Evidence-Based Critical Care: A Case Study Approach

Preface
Contents
Contributors
Part I: ER- ICU Shock and Resuscitation
	1: Cardiac Arrest Management
		Introduction
		Case Presentation
		Principles of Management
			Standard Approach to Resuscitation
				Introduction
				Recognition of Sudden Cardiac Arrest
				Chest Compressions
				Adjuncts to CPR: Oxygen and Ventilation
				Defibrillation
			Search for Precipitating Cause of Cardiac Arrest
				Ventricular Dysrhythmias
				Pulseless Electrical Activity (PEA)
			Quality Assurance
		Evidence Contour
			Are Outcomes with Mechanical Compressions Superior to Manual Compressions During Active CPR?
			What Physiologic Parameters Can Guide the Administration of Vasoactive Medications and Provide Feedback Regarding Quality of CPR?
				Hemodynamic Directed Resuscitation
		References
	2: Post-cardiac Arrest Management
		Introduction
		Case Presentation
		Principles of Management
			Overview of Post-cardiac Arrest Syndrome
				Post Cardiac Arrest Brain Injury
				Post-cardiac Arrest Myocardial Dysfunction
				Systemic Ischemia/Reperfusion Response
				Persistent Precipitating Pathology
			Hemodynamic Optimization
			Ventilation and Oxygenation
			Management of STEMI and ACS
			Hypothermic Targeted Temperature Management
			Glucose Control
			Seizure Management
			Neuroprognostication
			Organ Donation
		Evidence Contour
			Patient Selection for Emergency Coronary Angiography
			Patient Selection for Hypothermic TTM
			Optimizing Hypothermic TTM
			Mechanical Support for Refractory Post-cardiac Arrest Cardiogenic Shock
		References
	3: Undifferentiated Shock
		Case Presentation
		Standard Approach to Undifferentiated Shock
			Shock Types
		Evidence Contour
			Assessment of Volume Responsiveness
			Bedside Echocardiography
		Summary
		References
	4: Hypovolemic Shock and Massive Transfusion
		Case Presentation
		Principles of Management
			Hypovolemic Shock
				Establish Adequate IV Access
				Consider Physiologic Reserve
				Monitor Volume Responsiveness
				Administer the Appropriate Fluid(s)
				Track Endpoints of Resuscitation
			Hemorrhagic Shock
				Expedite Anatomic Control of Bleeding
				Utilize Damage Control Surgery
				Allow for Permissive Hypotension
				Correct and Reverse Augmenting Factors of Coagulopathy and Shock
				Minimize Crystalloid Administration
				Preserve Formed Clot with Antifibrinolytics
				Replace Losses via Transfusion Therapy
		Evidence Contour
			Hypovolemic Shock
				Normal Saline vs Balanced Solutions
				Role of Albumin
				Use and Timing of Pressors
			Hemorrhagic Shock
				Massive Transfusion Protocol
				Ionized Calcium Repletion
				Point-of-Care Monitoring the Hemostatic System
				Invasive Non-surgical Hemorrhage Control
				Timing and Role of Vasopressors
				Hemostatic Resuscitation with Concurrent Head Injury
		References
	5: Acute Respiratory Failure: NIV Implementation and Intubation
		Case Presentation
		Principles of Management
			Definition
			Indications, Contraindications and Settings
			Predictors of Failure of Non-invasive Ventilation
		Evidence Contour
			Use in Patients with Pneumonia
			Use in Patients with Asthma Exacerbation
			Use in Patients with ARDS
			Use of NIV in Patients with Altered Mental Status
			Use of NIV for Preoxygenation Prior to Intubation
			Use of NIV to Facilitate Weaning from Invasive Ventilation
			Palliative Care Indications
			Use of High-Flow Nasal Cannula as an Alternative to NIV
		References
	6: Diagnosis and Management of Tricyclic Antidepressant Ingestion
		Introduction
		Case Presentation
		Principles of Management
			Diagnosis
			Gastrointestinal Decontamination
			Plasma Alkalinization
			Management of Hypotension and Vasopressor Support
			Extracorporeal Elimination
			Seizure Management
		Evidence Contour
			Intravenous Lipid Emulsion
			Hypertonic Saline
			Antiarrhythmic Drugs
		References
	7: Management of Calcium Channel Blocker Poisoning
		Introduction
		Case Presentation
		Principles of Management
			Gastrointestinal Decontamination
			Hemodynamic Support
				Calcium Salts
				Glucagon
				Atropine
				Vasopressor Support
				High-Dose Insulin Therapy
				Invasive Circulatory Support
		Evidence Contour
			Intravenous Lipid Emulsions
			Sodium Bicarbonate
			Methylene Blue
			Extracorporeal Albumin Dialysis
		References
	8: Diagnosis and Management of Ethylene Glycol Ingestion
		Case Presentation
		Principles of Management
			Diagnosis
			Ventilator and Circulatory Support
			Gastric Decontamination/Lavage/Charcoal
			Aldehyde Dehydrogenase (ADH) Blockade
			Hemodialysis
		Evidence Contour
			Ethylene Glycol Treatment Threshold
			Fomepizole vs Ethanol
			ADH Inhibition without Hemodialysis
			Serum and Urine Alkalization
			Cofactor Supplementation
		Other Toxic Alcohols
			Methanol
			Isopropyl Alcohol
		References
	9: Accidental Hypothermia
		Case Presentation
		Principles of Management
			Diagnosis
			Patient Monitoring
			Adjunctive Testing
			Rewarming
			Hypothermia Without a Pulse
			Other Supportive Care
			Disposition
			Pediatric Patients
		Evidence Contour
			Withholding CPR
			Degree of Rewarming in Cardiac Arrest
			Timing of Extracorporeal Support
			Selection of Extracorporeal Support
			Transcutaneous Pacing
			Endovascular Rewarming
			Core Afterdrop
		References
Part II: Cardiac Disease
	10: Management of Cardiogenic Shock
		Case Presentation
		Principles of Management
			Diagnosis
		Early Revascularization
			Vasopressors/Inotropes
			Percutaneous Mechanical Circulatory Support
				Intra-Aortic Balloon Pump
				Impella® 2.5, CP, and 5.0
				TandemHeart®
				Venoarterial Extracorporeal Membrane Oxygenation (v-a ECMO)
			Temporary Surgical Mechanical Circulatory Support
		Evidence Contour
			Multivessel Revascularization
			Mechanical Circulatory Support
		References
	11: Management of Acute Heart Failure
		Case Presentation
		Principles of Management
			Diagnosis
			Diuretic Therapy
			Intravenous Vasodilators
			Emergent Mechanical Circulatory Support
		Evidence Contour
			Pulmonary Artery (PA) Catheters
			Inotropic Agents
			Diuretic Dosing – Intermittent Versus Continuous
			Ultrafiltration
			Nesiritide
			Renal-Dose Dopamine
		References
	12: Management of Acute Coronary Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Initial Assessment and Early Risk Stratification
			Initial Medical Therapy
				Anti-ischemic Therapy
				Anti-thrombotic Therapy
				Antiplatelet Therapy
			Early Reperfusion and Revascularization
				STEMI
				NSTE-ACS
		Evidence Contour
			Routine Early PCI After Successful Thrombolysis in STEMI
			Culprit Only vs Complete Revascularization in STEMI
			Manual Thrombectomy During Primary PCI in STEMI
			Ezetimibe in Acute Coronary Syndromes
			Optimal Duration of Dual Antiplatelet Therapy (DAPT)
		References
	13: Complications of Myocardial Infarction
		Case Presentation
		Standard Approach to Management
			Epidemiology
			Diagnosis
			Management of LV Failure
			Management of Mechanical Complications
		Evidence Contour
			Timing of Surgery in Ventricular Septal Rupture
			Percutaneous Closure of VSR
			Intra-aortic Balloon Pump
		References
	14: Management of Cardiac Tamponade
		Case Presentation
		Principles of Management
			Hemodynamic Derangements
			Clinical Findings
			Non-invasive Diagnostic Testing
			Invasive Diagnostic Testing
			Closed Pericardiocentesis
			Surgical Drainage
		Evidence Contour
			Effusive-Constrictive Pericarditis
		References
	15: Hypertensive Crises
		Case Presentation
		Principles of Management
			Diagnosis
			Treatment of Hypertensive Crises
			Pharmacotherapy (Table 15.1)
			Evaluation for Secondary Causes of Hypertension
		Evidence Contour
			Specific Subsets of Patients with Hypertensive Crisis May Warrant Specific Treatment Approaches
		References
	16: Atrial Fibrillation and Other Supraventricular Tachycardias
		Case Presentation
		Principles of Management
			Diagnosis
			Physiologic Effects
			Treatment Strategies
				Rate Control
				Rhythm Control
				Stroke Prevention
			Other Supraventricular Tachycardias (SVT)
		Evidence Contour
			High Bleeding Risk in Post-operative Cardiac Surgery Patients
			Concurrent Inotropic Support
			Rhythm Control in HFrEF
		References
	17: Ventricular Arrhythmias
		Case Presentation
		Principles of Management
			Diagnosis
				Classification of VT
				Monitoring and Testing
			General Measures
			Beta Blockers
			Amiodarone
			Lidocaine
			Digoxin Immune Fab
		Evidence Contour
			Anti-arrhythmic Drug Therapy
			Mechanical Circulatory Support – IABP
			Advanced Mechanical Circulatory Support – ECMO
			Radiofrequency Catheter Ablation
			Transcoronary Ethanol Ablation
			Cardiac Sympathetic Denervation
		References
	18: Management of Acute Aortic Syndromes
		Case Presentation
		Principles of Management
			Definition
			Diagnosis
			Medical Management
			Surgical Intervention
			Complications
		Evidence Contour
			Diagnosis of Aortic Dissection
			Medical Management of Type A Dissection
			Surgical Intervention for Aortic Arch Dissections
		References
	19: Management of Endocarditis
		Case Presentation
		Principles of Management
			Epidemiology
			Diagnosis
			Antimicrobial Therapy
			Indications for Surgery
			Follow-Up Evaluation
		Evidence Contour
			Timing of Non-emergent Surgery in IE
			Neuroimaging in IE
			Timing of Surgery in IE with Septic Cerebral Embolic Strokes
			Valve Repair Versus Valve Replacement
			Cardiac Device Related IE
		References
Part III: Respiratory Disease
	20: Community Acquired Pneumonia
		Case Presentation
		Principles of Management
			Site-of-Care Decisions
			Diagnostic Testing
			Microbial Culprits
			Empirical Versus Pathogen-Directed Therapy
			Parapneumonic Effusions
		Evidence Contour
			Risk of Multidrug Resistant (MDR) Pathogens
			Drugs to Suppress Toxin with MRSA
			Procalcitonin
			Corticosteroids
		References
	21: Management of Acute Respiratory Distress Syndrome
		Case Presentation
		Principles of Management
			Risk Factors for ARDS and Diagnosis
				Berlin Definition of ARDS
			Lung Protective Ventilation
			Open Lung Ventilation
			Prone Ventilation
			Fluid Management
			Supportive Care
		Evidence Contour
			Additional Risk Factors
			Subgroups and Subphenotypes
			Helmet Ventilation
			Transpulmonary Pressure
			Pressure Limited Mechanical Ventilation
			Neuromuscular Blockade
			High Frequency Oscillatory Ventilation (HFOV)
			Extra Corporeal Membrane Oxygenation (ECMO)
			Corticosteroids
			Inhaled Vasodilators
		References
	22: Acute Exacerbation of COPD: Non-­invasive Positive Pressure Ventilation
		Case Presentation
		Principals of Management
			Diagnosis
				Bronchodilators
			Systemic Corticosteroids
			Antibiotics
			Non-invasive Positive Pressure Ventilation (NIPPV)
		Evidence Contour
			NIPPV Use in Individuals with Do-Not-Intubate Orders
			NIPPV After Extubation
		References
	23: Management of Status Asthmaticus
		Case Presentation
		Principles of Management
			Inhaled Bronchodilators
			Corticosteroids
			Monitoring of Arterial Blood Gases
			Ventilator Strategies
			Permissive Hypercapnia/Hypoventilation
			Monitoring for Hyperinflation
			Recognizing Barotrauma
		Evidence Contour
			Adjuvant Pharmacologic Treatments
			Magnesium
			Intravenous Bronchodilators
			Lactic Acidosis from Beta Agonist
			Heliox
			Noninvasive Positive Pressure Ventilation (NIV)
			Anesthetics
			Bronchoscopy
			Extracorporeal Life Support (ECLS)
		References
	24: Immunocompromised Pneumonia
		Case Presentation
		Principles of Management
			Presentation
			Etiology
			Diagnosis
			Empiric Treatment
			Supportive Care
		Evidence Contour
			Utility of Invasive Testing
			Serum Indices of Infection
			Noninvasive Ventilation
		References
	25: Venous Thromboembolism in the Intensive Care Unit
		Case Presentation
			Case Scenario
		Standard Approach to Diagnosis and Management
			Risk Factors
			Epidemiology of VTE in the ICU
			Clinical Presentation
			Pulmonary Embolism Severity
			Diagnosis
			Treatment
		Evidence Contour
			Reperfusion Therapy in Patients with Hemodynamically Stable Pulmonary Embolism
			IVC Filter Placement
			Direct Factor Xa and Thrombin Inhibitors
		References
	26: Massive Hemoptysis
		Case Presentation
		Principles of Management
			Epidemiology
			Sources of Hemorrhage
			Diseases Associated with Massive Hemoptysis
			Imaging
			An Approach to Managing Life Threatening Hemoptysis (Algorithm, Fig. 26.4)
			Assessment
		Evidence Contour
			Rigid Versus Flexible Bronchoscopy
			Dual Lumen Versus Unilateral Airway Intubation: Benefits and Limitations
			One Transport or Two?
			Recurrent Bleeding; Repeat Embolization or Surgery?
		References
	27: Sedation and Delirium
		Case Presentation
		Principles of Management
			Monitoring Sedation and Delirium
			Minimizing Sedation
			Risk Factors for Delirium
		Evidence Contour
			Sedative Choice
			Spontaneous Awakening Trials (SATs)
			Sedative-Related Delirium
			Prevention of Delirium
			Antipsychotics
			Delirium and Long-Term Outcomes
		References
	28: Prolonged Mechanical Ventilation
		Case Presentation
		Principles of Management
			Diagnosis
			Assess Expected Survival
			Place Tracheostomy
			Daily Tracheostomy Collar Trials
			Early Mobility
			Speaking Valve Trials
			Tracheostomy Removal
		Evidence Contour
			Timing of Tracheostomy
			Benefit of Transfer to LTAC
			Survivorship Clinics and Symptom Burden
		References
	29: Ventilator-Associated Pneumonia and Other Complications
		Case Presentation
		Principles of Management
			Rapid Identification and Empiric Treatment of VAP Is Essential
			Treat Patients with VAP Broadly for Multidrug Resistant Organisms
			Duration of Therapy – 8 or 15 Days
			Rapidly De-Escalate Antimicrobial Therapy
			Clinicians Should Remain Vigilant for Other Causes of Fever in the ICU
		Evidence Contour
			Invasive Versus Noninvasive Sampling Strategies
			Effective Treatment Strategies for MRSA VAP
			Utility of ATS/IDSA Recommendations for Dual Gram-Negative Coverage
			Evolving Surveillance Definitions
			New and Old Strategies to Prevent VAP
		References
	30: Respiratory Failure in a Patient with Idiopathic Pulmonary Fibrosis
		Case Presentation
		Principles of Management
			Incidence and Prognosis
			Corticosteroids
			Supportive Care
			Palliative Care
			Ensure Correct Diagnosis
			Exacerbation During Surgical Procedures
		Evidence Contour
			Noninvasive Ventilation
			High Flow Nasal Cannula
			Ventilator Settings
			Anticoagulation
			Cyclophosphamide
			Cyclosporin A
			Restrictive Operative Fluid Balance
			Pulmonary Transplantation
			Extracorporeal Life Support
			Anti-fibrotic Medications
		References
	31: Weaning from Mechanical Ventilation
		Case Presentation
		Principles of Management
			Strategies to Minimize the Requirement for Mechanical Ventilation
			Strategies to Reduce the Duration of Mechanical Ventilation
			Evaluation of Patient’s Readiness for Spontaneous Breathing
			Perform a Spontaneous Breathing Trial in Patients Deemed Ready
			Assess Patient’s Ability to Protect the Airway
		Evidence Contour
			Assessing the Need for an Artificial Airway
			Weaning Protocols
			Sample Ventilator Liberation Pathway
			Diaphragmatic Ultrasound as an Index for Discontinuation of Mechanical Ventilation
			Pressure Support Versus T-Tube for Weaning from Mechanical Ventilation
			Tracheostomy for Prolonged Transition
		References
	32: The Post-intensive Care Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Prevention and Rehabilitation
		Components of the ABCDEF Bundle
		Evidence Contour
			ICU Follow Up Clinic
			Cognitive Rehabilitation
		References
	33: Management of Decompensated Right Ventricular Failure in the Intensive Care Unit
		Case Presentation
		Principles of Management
			Diagnosis
			Monitoring of End-Organ Perfusion
			Optimization of Right-Sided Filling Pressures
			Reversal of Conditions that Heighten Pulmonary Vascular Tone
			Ventilation Strategy
			Supportive Care
		Evidence Contour
			Pulmonary Artery Catheter Use in Decompensated RV Failure
			Choice of Vasopressor
			Selective Use of Inotropic Agents
			Use of Selective Pulmonary Vasodilators
			Ventilatory Considerations in the Face of ARDS
			Extra Corporeal Membrane Oxygenation (ECMO)
		References
	34: Diffuse Alveolar Hemorrhage
		Case Presentation
		Principles of Management
			Differential Diagnosis
			Classification
			Diagnosis
			Treatment
		Evidence Contour
			Rituximab
			Recombinant Factor VII
		References
Part IV: Neurologic Disease
	35: Acute Stroke Emergency Management
		Case Presentation
		Principles of Management
			Diagnosis
			Acute Stroke Management, tPA Administration
			Acute Stroke Management, Endovascular Thrombectomy
			Supportive Care
			Atrial Fibrillation, Heart Failure and Anticoagulation
			Secondary Stroke Prevention in the Acute Stroke Setting
		Evidence Contour
			“Wake-Up” Strokes
			Acute Cerebral Artery Dissection, Antiplatelets Versus Anticoagulation
			Blood Pressure Management in Acute Stroke Patients
			Hemicraniectomy in Patients Older than 60 Years Old with Large Hemispheric Stroke
			Early Rehabilitation in Stroke Patients
			Basilar Artery Thrombosis, Therapy After 4.5 Hours
			Endovascular Therapy Without IV tPA, After 4.5 Hours
			Stenting in Acute Stroke Therapy
			Dual Anti-platelet Therapy, Aspirin plus Clopidogrel for Secondary Stroke Prevention
		References
	36: Bacterial Meningitis in the ICU
		Case Presentation
		Principles of Management
			Epidemiology
			Diagnosis
			Antibiotics
			Steroids
			Long Term Neurologic Complications
			Meningococcemia
		Evidence Contour
			ICP Management
			Hypothermia
			Gram-Negative Bacilli Meningitis
			Shunts and Other Intracranial Devices
			Post Exposure Prophylaxis
		References
	37: Management of Intracerebral Hemorrhage
		Case Presentation
		Principles of Management
			Clinical Presentation
			Diagnosis
			Acute Management
			Natural History
			Complications
		Evidence Contour
			Hyperosmolar Therapy
			Seizure Prophylaxis
			Hypothermia
			Hypertension Management
		References
	38: Status Epilepticus
		Case Presentation
		Principles of Management
			Diagnosis of SE and Underlying Etiology
			Pharmacologic Therapy of SE
			Refractory SE (RSE)
			Medical Management of SE
			Multidisciplinary Care
		Evidence Contour
			Goals of Treatment
			Non-convulsive Status Epilepticus (NCSE)
			Other Treatment Options in SE
		References
	39: Neuroleptic Malignant Syndrome
		Introduction
		Case Presentation
		Principles of Management
			Diagnosis
			Medication History and Temporal Clues
			The Clinical Tetrad of NMS: Clues to Diagnosis and Management Concerns
				Hyperthermia
				Altered Mental Status
				Muscular Rigidity
				Autonomic Dysfunction
		Evidence Contour
			Benzodiazepines
			Dantrolene
			Bromocriptine
			Amantadine
			Electroconvulsive Therapy
		References
	40: Traumatic Brain Injury
		Case Presentation
		Principles of Management
			Primary and Secondary Brain Injury
			Severity of Traumatic Brain Injury
			Prehospital and Emergency Department
			Mechanical Ventilation
			Analgesia, Sedation and Neuromuscular Paralysis
			Surgical Treatment
				Epidural Hematoma
				Subdural Hematoma
				Intraparenchymal Hematoma/Traumatic Cerebral Contusion
		Evidence Contour
			Indication of Intracranial Pressure Monitoring and Pressure Threshold
			Post-traumatic Seizures
			Therapeutic Hypothermia
			Advanced Neuromonitoring
				Brain Tissue Oxygen (PbtO2)
				Cerebral Microdialysis
				Jugular Bulb Oximetry
			Prophylactic Antibiotics
			Steroids and Neuroprotective Agents
		References
	41: Management of Anoxic Brain Injury
		Case Presentation
		Principles of Management
			Diagnosis
			Therapeutic Hypothermia
			Maintenance of Normothermia
			Supportive Care
		Evidence Contour
			Therapeutic Hypothermia
			Rewarming and Maintenance of Normothermia
			Neurologic Prognostication
		References
Part V: Renal Disease
	42: Traditional and Novel Tools for Diagnosis of Acute Kidney Injury
		Case Presentation
		Principles of Management
			Serum Creatinine and Urine Output
			Relationship Between Serum Creatinine and Urine Output
			Differentiating Between AKI and CKD
			Clinical Use of Novel Biomarkers
		Evidence Contour
			Determining Baseline Serum Creatinine
			Imaging Techniques for Diagnosis of AKI
			Emerging Role for Novel Biomarkers
		References
	43: Management of Acute Kidney Injury
		Case Presentation
		Principles of Management
			Intravenous Fluids and Vasopressors
			Consider Alternative Etiologies and Specific Treatments for AKI
			Prevention of Further Injury
			Diuretics
			Medical Management of Complications of AKI
			Renal Replacement Therapy
		Evidence Contour
			Choice of Intravenous Fluid Solution
			Nutrition in AKI
			Tight Glycemic Control
			Vasodilators and Growth Factor Interventions
			Early Initiation of Dialysis
		References
	44: Rhabdomyolysis
		Case Presentation
		Principles of Management
			Diagnosis
			Fluid Therapy
			Treating Reversible Causes of Muscle Damage
			Management of Complications
		Evidence Contour
			Bicarbonate Therapy
			Diuretics and Mannitol
			Antioxidants and Free Radical Scavengers
			RRT for Prevention of Acute Kidney Injury
		References
	45: Hyponatremia
		Case Presentation
		Principles of Management
			ABCD Followed by Diagnosis
			Bolus Therapy
			Avoidance of Overcorrection
			Mechanisms Behind the Hyponatremia/Lasting Correction
				Hyponatremia with Reduced ECV/Sodium
				Hyponatremia with Increased Extracellular Volume/Sodium
				Hyponatremia Despite Suppressed ADH
				Syndrome of Inappropriate Antidiuretic Hormone
				Adrenal Deficiency
		Evidence Contour
			Rate of Correction/Risk of Osmotic Demyelination
			Acute Versus Chronic Hyponatremia
			Hyponatremia and Association with Mortality?
		References
Part VI: Endocrine Disease
	46: Management of Severe Hyponatremia and SIADH
		Case Presentation
		Principles of Management
			Risk Stratification
			Evaluation
			Correcting Serum Sodium
			Monitoring Correction Rate
			Osmotic Demyelination Syndrome (ODS)
		Evidence Contour
			Diagnostics
			Novel Treatments
			Osmotic Demyelination Syndrome
				Outcomes
				Prevention
		References
	47: Diabetic Ketoacidosis
		Case Presentation
		Principles of Management
			Diagnosis
			Fluid Replacement
		Insulin
			Electrolyte Repletion
			Treatment of Precipitating Condition
			Complications
		Evidence Contour
			Bicarbonate Infusion
			Site of Care
			Form of Insulin Administered
			Euglycemic DKA
		References
	48: Thyroid Storm
		Case Presentation
		Principles of Management
			Incidence
			Etiology
			Presentation
			Diagnosis
			Treatment
				Beta-Blockers
				Thionamides
				Iodine Containing Solutions
				Glucocorticoids
				Patients Unable to Take a Thionamide
		Evidence Contour
			Diagnostic Clinical Tools
			Iodinated Radiocontrast Agents
			Extracorporeal Plasmapheresis
			L-Carnitine
		References
	49: Adrenal Insufficiency
		Case Presentation
		Principles of Management
			Presentation of Adrenal Insufficiency
			Absolute Versus Relative Adrenal Insufficiency and Critical-Illness Related Corticosteroid Insufficiency (CIRCI)
			Interpretation of Test Results in Critically Ill Patients
				Measurement of Serum Cortisol
				ACTH Stimulation Test
				Interpretation of Random Cortisol and ACTH Stimulation Testing
			Steroid Replacement Strategies
				Choice of Steroid
				Dose and Duration
			Concurrent Fluid Management
			Additional Testing
		Evidence Contour
			Steroid Replacement in Septic Shock
			ACTH Stimulation Test: Low Dose Versus High Dose
			Role of Salivary Cortisol Testing
			Role of Etomidate and Opiates in Development of Adrenal Insufficiency
		References
	50: Management of Hyperglycemic Hyperosmolar Syndrome
		Case Presentation
		Principles of Management
			Diagnosis of HHS
			Fluid Therapy
			Insulin Therapy
			Correcting Electrolytes
				Sodium
				Potassium
				Magnesium
				Phosphate
		Evidence Contour
			Type of IV Fluid
			Anticoagulation
		References
	51: Management of Myxedema Coma
		Case Presentation
		Principles of Management
			Diagnosis
			Thyroxine Replacement
			Corticosteroid Replacement
			Supportive Care
		Evidence Contour
		References
Part VII: Infectious Disease
	52: Urosepsis
		Case Presentation
		Principles of Management
			Diagnosis
			Empiric Antimicrobial Administration
			Procedures/Surgery
		Evidence Contour
			Empiric Anitbiotic Choice
			Indications for Imaging
			Intervention Method
		References
	53: Management of Sepsis and Septic Shock
		Case Presentation
		Principles of Management
			Definition and Recognition
			Surviving Sepsis Campaign Sepsis Bundle
			Fluid Management
			Hemodynamic Response
			Tissue Perfusion
			Vasopressors
			Treatment of Infection and Antimicrobial Stewardship
			Ventilator Management
			Glycemic Control and Nutrition
		Evidence Contour
			Early Goal Directed Therapy (EGDT)
			Corticosteroids
			SIRS Criteria in Sepsis
			Blood Pressure Target in Septic Shock
			Fluid Resuscitation in Septic Shock
			Bicarbonate Infusion in Lactic Acidosis
			Heart Rate Control in Septic Shock
			Sequella After Surviving Severe Sepsis/Septic Shock
		References
	54: Invasive Aspergillus
		Case Presentation
		Principles of Management
			Diagnostic Approach
		Risk Factors for Invasive Aspergillosis
			Classic Risk Factors
			Newer Risk Factors
			Therapy
				Antifungal Therapy
				Monotherapy
				Combination Therapy
				Antifungal Resistance
		Evidence Contour
		References
	55: Management of Strongyloides Hyperinfection Syndrome
		Case Presentation
		Principles of Management
			Epidemiology
			Life Cycle
			Disseminated Infection and Hyperinfection
			Diagnosis
			Anti-parasitics
			Supportive Care and Follow Up
		Evidence Contour
			Severe Infections
			Hyperinfection Associated with Paralytic Ileus
		References
	56: Treatment of Viral Hemorrhagic Fever in a Well-Resourced Environment
		Case Presentation
		Principles of Management
			Isolation and Infection Control
			Active Screening
			Isolation Unit
			Protective Equipment
			Protocols and Policies
				Specimen Collection and Handling
				Decontamination
				Waste Management
			Provisions of Clinical Care
				Team Structure
				Monitoring
				Bedside Assessments
			Diagnostic Testing
				Blood Analysis
				Imaging
				Invasive Procedures
		Central Venous Catheter(CVC) Placement
			Threshold for Placement
			Location of Placement
			Sterile Precautions
		Endotracheal Intubation
			Threshold for Intubation
			Modality
		Emergency Response Teams
		Diagnostic Evaluation
			Establishing the Likelihood of EVD
			Identifying Alternative or Concomitant Diagnoses
			Specific Testing for EVD
			Supportive Therapy
				Fluid and Electrolytes
				Mechanical Ventilation
				Renal Replacement Therapy
				Nutrition
		Evidence Contour
			Targeted Therapy
			Ethical Considerations
				Staffing Model
			Provisions of Care
		References
	57: Management of Severe Malaria
		Case Presentation
		Principles of Management in Severe Falciparum Malaria
			Definition of Severe Malaria
			Diagnosis
			Clinical Management
				General Principles
			Antimalarial Therapy (See Treatment Table 57.4)
			Monitoring Parasite Density
			Respiratory System
			Neurologic Involvement
			Seizure Management
			Anemia and Coagulopathy
			Blood Products
				Hypoglycemia
				Volume Management
			Nutrition
			Fever
			Bacterial Infection
		Evidence Contour
			Other Diagnostic Modalities
				Quantitative Buffy Coat
				Antigen Rapid Detection Test (RDT)
				Serology
				Molecular Methods
			Exchange Transfusion
		References
	58: Dengue
		Case Presentation
		Principles of Management
			Phases of Illness and Diagnosis
			Supportive Treatment
		Evidence Contour
			Volume Replacement
			Other Aspects of Care
		References
	59: Chikungunya
		Case Presentation
		Principles of Management
			Diagnosis
			Volume Management
		Evidence Contour
			Epidemiology
			Treatment
		References
	60: Leptospirosis
		Case Presentation
		Principles of Management
			Epidemiology
			Microbiology
			Clinical Presentation
			Laboratory Presentation
			Differential Diagnosis
			Antibiotic Administration
		Evidence Contour
			Diagnostic Tools
				Reference Standard
				Serology
				Molecular Tests
				Culture
			Drug Resistance
			Role of Corticosteroids
			Prevention
		References
Part VIII: Gastrointestinal Disease
	61: Management of Acute Upper Gastrointestinal Hemorrhage
		Case Presentation
		Principles of Management
			Diagnosis
			Risk Stratification
			Blood Transfusion
			Post-endoscopic Intensive Proton Pump Inhibitor Therapy
		Evidence Contour
			Nasogastric Lavage
			Optimal Dosing of Post-endoscopic Proton Pump Inhibitor Therapy
			Pre-endoscopic Proton Pump Inhibitor Therapy
			Salvage Therapy
			Reversal of Coagulopathy and Thrombocytopenia
			Reversal of Warfarin
			Reversal of Newer Oral Anticoagulants
		References
	62: Variceal Hemorrhage
		Case Presentation
		Principles of Management
			Initial Resuscitation
			Vasoactive Medications
			Hemostasis Interventions
			Transjugular Intrahepatic Portosystemic Shunt
			Antibiotic Prophylaxis
		Evidence Contour
			Red Blood Cell Transfusion
			Correction of Coagulopathy
			Endotracheal Intubation
			Acid Suppression
			Balloon Tamponade
			Transjugular Intrahepatic Portosystemic Shunt
			Balloon-Occluded Retrograde Transvenous Obliteration
			Surgery
		References
	63: Acute Pancreatitis
		Case Presentation
		Principles of Management
			Disease Burden, Diagnosis, and Assessment of Severity
			Intravenous Fluids
			Antibiotics
			Pain Control
			Etiology
		Evidence Contour
			Early Nutritional Support
		References
	64: Management of Acute Liver Failure
		Case Presentation
		Principles of Management
			Etiology of ALF
			Correction of Coagulopathy
			Hemodynamic Support
			Renal Insufficiency
			Infection
			Neurologic Complications
		Evidence Contour
			Recombinant Factor VIIa to Correct Coagulopathy
			Serial NH3 Levels in ALF Patients
			Targeted Temperature Management
			Bioartificial Hepatic Support Systems
			Criteria for Liver Transplantation
		References
	65: Acute Lower Gastrointestinal Bleeding
		Case Presentation
		Principles of Management
			Definitions
			Initial Evaluation
			Initial Resuscitation and Management
			Appropriate Patient Disposition
			Nasogastric Tube Lavage
			Urgent Colonoscopy
			Mesenteric Angiography
			Surgery
		Evidence Contour
			Predicting Severity and Outcomes of LGIB
			Blood Transfusion Goals
			Massive Transfusions
			Diagnostic Imaging Modalities
			Provocation Testing
		References
	66: Diagnosis and Management of Clostridium Difficile Infection (CDI)
		Case Presentation
		Principles of Management
			Symptoms of C. Difficile Infection
			Diagnosis
			Risk Factors
			Severity of Disease
			Medical Therapies
			Surgical Intervention
			Epidemiology and Infection Control
		Evidence Contour
			Fecal Microbiota Transplant
			Capsulized Frozen Fecal Microbiota
			Probiotics
			Monoclonal Antibodies and Vaccines
			Nontoxogenic C. Difficile Spores
			Investigational Antibiotics
		References
	67: Principles of Nutrition in the Critically Ill Patient
		Case Presentation
		Principles of Nutrition
			If the Gut Works, Use It
			Full Feedings are Preferred; Trophic Feedings May Be Acceptable
			Immunologic Benefits of Enteric Feedings
			Do Not Use Increased Gastric Residuals or Decreased Bowel Sounds as Markers upon Which to Hold Feedings
		Evidence Contour
			The CALORIES Trial Did Not Reliably Support PN due to Study Design
			Actual Caloric Goals Remain an Area of Ongoing Research
			Actual Micronutrient Goals Are Not Clear
			No Recommendations Can Be Made for or Against Specific Lipid Choices in Tube Feeds
			Obese Patients Should Be Treated Like Normal or Underweight Patients
		References
	68: Spontaneous Bacterial Peritonitis
		Case Presentation
		Principles of Management
			Diagnosis
			Microbiologic Etiology
			Treatment
				Antibiotics
				Albumin
				Discontinue Nonselective Beta Blockers (NSBB)
			Prophylaxis
				Antibiotic Prophylaxis
		Evidence Contour
			Duration of Therapy
			Choice of Antibiotics
			Patient with Non-neutrocytic Bacterascites
		References
	69: ICU Management of the Patient with Alcoholic Liver Disease
		Case Presentation
		Principles of Management
			Classification of Alcoholic Liver Disease
			Prognosis in Alcoholic Hepatitis
			ICU Management of Alcohol Use Disorders, Including Alcohol Withdrawal Syndrome (AWS) and Delirium Tremens (DTs)
			Nutritional and Micronutrient Supplementation
			Upper GI Bleeding in Patients with Alcoholic Liver Disease
			Medical Management of Acute Alcoholic Hepatitis
			Management of Hepatorenal Syndrome
		Evidence Contour
			Optimal Medications for Alcohol Withdrawal Syndrome
			Intubation for EGD
		References
Part IX: Hematologic Disease
	70: Diagnosis and Management of Thrombotic Thrombocytopenic Purpura
		Case Presentation
		Principles of Management
			Diagnosis of Thrombotic Thrombocytopenic Purpura
			ADAMTS13 Activity Level and Autoantibody Testing
			Therapeutic Plasma Exchange
			Fresh Frozen Plasma (FFP)
			Immunosuppressive Agents
			Drug-Induced Thrombotic Microangiopathy
			Venous Thromboembolism Prophylaxis
		Evidence Contour
			Prevention of Relapses with Other Immunosuppressive Agents
			Anti-platelet Agents
			Duration and Intensity of TPE
			Amount of FFP
		References
	71: Acute Leukemia Presentation with DIC
		Case Presentation
		Principles of Management
			Confirm the Diagnosis of AML
			Make the Correct Diagnosis of DIC
				Differential Diagnosis of DIC
				Laboratory Profile of DIC
			Treat the Underlying Disease
			Supportive Care/Blood Product Transfusion for DIC
		Evidence Contour
			Heparin
			Anti-thrombin III
			Recombinant Factor VIIa
		References
	72: Disseminated Intravascular Coagulation
		Case Presentation
		Principles of Management
			Diagnosis
			Treatment of the Underlying Disorder
			Management of Acute Coagulopathy in Hemorrhaging Patients
			Thrombotic Predominant DIC and Purpura Fulminans
		Evidence Contour
			Heparin Therapy
			Thrombomodulin-α
			Antithrombin III (ATIII)
		References
	73: Hemophagocytic Lymphohistiocytosis
		Case Presentation
			Presentation
			Diagnosis
			Treatment
		Evidence Contour
			Prognosis
			Biomarker Testing
		References
	74: ICU Complications of Hematopoietic Stem Cell Transplantation Including Graft Versus Host Disease
		Case Presentation
		Principles of Management
		Impact of Graft-Versus-Host Disease on the Critically Ill HCT Patient
		Pulmonary Complications in the GVHD Patient
		Recovery “Phases” Post-HCT
		Common Infectious Complications of Phase 1
		Common Non-Infectious Phase 1 Pulmonary Complications of HCT
		Common Infectious and Non-Infectious Pulmonary Complications in Phase 2
		Phase 3 Pulmonary Complications Post HCT
		Evaluation of Respiratory Failure
		Evidence Contour
			When to Withhold or Withdraw Life Support
		References
	75: Tumor Lysis Syndrome
		Case Presentation
		Principles of Management
			There Are Laboratory and Clinical Classifications of Tumor Lysis Syndrome (TLS)
			Risk Stratification for Development of Clinical TLS Is Complex, but Useful
			Treatment Prephase with Low Intensity Chemotherapy May Prevent TLS in High-Risk Patients
			Hydration Is Essential to Prevention and Treatment of TLS
			Hypouricemic Agents Are Essential to the Prevention and Treatment of TLS
			Close Monitoring Is Essential in TLS
			Prevention of Cardiac Arrhythmias
			Acute Renal Failure Requiring Renal Replacement Therapy May Develop Despite Best Practice
		Evidence Contour
			Use of IV Diuretics in Addition to IV Hydration Has Conflicting Clinical Outcomes
			There Is Unclear Utility of Phosphate Binders in TLS with AKI
			Choice of Renal Replacement Therapy Has Variable Outcomes
		References
	76: Management of Hyperviscosity Syndromes
		Case Presentation
		Principles of Management
			Pathophysiology
			Diagnosis
			Management
		Evidence Contour
			How to Measure Viscosity
			Lack of Procedural Standardization
			Efficacy of Leukapheresis in AML
		References
Part X: Surgical
	77: Thoracic Trauma
		Case Presentation
		Principles of Management
			Pneumothorax
			Hemothorax
			Rib Fractures
			Lung Contusion
		Evidence Contour
			Pneumothorax
			Hemothorax
			Rib Fractures
			Lung Contusion
		References
	78: Blunt Abdominal Trauma
		Case Presentation
		Principles of Management
			Unstable Versus Stable Blunt Abdominal Trauma
			Balanced Resuscitation
			Imaging and Diagnosis
			Nonoperative Management (NOM) of Blunt Solid Organ Injury
			Angioembolization for Blunt Solid Organ Injury
			Post-splenectomy Vaccinations
		Evidence Contour
			Who Should Be Managed Nonoperatively?
			How Should Nonoperative Management Be Accomplished?
			Is Follow-Up Imaging Necessary?
			When Should We Initiate Venous Thromboembolism (VTE) Prophylaxis in Solid Organ Injury Patients?
		References
	79: Abdominal Sepsis and Complicated Intraabdominal Infections
		Case Presentation
		Principles of Management
			Diagnosis
			Resuscitation
			Source Control
			Anti-Infective Therapy
		Evidence Contour
			Laparoscopic Peritoneal Lavage
			Minimally Invasive Approaches to Infected Pancreatic Necrosis
			Procalcitonin
		References
	80: Intestinal Obstruction: Small and Large Bowel
		Case Presentation
		Standard Approach to Management
		Evidence Contour
			Timing of Operating for SBO
			Management Differences Between Small and Large Bowel Obstruction
			Management of Acute Small Bowel Obstruction in a Patient with No Prior Abdominal Surgery or Pathology
			CT Imaging Findings Indicative of a Need for Exploration
		References
	81: Management of Acute Compartment Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
				Abdomen
				Extremity
			Decompression
				Abdomen
				Extremity
			Wound Management
				Abdomen
				Extremity
		Evidence Contour
			Abdomen
				Abdominal Perfusion Pressure
				Fluid Management
				Percutaneous Drainage
			Extremity
				Infared Spectroscopy
				Dermotraction
		References
	82: Extracorporeal Membrane Oxygenation (ECMO) and Extracorporeal CO2 Removal (ECCO2R)
		Case Presentation
		Principles of Management
			ECMO Indications
			ECMO Contraindications
			Initial ECMO Management
			Weaning Off of ECMO
			Post-ECMO Considerations
			Extracorporeal CO2 Removal (ECCO2R)
		Evidence Contour
			ECMO
			Prolonged ECMO
			ECMO Trial Data
			ECMO Outcome Prediction
		References
	83: Management of Acute Thermal Injury
		Case Presentation
		Principles of Management
			Diagnosis
			Wound Care
			Surgical Intervention
			Fluid Management
				Parkland Formula
			Supportive Care
		Evidence Contour
			Fluid Resuscitation Monitoring
			Scar Management
		References
	84: Acute Arterial Ischemia
		Case Presentation
		Principles of Management
			Initial Evaluation
			Diagnostic Imaging
			Intervention and Post-operative Management
		Evidence Contour
			Controversial Aspects of Management/Imaging
			Endovascular Treatment Approach to Lower Extremity Vascular Trauma
		References
	85: Management of Necrotizing Soft Tissue Infection
		Case Presentation
		Principles of Management
			Rapid Diagnosis
			Empiric Broad Spectrum Antibiotic Therapy and Resuscitation
			Surgical Source Control
		Evidence Contour
			Predicting NSTI Diagnosis and Outcome
			Early Amputation
			Adjunctive Therapies
				Immunomodulatory Therapy
				Hyperbaric Oxygen
		References
	86: Biliary Infections
		Case Presentation
		Principles of Management
			Diagnosis
			Severity Assessment
			Medical Management
			Surgical and/or Interventional Management
		Evidence Contour
			Diagnostic Studies
			Duration of Antibiotics
			Type and Timing of Intervention
		References
Part XI: Critical Care in Obstetrics
	87: Peripartum Cardiomyopathy
		Case Presentation
		Principles of Management
			Diagnosis
			Standard Medical Therapy for Heart Failure
			Chronic Medical Therapy
				Anticoagulation
				Implantable Cardioverter Defibrillator
			Mechanical Support
			Delivery
			Postpartum Supportive Care
		Evidence Contour
			Immunotherapy and Anti-­inflammatory Mediators
		References
	88: Management of Amniotic Fluid Embolism
		Case Presentation
			Pathophysiology
		Principles of Management
			Diagnosis
			Management
			Initial Assessment
			Oxygenation
			Hemodynamic Support
			Delivery of Fetus
		Evidence Contour
			Diagnosis
			Adjunctive Therapies
		References
	89: Respiratory Diseases of Pregnancy
		Case Presentation
		Principles of Management
			Physiologic Respiratory Changes Seen in Pregnancy
				Pulmonary Edema
				Airway Disease
				Obstructive Sleep Apnea in Pregnancy
			Pulmonary Infections in Pregnancy
				Viral Pneumonia
				Bacterial Pneumonia
			Neuromuscular Diseases and Central Causes
			Pneumothorax in Pregnancy
			Pulmonary Embolism in Pregnancy
			Cystic Fibrosis
		Evidence Contour
			Ventilation Strategies in the Pregnant Patient
				Challenges
				Goals of Ventilation
				Non-invasive Ventilation
				Mechanical Ventilation
				Extra Corporeal Membrane Oxygenation (ECMO)
				Prone Ventilation
				Delivery
		References
	90: Preeclampsia, Eclampsia and HELLP Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Seizure Prophylaxis
			Treatment of Eclamptic Seizure
			Antenatal Steroids and Delivery
			Anti-hypertensive Therapy
			Treatment of DIC
		Evidence Contour
			Magnesium Sulfate Therapy
			Invasive Monitoring
			Dexamethasone Therapy in HELLP Syndrome
			Differentiation from Acute Fatty Liver of Pregnancy (AFLP)
		References
Part XII: Other Conditions
	91: Management of Severe Skin Eruptions
		Case Presentation
			Pathogenesis
		Principles of Management
			Supportive Care
		Evidence Contour
			Systemic Corticosteroids
			Intravenous Immunoglobulins (IVIG)
			Cyclosporine
			TNF Alpha Inhibitors
			Thalidomide
		Summary
		References
	92: Management of Alcohol Withdrawal Syndromes
		Case Presentation
		Principles of Management
			Diagnosis
			Initial Phase of Care
		Evidence Contour
			Patient Disposition
			Propofol
			Phenobarbital
			Central Alpha 2 Agonists
			Antipsychotics
			Anticonvulsants
			Other Agents
		References
Part XIII: Medical Ethics
	93: End of Life Care in the ICU
		Case Presentation
		Principles of Management
			Making Decisions in the ICU
			Prognostication
			What Constitutes Good End of Life Care?
		Evidence Contour
			Code Status and the ICU Patient
				Background
				Problems with DNR
				Who Should Make Decisions About Life Support?
				Going Forward with Life-Sustaining Treatment Decisions
			Futility and Requests for Inappropriate Treatments
				Defining Futility
		References
Index