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The Critically Poisoned Patient

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Critical Care Toxicology

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Abstract

Medical toxicology is a medical subspecialty focusing on the diagnosis, management, and prevention of poisoning and other adverse health effects due to medications, drug overdose, acute drug abuse problems, chemical exposures, occupational and environmental toxins, biological agents, and envenomations. Critical care is the specialized care of patients whose conditions are life-threatening and who require comprehensive care and constant monitoring, usually in intensive care units. The disciplines of critical care medicine and medical toxicology have been intertwined throughout medical history. Texts combining the principles of these closely related specialties may be traced to medieval times; Maimonides wrote his Treatise on Poison and Their in 1198 [1]. In his Treatise, Maimonides outlined the classification, diagnosis, and antidotal therapy of poisonings and described some resuscitation methods of the age. He also, in undoubtedly what was among the first attempts to evaluate therapies critically, refuted many of the then-popular treatments. The need to continually reevaluate – and commonly refute – generally accepted therapies continues to this day. This book continues this tradition in the spirit established by Maimonides, except, of course, with a more data-driven approach.

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Author information

Authors and Affiliations

  1. Emergency Medicine, Penn State University, Hershey, PA, USA

    J. Ward Donovan

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, MD, USA

    Keith K. Burkhart

  3. Clinical Pharmacology and Toxicology, University of Colorado, Denver, CO, USA

    Jeffrey Brent

Authors
  1. J. Ward Donovan
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  2. Keith K. Burkhart
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  3. Jeffrey Brent
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Corresponding authors

Correspondence to J. Ward Donovan , Keith K. Burkhart or Jeffrey Brent .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Donovan, J.W., Burkhart, K.K., Brent, J. (2016). The Critically Poisoned Patient. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_14-1

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