Not all drug overdoses or fatal interactions are immediately obvious.
Presentation: cardiac arrest with no other apparent cause at the scene
True situation:
(1) secret substance abuse: high-functioning addict, accidental overdose, exposure to more potent or toxic substance, drug interaction
(2) suicide without note
Risk factors for error:
(1) high case load with other cases high-profile and/or need for cost-cutting
(2) making assumptions and going with first impressions, such as an older adult from an affluent background
(3) failure to perform drug and alcohol screen on all cases
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Specialty: Clinical Laboratory, Toxicology
