Toxicologic ingestions and overdoses are common in school aged children, whether the exposures are accidental or intentional. These exposures have the potential for significant morbidity and mortality; thus, timely identification and management pre-hospital is critical. In this chapter, we will discuss the approach to a patient with a toxicologic exposure by providing an organized framework for building a differential diagnosis through recognition of toxidromes as well as providing initial stabilization and disposition recommendations.