Patients who are dependent on alcohol or illicit substances should be identified in order to facilitate appropriate disposition. For homeless patients who present intoxicated and sedated, close monitoring of body temperature, blood glucose monitoring, and serial evaluations for arousability should be performed in addition to a thorough physical examination. Whenever possible, a specific history of substance use should be obtained. A specific history of withdrawal from any sedative-hypnotic agent or ethanol should alert the clinician to the need for careful observation while primary evaluation of the chief complaint is undertaken. The patient should be asked whether he or she has a past history of participating in detoxification programs and whether that is a current desire. Accordingly, psychiatric evaluation can be undertaken.
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