Several years ago a mentor suggested that I write a book. I nearly laughed at her. A book?? Inconceivable! Who would buy it? Would they actually read it? Would it be there at 3 AM when they needed it? How could it be updated? A physical book didn't seem compatible with the breakneck speed of critical care or our internet-based culture.

It later occurred to me that I could write an internet book. This could have the same organization and content of a traditional book. However, it would have many advantages:

freely available to anyone, anywhere, anytime

optimized for smartphones, facilitating on-the-fly use

robust peer review provided by any reader

updated in real time based on peer review, new evidence, and new opinions

seamless links to references and other online resources

embedded graphics, tweets, and videos

accompanying podcasts that highlight key points of each chapter

ability to search the book for any word (easier than a traditional index)

no conflicts of interest (unlike many traditional multi-author textbooks 1 )

) its own twitter account, of course

My overall goal is to create something which packs a lot of clinical punch, on par with a standard critical care textbook or review article. However, it will hopefully be more readable and enjoyable than a textbook. And easy to share with colleagues and trainees (for example if I'm busy, I will send my trainees a link to the relevant chapter via text-message; this provides a general outline of how to approach a problem, which we can fine-tune later).

After two years of writing, the rough draft is mapped out. I am now going to review the book with an emphasis on late-breaking evidence, releasing the chapters as I go. Chapters will be released out of order to avoid topic fatigue. The book contains ~150 chapters which will be unrolled over 2-3 years.

The book will have an associated twitter account (@iBookCC) with highly nerdy material such as chapter updates based on new literature. If you encounter new articles or FOAMed that belong in the book, please tweet it @iBookCC.

Perhaps the most important aspect of the book will be robust post-publication peer review. If you find errors please point them out (ideally with supporting references to back you up). Please feel encouraged to ask questions or suggest updates with new information.

The approaches described in this book are generally based on my practice patterns. They are neither the only way to do things, nor necessarily the best. I have focused on my practice in efforts to stay realistic and concise.

This book isn't intended as the last word, but rather as a jumping-off point for further study. As such, each chapter contains links to related blogs, podcasts, and articles for more information and additional opinions. The book isn't encyclopedic. I've tried to cover the more interesting and common ICU problems. If you think something is missing, let me know and I can try to add it.

Please feel encouraged to freely reproduce anything that I've created with attribution (that is, everything except graphics/videos which I've attributed to other authors). Images are already tagged with attribution, so you can easily drop them into presentations or blogs (example below).

new philosophies about knowledge construction

The way that we construct knowledge in medicine is changing. Many icons of medical knowledge have quietly fallen by the wayside (e.g., Harrison's Principles of Internal Medicine, Goodman & Gillman's Pharmacology Textbook). Other resources have sprung up in their place (e.g. UpToDate, Epocrates). Social media has evolved into a powerful force allowing practitioners from around the globe to have ongoing discussions about topics ranging from the mundane to the ridiculous. The pace of new discoveries has accelerated to the point that textbooks re-issued every five years can't possibly keep up.

The IBCC is created in the spirit of this new, bustling international knowledge marketplace. My goal isn't to always be right (which is clearly impossible) but rather to listen and evolve in response to comments and discussion. My hope is that the IBCC will be able to harness the power of FOAMed and ongoing feedback in order to create a book more vibrant and reader-centric than any printed text (the writers of a traditional textbook are trying to satisfy the editor, whereas I'm trying to connect directly with you).

about the authors & the IBCC podcast

The IBCC is written by Josh Farkas (@PulmCrit). I'm an attending intensivist at the University of Vermont. Although I was trained in pulmonology and critical care, I've worked solely in the ICU for the past five years. At my shop I have the dubious honor of having the smallest office in the hospital and the largest amount of ICU time.

Adam Thomas is collaborating with me to create a podcast which will accompany the IBCC. He is a critical care fellow in British Columbia and cofounder of the CrackCast podcast. After completing my first venture into medical education podcasts, I'm very excited to have this project progress my travels along the Dunning-Kruger pathway to competent and confident practice. I encourage everyone to build upon Josh's tireless efforts creating the IBCC and help engage, discuss, and advance it into a truly high-level, instantly peer-reviewed education platform.

The IBCC podcast will explore key points in each chapter. Initially the release of podcasts may lag a bit behind the chapters for logistic reasons. However, our goal is to eventually have a podcast for each chapter. Subsequently, the podcast will discuss updates to the IBCC based on new evidence.

differences between PulmCrit blog vs. IBCC

The PulmCrit blog will continue in its current form. The blog is intended for more in-depth pieces with examination of the literature and an emphasis on new developments. In contrast, the IBCC is intended more for bedside management, with an emphasis on clinically applicable information and rapid readability. Many topics are covered in both formats, allowing you to choose either a more detailed or boiled-down version.

I very rarely change a blog post after it's done, but rather if an update is needed I will write an entirely new post. That model isn't feasible with the IBCC, due to the amount of ground it covers. Therefore, if there is something in the IBCC that is wrong or confusing I will try to fix it immediately. So, if you point out an error, I will thank you for your comment and fix it without delay. This might be a bit confusing at times, because it will create a mis-match between your original comment and the revised text.

some nuts & bolts

Each IBCC chapter will be split onto two webpages. The main chapter contains no comments (so that it loads quickly and is easy to scroll through). This will be linked to a webpage on the PulmCrit RSS feed, which is where comments & discussion about that chapter will be found. This will require a couple of additional clicks, but will make the IBCC faster if you're in a rush.

The book is written mostly in bullet format, to facilitate rapid extraction of information. For best reading experience on a phone, consider viewing in a horizontal orientation.

Bold-italicized links connect to concise information useful for bedside management:

Bolded drug names link to Medscape monographs with further information (dosing, interactions, etc.).

link to Medscape monographs with further information (dosing, interactions, etc.). Bolded equation names link to MDCalc online calculators.

link to MDCalc online calculators. Other text which is bold-italicized will link to other chapters within the book.

Live embedded tweets are included to add some additional depth and color. Comments about tweets are in green italics beneath the tweets. For example:

Perfect recent example: brake fluid. Persistent “high lactate” despite clearing of acidosis. pic.twitter.com/ts3ddv87Rs — Victoria Stephen (@EMcardiac) March 14, 2018

Insert witty comment about above tweet here.

please be patient with us

I drafted this post two years ago, as an aspiration of where I wanted the book to go. We've made lots of progress since then, but we're not there yet. Reviewing and posting all the chapters will probably take 2-3 years. All told, we might be 4-5 years away from a fully peer-reviewed “final” product (although the IBCC will always remain a work in evolution). I suppose this is one drawback to a FOAMed book: we're not inviting you into our fully furnished home for cocktails. We're inviting you to help build it. Please be patient with us while we work on the roof. The martini mixer will be arriving from Amazon any moment now.

acknowledgements & thanks

I am grateful for the support of Scott Weingart, including his designing the technical aspects of this ibook and the EMCrit website. I would also like to acknowledge my parents for tirelessly proofreading it (mom with an emphasis on grammar and physics, dad with an emphasis on Gastroenterology).

I never have conflicts of interest. Opinions expressed in this book are mine alone, they don't necessarily represent those of my institution, colleagues, or other editors of EMCrit.org. Any errors in the podcast are Adam's fault.

Thanks for reading, reviewing, and being part of the FOAM movement,

Cheers,

Josh