Medical Toxicology Podcast
In this episode, we discuss calcium channel blocker (CCB) overdose and how bedside echocardiography and point-of-care ultrasound (POCUS) can help distinguish vasoplegic shock from cardiogenic shock in critically ill patients. Based on our recent paper, Dr. Omid Mehrpour and Dr. Jeffrey Brent present an echocardiography-guided flowchart designed to support faster bedside phenotyping, more targeted treatment, and safer escalation of care in severe CCB poisoning. We explore how early echo findings may guide the use of norepinephrine, vasopressin, IV calcium, methylene blue, high-dose insulin (HDI), pacing, lipid emulsion, and ECMO, while helping reduce the risk of treatment misclassification. This episode is especially relevant for clinicians in medical toxicology, emergency medicine, critical care, and poison center practice who manage severe overdose and toxicologic shock. Whether the overdose involves amlodipine, nifedipine, verapamil, or diltiazem, this conversation highlights a practical, phenotype-based approach to CCB toxicity and the growing role of echocardiography in overdose management. keywords: calcium channel blocker overdose, CCB overdose, CCB toxicity, echocardiography, POCUS, bedside ultrasound, toxicologic shock, vasoplegia, cardiogenic shock, high-dose insulin, ECMO, medical toxicology, emergency medicine, poison center, overdose management
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