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Vearrier D, Osterhoudt KC. 
“A teenager with agitation: higher than she should have climbed”. 
Pediatr Emerg Care. 2010 Jun 10;26(6):462-5.
A 17-year-old adolescent girl arrives at the emergency department with concerns that she appears agitated and intoxicated. She is previously healthy but is reported to occasionally abuse ethanol and marijuana. She appeared well to friends until she took a single 'bong hit' from a water pipe approximately 15 minutes before her arrival in the emergency department. Her friends called an ambulance when she became 'violent' and 'crazy' after inhaling the drug. They believe that she was having visual hallucinations and that, 'she has never been high like this before.'

The girl appears restless and anxious but is oriented to person, place, and time. She says that her legs feel 'numb and twitchy.' Her heart rate is 120 beats per minute, and her blood pressure is 135/85 mm Hg. She is afebrile, and her blood hemoglobin oxygenation is 98 as measured by transcutaneous pulse oximetry. Her pupils are slightly dilated but reactive, and she has normal extraocular muscle function. Her mucous membranes are moist and she has no goiter. Her breath sounds are clear, and her heartbeat is heard without murmur or gallop. She has normally active bowel sounds. Her skin is mildly sweaty but is not flushed, and no rashes are apparent. Result from examination of the cranial nerves is normal, fine touch sensation is intact in the upper and lower extremities, strength appears vigorous, and occasional muscle fasciculations are noted in the quadriceps. She does not display clonus at the Achilles tendon.
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