Preface

Goldfrank's Toxicologic Emergencies is a multiauthored text of approximately 2,000 pages prepared by using the educational and management principles we apply at the New York City Poison Control Center, New Jersey Poison Information & Education System, and at our clinical sites. In this eleventh 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 investigation of all available information by a team of authors and editors required to create and revise this text is essential to analyze the 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 experts from diverse backgrounds in order to provide the information necessary to achieve excellence. We offer our readers the evidence, shared thoughts, and structured analysis 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 six toxicologists who work together continuously, 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 local, national, and international toxicologists, thus creating new chapters that these toxicologists have revised by adding information and insight that has come to light since the publication of the tenth edition of the text. In this way, knowledge from their experience as toxicologists 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. In this edition, we have tried to enhance our rigor focusing on as precise an analysis of the literature as we can all do and an attempt to tell you as clearly as possible what we and our authors think and how we practice. Because we occasionally disagree, we then reread, research, look for special cases, and reflect on a final version with our authors.

In this edition, we have asked Rana Biary, MD to expand the concept of the patient narrative in the Case Studies section. These are the patients who challenge us to be vigilant as toxicologists. Such patients, whose signs and symptoms are 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 contextual cases representative of our work. Patients with a pesticide exposure, bradycardia, metabolic acidosis, medication error, seizures, 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 understand our approach to patient management. This classic Socratic development of knowledge and improvement of clinical decision making will improve problem solving, stimulate creative investigation, and enhance care. We hope to facilitate your participation in the intellectual processes that we believe to be essential in order to create a fine book for thoughtful readers who desire to render excellent attention to their patients. The cases serve as the transition between the patient and population as you diminish the gap between your roles as a medical or clinical toxicologist at the bedside and that of a toxicologist serving the needs of the community. Our hope is that these cases re-create the clinicians' thoughts prior to, during, and after care is initiated.

In this eleventh edition, Silas W. Smith, MD, became an editor reflecting his superior work on prior editions. We are sure that his knowledge and thoughtfulness will be appreciated by all.