Abstract

The fine line between emergency medicine and critical care has been blurred during the past decade. The causes are many. In the past, a critical patient was stabilized in the emergency department (ED) then transported quickly to the appropriate intensive care unit (ICU), now we board these patients in the ED because “there is no room in the inn.” Emergency physicians are becoming fellowship-trained and board-certified in critical care specialties. In my institution, my former residents are attending in all of the ICUs. Emergency physicians are now performing procedures formerly practiced by intensivists; extracorporeal membrane oxygenation (ECMO), fiberoptic intubations, resuscitative endovascular balloon occlusion of the aorta, continuous electroencephalography, and dialysis. The number of drugs and poisons that patients are exposed to seems to increase exponentially. Intentional overdoses, illegal drugs of abuse, over-the-counter medications, herbals, accidental ingestions, alternative therapies, and occupational exposures have complicated the diagnosis and management of the poisoned patient. It is not unusual to see a patient with a combination of β-blocker, calcium channel blocker, opioid, and antidepressant overdose who is comatose, hypotensive, hypoxic, and having seizures.

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