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Goldfrank's Toxicologic Emergencies is a multiauthored text of approximately 2000 pages prepared by using the educational and management principles we apply at the New York City Poison Center and at our clinical sites. In this tenth edition of Goldfrank's Toxicologic Emergencies, we proudly offer readers an approach to medical toxicology using evidence-based principles viewed through the lens of an active bedside clinical practice.

Some would ask why create textbooks and e-books in an era when podcasts and blogs appear so successful. We still believe that the slow, thoughtful, rigorous development by a team of authors and editors that is required to create and revise this text is necessary to appropriately analyze the most complex problems that challenge our daily practices. Although in our field we have made great progress, the level of uncertainty remains substantial. We have attempted to integrate the collaborative wisdom of many experts from diverse backgrounds into the text to provide the most up to date information. We offer our readers the evidence, shared thoughts, and commitments necessary to arrive at a decision. Evidence is created not only with randomized clinical trials, observational studies, case control studies, and case reports, but also with the insights of five toxicologists who have worked together for decades, along with the gifted scholars we selected as authors. We have worked together defining and redefining the scope and context of chapters, Antidotes in Depth, and Special Considerations. We then shared our ideas with many respected toxicologists, thus creating new chapters that these toxicologists have revised by adding information that has come to light over the last 4 years. In this way, knowledge from their work in toxicology and related disciplines is merged with ours, allowing us to create chapters that represent our collective thoughts. This iterative process is continued until the authors and editors are satisfied that we have closely approximated the best strategy to evaluate and care for poisoned or overdosed patients. This is a fascinating process. Because we occasionally disagree, we then reread, research, look for special cases, and reflect on a final version with our authors. By reviewing the quality of each chapter, we thus create, recreate, and reformat.

In this edition, we have reintroduced the patient into the text. These are the patients who wake us up at night. Such patients, whose signs and symptoms might be related to the whole book or to several chapters, serve to return us to focus on the unknown, the differential diagnosis, and problem solving and include cases representative of our work. Patients with a pesticide exposure, bradycardia, metabolic acidosis, medication error, seizures, as well as coma or agitation and hyperthermia, are offered as examples for contemplation. We believe that analyzing the care of these complex, undifferentiated patients will help you as much as they have helped us and those who read the first edition of this book. These cases act as the building blocks for chapters in this edition and represent provocative introductions to several sections of this text. We have demonstrated our thought processes so that you can read, think, criticize, and communicate. This classic Socratic development of knowledge and improvement of clinical decision making will foster problem solving, initiate creative investigation, and improve care. We hope to facilitate your participation in the intellectual process that we believe to be essential in order to create a fine book for thoughtful readers who must render exceptional attention to their patients. The cases serve as the transition between the patient and population. You can switch your role from the medical or clinical toxicologist at the bedside to the toxicologist serving the public needs of a community. Our hope is that these cases recreate the clinicians experience of the thinking that occurs before the action.

The other major change in this edition has occurred in one of our most valued sections—the Antidotes in Depth. Mary Ann Howland, PharmD, has worked on improving the presentation of each of the Antidotes in Depth with an even more rigorous format. Her wisdom in this area is unmatched, as she has nurtured these key toxicologic elements since the third edition of this textbook. In this tenth edition, Silas W. Smith, MD, has collaborated with her as an Associate Editor for the Antidotes in Depth section. We are sure that you will appreciate the reorganization of this section, which will enhance your ability to use the material the Antidotes in Depth provide. Their collaboration should be a great asset to the reader.

Robert S. Hoffman
Mary Ann Howland
Neal A. Lewin
Lewis S. Nelson
Lewis R. Goldfrank

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