Monthly Archives: October 2012

Dominating the Ventilator

What do all of those dials on the ventilator do? Well, Scott Weingart has a great two part series on Dominating the Ventilator that explains them, and how to use them to help your patient. I have posted his video podcasts below, along with some of his notes, but you can find the links to his original postings listed below as well.

Part 1 (Handout)

Part I, deals with the lung injury strategy. In part 2 below, he talks about the strategy for patients with obstructive lung disease.

There are only 4 things you need to remember for a lung injury patient:

Vt (Tidal Volume) = Lung Protection

Flow Rate = Patient Comfort

Resp Rate = Ventilation

FiO2/PEEP = Oxygenation

Part 2 (Handout)

This is Part II, it deals with the obstructive strategy.Your goal with these patients is to let them have adequate time to breathe out.

There are only 4 things you need to remember for an obstructive patient

Vt (Tidal Volume) = 8 ml/kg, don’t mess with it

Flow Rate = shorter insp times, 80-100 lpm

Resp Rate = Lung protection, start at 10 work your way down if necessary

FiO2/PEEP = Oxygenation, should need much O2 (40%)m I recommend PEEP of 0, but certainly keep it less than 5



If you’re looking for a great toxicology resource then TOXNET is your answer. TOXNET serves as a comprehensive reference for Poison Control Centers and Emergency Departments around the United States. However, if you’re completely new to toxicology you may want to start out here first, with the NLM Toxicology Tutorials, or here at TOXLearn. For brief introduction to this superb tool, have a look at the TOXNET Brochure.

TOXNET (TOXicology Data NETwork) is a group of databases covering chemicals and drugs, diseases and the environment, environmental health, occupational safety and health, poisoning, risk assessment and regulations, and toxicology. It is managed by the Toxicology and Environmental Health Information Program (TEHIP) in the Division of Specialized Information Services (SIS) of the National Library of Medicine (NLM). A mobile version of TOXNET is available.

TOXNET provides you with a wealth of information. For instance, the Hazardous Substances Databank (HSDB) alone provides information on chemical properties and handling, the human health effects and emergency medical treatment, animal toxicity studies, metabolism, pharmacology, environmental standards and exposures, manufacturing data, lab methods and more.

Information in the TOXNET databases covers:

  • Specific chemicals, mixtures, and products
  • Chemical nomenclature
  • Unknown chemicals
  • Special toxic effects of chemicals in humans and/or animals
  • Citations from the scientific literature

Here is a great example video of “How to Navigate TOXNET” that will walk you through getting started with it.

The main reference for using TOXNET is “TOXNET and Beyond: Using the National Library of Medicine’s Environmental Health and Toxicology Portal”. In addition, the University of Cincinnati, College of Engineering created a great abbreviated “TOXNET Procedure Manual”. However, if it’s a bare bones introduction to using TOXNET check out the following SlideShare presentation.

The listing below explains the main TOXNET databases, and what they offer. However, the following link provides a more complete breakdown, of each of the specific TOXNET databases along with sample records for each.

Chemical Nomenclature and Structure


ChemIDplus contains over 390,000 chemical records. More than 299,000 of those records include chemical structures. ChemIDplus is searchable by Name, Synonym, CAS Registry Number, Molecular Formula, Classification Code, Locator Code, Structure, and/or Physical properties. Enhanced structure display is available in ChemIDplus Advanced..

Toxicology Data

CCRIS (Chemical Carcinogenesis Research Information System)

CCRIS is developed and maintained by the National Cancer Institute (NCI). It contains over 9,000 chemical records with carcinogenicity, mutagenicity, tumor promotion, and tumor inhibition test results. Data are derived from studies cited in primary journals, current awareness tools, NCI reports, and other special sources. Test results have been reviewed by experts in carcinogenesis and mutagenesis.

CPDB (Carcinogenic Potency Database)

CPDB provides standardized analyses of the results of 6540 chronic, long-term animal cancer tests conducted since the 1950s and reported in the general published literature or by the National Cancer Institute and the National Toxicology Program. This database was developed at the University of California, Berkeley, and Lawrence Berkeley Laboratory.

CTD (Comparative Toxicogenomics Database)

The Comparative Toxicogenomics Database (CTD) elucidates molecular mechanisms by which environmental chemicals affect human disease. It contains manually curated data describing cross-species chemical-gene/protein interactions and chemical- and gene-disease relationships. CTD is developed at North Carolina State University (NCSU). The development team is located at NCSU and the Mount Desert Island Biological Laboratory (MDIBL).

GENE-TOX (Genetic Toxicology)

GENE-TOX was created by the U.S. Environmental Protection Agency (EPA) and has genetic toxicology test results on over 3,200 chemicals. Selected literature was reviewed by scientific experts for each of the test systems under evaluation.

HSDB® (Hazardous Substances Data Bank)

HSDB provides toxicity data for over 5,000 potentially hazardous chemicals. It also has information on emergency handling procedures, industrial hygiene, environmental fate, human exposure, detection methods, and regulatory requirements. The data are fully referenced and reviewed by a Scientific Review Panel.


Haz-Map is an occupational health database designed for health and safety professionals and for consumers seeking information about the adverse effects of workplace exposures to chemical and biological agents. The main links in Haz-Map are between chemicals and occupational diseases. These links have been established using current scientific evidence. In Haz-Map, chronic occupational diseases are linked to both jobs and industries, while acute diseases and infectious diseases are linked only to jobs. Cancers are not linked to jobs, industries or findings.

Household Products Database

The Household Products Database has information on the potential health effects of chemicals contained in common products used inside and around the home. Products can be searched by brand name, product type, manufacturer, ingredient/chemical name, and by health effects. The record for each product shows the ingredients as reported in the manufacturer’s Material Safety Data Sheet (MSDS) and includes more information such as handling, disposal, and health effects.

IRIS (Integrated Risk Information System)

IRIS is developed by the U.S. Environmental Protection Agency (EPA). It contains carcinogenic and non-carcinogenic health risk information on over 500 chemicals. IRIS risk assessment data has been reviewed by EPA scientists and represents EPA consensus.

ITER (International Toxicity Estimates for Risk)

ITER data focuses on hazard identification and dose-response assessment for human health. The database provides a table of comparisons of international risk assessment information and explains differences in risk values derived by different organizations. It is compiled by Toxicology Excellence for Risk Assessment (TERA) and contains over 650 chemical records. Data is extracted from each of the included agencies’ assessments and contains links to the documentation for the source.

LactMed (Drugs and Lactation)

A database of drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Statements of the American Academy of Pediatrics concerning a drug’s compatibility with breastfeeding are provided, as are suggested therapeutic alternatives to those drugs where appropriate. All data are derived from the scientific literature and fully referenced.

Toxics Release Inventory (TRI)

TRI is a set of publicly available databases containing information on releases of specific toxic chemicals and their management as waste, as reported annually to the EPA by U.S. industrial and federal facilities. This inventory was established under the Emergency Planning and Community Right to Know Act of 1986 (EPCRA). TRI’s data, beginning with the 1987 reporting year, covers air, water, land, and underground injection releases, as well as transfers to waste sites. In agreement with the Pollution Prevention Act of 1990, source reduction and recycling data is also included in TRI.


TOXMAP is a Geographic Information System (GIS) using maps of the United States to show the amount and location of toxic chemicals released into the environment. Data is derived from the EPA’sToxics Release Inventory (TRI), which provides information on the releases of toxic chemicals into the environment as reported annually by industrial facilities around the United States. TOXMAP also contains information from the EPA’s Superfund Program.

Toxicology Literature


TOXLINE provides bibliographic information (1965 to present) covering the biochemical, pharmacological, physiological, and toxicological effects of drugs and other chemicals. It contains over 4 million references, most with abstracts, indexing terms, and Chemical Abstracts Service (CAS) Registry Numbers. The toxicology subset of MEDLINE/PubMed is part of TOXLINE. TOXLINE also contains references from specialized journals, government reports, and meeting abstracts.

Developmental and Reproductive Toxicology Database (DART)

DART covers the scientific literature on reproductive and developmental toxicology. DART is managed by NLM and funded by the EPA, the National Institute of Environmental Health Sciences (NIEHS) and NLM. DART contains references to reproductive and developmental toxicology literature published since 1965.

Medical Blogs and Podcasts

Here is a link to the many (200+) medical blogs and podcasts that I follow using Google Reader, and that you can easily subscribe to as well.There is a great deal of fantastic content created on all of these sources, check them out!

Also, here is a YouTube video showing how to create your own Google Reader Bundle similar to the one I created.