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.

The patient is a 21-year-old male who presents to your ED with vomiting and dizziness after drinking homemade tea made with leaves and flowers from the plant pictured.