The Poison Review

Severe calcium channel blocker (CCB) overdose is among the most daunting and difficult toxicology cases seen in the emergency department.  With these patients, the clinician is confronted with what has been called a “perfusion salad” — impaired cardiac contractility combined with vasodilatation. The resulting hypotension and shock is frequently resistant to standard measures — fluid infusion, calcium, glucagon, and pressors.  

In the lastest post on Scott Weingart’s wonderfully informative EMCrit podcast, I am interviewed about state-of-the-art care in serious CCB poisoning. The most important point that both Scott and I emphasize is that high insulin euglycemic therapy (HIET) is no longer a last-ditch desperation intervention, but standard accepted therapy that is best started early, before the patient becomes significantly unstable. 

A word about EMCrit. The site focuses on principles of critical care as they apply to the emergency department.  Subjects such as ventilator management, pressor selection, and sedation of the critically ill patient are presented in thoughtful and logical terms that make the podcast an educational resource that I look forward to and regularly follow — often listening to an episode several times.  A free subscription is available through the iTunes store.