In this episode, flight paramedic Nicholas Henchal and EMS physician Dr. Harrison Brookeman break down salicylate toxicity from the ground up. What started as a casual conversation at the crew table turns into a deep dive into one of the most misunderstood overdoses in EMS and critical care. They walk through the full spectrum of aspirin toxicity, from subtle prehospital clues to advanced hospital management. You'll hear how patients can appear relatively stable early on, why respiratory alkalosis precedes metabolic acidosis, and how the situation can spiral once the electron transport chain is disrupted. The conversation also delves into real-world decision-making: when to suspect it, when not to intubate, how to manage ventilation if you have to, and why treatments like bicarbonate, glucose, and even dialysis play a critical role. There's also a strong discussion of the dangers of missing this diagnosis and how quickly things can go downhill if the underlying physiology isn't understood. Link to interactive Anion Gap Tool: https://claude.ai/artifacts/latest/d3b744cf-5a1b-4bb7-88bc-4f74fd97ec16 FOAMfrat.com