratory arrest. In October 2010, the American Heart Association and the American Red Cross issued their most recent first aid guidelines.

A 35 year-old male with a past medical history of severe mental retardation and a seizure disorder was observed eating 16 “snake” fireworks by nursing home staff. He presented to the ED uncooperative and was tachycardic.

The patient is a 27-year-old stock exchange worker who presents to the ED with a complaint of anxiety, chest pain, sweating, palpitations and a feeling of “paranoia and impending doom” following the recreational ingestion of “bath salts” two hours prior at a company party.

Indigenous to Mexico and Central America, the red green poinsettia (or Christmas Star), was first introduced to the US in the 1800s. The plant’s reputation for toxicity stemmed from a single unconfirmed case fatality of a 2-year-old child in the early 1900s.

Over the last six months, the drug K2 – or “spice” – has gained national attention both from the media and the medical community. This synthetic cannabinoid, which is completely legal in most states, is sending users to the ED with symptoms from hallucinations to seizures.