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While the misuse of traditional drugs remains common, the emergence of new psychoactive substances (NPS) has changed the landscape of drug misuse in recent years. Although hundreds of NPS have been identified, opioids, including new synthetic examples, still dominate mortality. The exact substances causing toxicity are often unknown on presentation, and multiple exposures are commonly involved. Management is therefore based on a recognition of the drug group(s) involved by identifying the clinical toxidrome. Depressants, stimulants, hallucinogens, cannabinoids and dissociatives represent the most frequently identified drug toxidromes.

The decision to perform cardiopulmonary resuscitation (CPR) remains one of the most important and difficult decisions a physician must make. This study examined differences in CPR decision making among senior hospital clinicians. A questionnaire was sent out to consultants and specialist registrars in general medicine, elderly care and intensive care in a large UK district general hospital, with anonymous returns. Short clinical scenarios were presented, and participants stated their CPR decision and their confidence level. In total, 86 questionnaires were sent out and 54 replies (63%) were received. There were significant differences between specialties in making the decision to perform CPR and the confidence in doing so, with three cases producing polarised results within the specialties, despite equal confidence in the decision. There is lack of consensus with the CPR decisions made between specialties and within them. Formal training in recognition of futility should be encouraged for all clinicians.