The Intensive Care Unit Manual

Intensive Care Unit Manual
......Page 1
Front Matter......Page 2
Copyright......Page 3
Dedication......Page 4
Contributors......Page 5
Preface to First Edition......Page 17
Preface to Second Edition......Page 18
Four Components of the Respiratory System......Page 19
Respiratory Pump and Control of Paco2......Page 20
Respiratory Muscle Fatigue......Page 22
Chest Bellows Component......Page 23
Arterial Blood Gas Changes in Chronic Obstructive Pulmonary Disease Flares......Page 26
Alveolar Component......Page 28
Bibliography......Page 30
Ventilating the Respiratory System......Page 31
Dynamic Pressure-Volume Curve......Page 33
Settings......Page 34
Clinical Considerations......Page 36
Intermittent Mandatory Ventilation Mode......Page 37
Alternative Closed Loop Modes of Ventilation......Page 39
Clinical Considerations......Page 40
Mechanical Considerations......Page 41
Monitoring and Alarms......Page 42
Patient Dysphoria......Page 43
Physiology, Adverse Effects, and Management......Page 44
Clinical Pearl......Page 46
Bibliography......Page 48
Practical Application of NIV......Page 49
Ventilator Modes and Settings......Page 50
Monitoring......Page 51
Indications......Page 52
Complications......Page 53
Potential Indications......Page 54
Bibliography......Page 57
When to Stop Mechanical Ventilation: The “First Fix What’s Broken” Approach......Page 58
Categories of Problems to Consider and Fix......Page 59
Loss of Upper Airway Protection......Page 60
Decreased Mental Status......Page 61
Changes in Chest Bellows Function......Page 62
Upper Airway Injuries......Page 63
Performing a Tracheostomy to Facilitate Weaning......Page 64
Problems from Nonrespiratory Organ Systems......Page 65
When to Stop Assisted Ventilation: Testing for Physiologic Capacities......Page 66
Test Characteristics......Page 67
Weaning Trials......Page 68
Importance of Protocols in Weaning......Page 69
Blood Gases in Weaning and Extubation......Page 72
Bibliography......Page 73
Distress and Agitation......Page 75
Assessment of the Patient with Distress or Agitation......Page 76
General Treatment Guidelines......Page 78
Pharmacologic Treatment......Page 79
Benzodiazepines......Page 81
Propofol......Page 82
Drug De-escalation and Patient Mobilization......Page 83
Other Agents......Page 84
Bibliography......Page 86
Physiology of Neuromuscular Excitation......Page 88
Depolarizing Neuromuscular Blocking Drugs (D-NMBDs)......Page 89
Drug and Electrolyte Interactions......Page 90
Complications of Neuromuscular Blocking Drugs......Page 91
Bibliography......Page 93
Pressures, Volumes, Compliance, and Resistance......Page 95
Measurements within the Circuit......Page 96
Systemic Blood Pressure......Page 98
Cardiac Output......Page 99
An Integrated Approach......Page 101
Bibliography......Page 103
Stages of Shock......Page 104
Preshock......Page 105
Frank Shock......Page 106
Irreversible Shock......Page 107
Differential Diagnosis......Page 108
Early Diagnosis......Page 109
Impaired Left Ventricular Function......Page 110
Diagnosis......Page 111
Sympathetic Amines......Page 112
Intra-aortic Balloon Counterpulsation and Other Circulatory Support Devices......Page 113
Reperfusion Therapy with Thrombolytic Therapy......Page 114
Impaired Right Ventricular Function......Page 115
Disturbances of Cardiac Rhythm......Page 116
Acute Myocarditis and Cardiomyopathy......Page 117
Bibliography......Page 118
Pathophysiology of Decreased Preload......Page 119
Physiologic and Pathophysiologic Changes in Hypovolemic Shock......Page 120
Clinical Manifestations......Page 123
Clinical Management......Page 124
Bibliography......Page 127
Pathophysiology......Page 128
Recognition......Page 130
Antimicrobial Therapy......Page 131
Fluid and Protocol-Directed Resuscitation......Page 132
Vasoactive Therapy......Page 133
Anti-inflammatory Therapy......Page 134
Refractory Shock......Page 135
Bibliography......Page 137
Extended Bibliography......Page 138
Methodology......Page 140
Sites......Page 141
Insertion Methods......Page 143
Indications......Page 145
Sites......Page 147
Insertion Methods......Page 148
Complications......Page 149
Sites......Page 151
Hemodynamic Measurements......Page 152
Complications......Page 153
Bibliography......Page 155
Body Positioning......Page 157
Wounds......Page 159
Special Care Beds......Page 160
Non-invasive Monitoring......Page 161
Urinary Catheters......Page 162
Endotracheal Tubes......Page 163
Glucose Control......Page 164
Phlebotomy and Erythropoietin......Page 165
Bibliography......Page 167
A Primer on Data Collection......Page 169
Monitoring of Overnight Events and Patient Assessment......Page 170
Laboratory Data......Page 172
Other Studies......Page 173
Falling Urine Output and Rising Creatinine......Page 174
Fever/Hypothermia and Leukocytosis......Page 179
Respiratory Tract Infections......Page 180
Abdominal Infections......Page 181
Postoperative Infections......Page 182
Diagnostic Algorithm......Page 183
Management......Page 184
Bibliography......Page 186
Infection Control Policies......Page 187
Clinical Definitions and Surveillance Definitions......Page 188
Incidence Rates and Pathogens......Page 189
Prevention......Page 190
Definitions......Page 192
Rates and Risk Factors......Page 193
Diagnosis......Page 194
Prevention......Page 195
Epidemiology, Pathogenesis, and Prevention......Page 197
Diagnosis......Page 198
Treatment Guidelines for Candida Species......Page 199
EPIDEMIOLOGY, PATHOGENESIS, AND PREVENTION......Page 200
Bibliography......Page 203
Body Weight......Page 205
Protein Goal Delineation......Page 206
Selecting the Route of Administration......Page 209
Enteral Access......Page 210
Delivery and Administration of Enteral Nutrition......Page 211
Indications and Specifications......Page 212
Central Venous Access......Page 213
Clinical Pearls and Pitfalls......Page 214
Bibliography......Page 216
Renal Dysfunction......Page 218
Obesity......Page 219
Transdermal Drug Delivery......Page 220
Aminoglycosides......Page 221
Vancomycin......Page 222
Phenytoin......Page 223
Digoxin......Page 224
Unfractionated Heparin......Page 225
Direct Thrombin Inhibitors......Page 226
Bibliography......Page 228
Fever and Leukocytosis......Page 229
Antibiotic Stewardship in the ICU......Page 230
Health Care–Associated Pneumonias......Page 231
Urinary Tract Infections......Page 240
Unexplained Fever, Leukocytosis, and Sepsis......Page 241
Bibliography......Page 243
Red Blood Cell Transfusion......Page 244
General ICU Patients......Page 245
Acute Coronary Syndrome......Page 246
Neurologic Injuries......Page 247
Red Blood Cell Transfusion......Page 248
Cryoprecipitate Transfusion......Page 250
Platelet Transfusion......Page 251
Massive Exsanguination and Transfusion......Page 252
Adverse Events Associated with Recombinant Factor VIIa......Page 253
Sequelae of Large Volume Transfusion......Page 254
Costs of Transfusion......Page 255
Bibliography......Page 256
When to Start Renal Replacement Therapy......Page 257
Intermittent Hemodialysis......Page 258
Isolated Ultrafiltration......Page 259
Continuous Venovenous Hemodialysis (CVVHD)......Page 260
Continuous Venovenous Hemodiafiltration......Page 262
Patient Survival and Recovery of Kidney Function......Page 263
Other Factors That May Influence Modality Choice......Page 264
Summary and Recommendations Regarding Choice of Modality......Page 265
CRRT......Page 266
Bibliography......Page 267
Starting Rehabilitation in the Intensive Care Unit......Page 268
Deconditioning......Page 269
Cognitive Deficits......Page 270
Agitation......Page 274
Contractures and Spasticity......Page 276
Planning for Rehabilitation after Leaving the Intensive Care Unit......Page 278
Post-Acute Care Continuum......Page 279
Bibliography......Page 283
The Swallowing Mechanism......Page 285
Clinical Assessment for Swallowing Dysfunction......Page 286
Videofluoroscopy......Page 288
Management of Swallowing Dysfunction......Page 289
General Approaches......Page 290
Upper Esophageal Sphincterotomy......Page 291
Indications and Insertion......Page 292
Components and Types of Tracheostomy Tubes......Page 293
Conclusion......Page 295
Bibliography......Page 296
Bacterial Pneumonias......Page 298
Diagnostic Considerations......Page 300
Mycobacterial Infections......Page 301
Cryptococcal Meningitis......Page 302
Other Causes of Focal Neurologic Disease......Page 303
Volume-Depletion Causes......Page 304
Renal Disorders......Page 305
Immune Reconstitution Inflammatory Syndrome......Page 306
Bibliography......Page 308
Neutropenia......Page 310
Thrombocytopenia......Page 311
Diagnostic Evaluation......Page 312
Febrile Neutropenia......Page 313
Neutropenia without Fever......Page 315
Thrombocytopenia......Page 316
Bibliography......Page 318
Prevalence......Page 320
Factors Associated with Prolonged Mechanical Ventilation......Page 321
Factors That Increase Work of Breathing (WOB)......Page 322
Psychological Factors......Page 324
COPD......Page 325
Chest Wall Disorders......Page 326
Long-Term Mechanical Ventilation......Page 327
Postcardiac Surgery Patients......Page 328
Options for the Persistently Ventilator-Dependent Patient......Page 329
Bibliography......Page 331
Cardiovascular Complications......Page 332
Infectious Complications......Page 334
Nutritional Complications......Page 335
Diagnostic Considerations......Page 336
Infectious Problems......Page 337
Nutritional Problems......Page 338
Clinical Pearls and Pitfalls......Page 340
Bibliography......Page 341
Ascites......Page 342
Spontaneous Bacterial Peritonitis (SBP)......Page 344
Variceal Hemorrhage......Page 345
Hepatic Encephalopathy......Page 346
Hepatorenal Syndrome (HRS)......Page 347
Conclusion......Page 349
Bibliography......Page 350
Hemodynamic Changes......Page 352
Respiratory Changes......Page 353
Epinephrine (Category C)......Page 354
Sodium Nitroprusside (Category C)......Page 355
Sedatives, Opioids, and Neuromuscular Blocking Agents......Page 356
Imaging Studies in Pregnancy......Page 357
Fetal Monitoring......Page 358
Bibliography......Page 361
Respiratory Effects of Obesity......Page 362
Other Organ System Manifestations......Page 364
Breathing......Page 365
Venous Thromboembolic Disease......Page 366
Pharmacokinetics......Page 367
Obesity and Outcomes from Critical Illness......Page 368
Bibliography......Page 370
Local Anesthetics......Page 371
Hypnotic Agents, Sedatives, and Neuromuscular Blockers......Page 374
Tools for Mask Ventilation......Page 375
Rescue Airway Devices......Page 376
Endotracheal Tubes......Page 378
Surgical Cricothyrotomy......Page 379
Complications of Surgical Airways......Page 381
Approach to the Malfunctioning Airway......Page 382
Tube Exchange......Page 384
Bibliography......Page 385
Neurophysiology and Physiology of Alcohol Withdrawal......Page 386
Timing of Withdrawal Symptoms......Page 387
Indications for Transfer to the ICU......Page 388
Benzodiazepine Prophylaxis......Page 392
Benzodiazepine Selection......Page 393
Adjuvant Agents......Page 394
Resistant Alcohol Withdrawal (RAW) Treatment......Page 395
Protocolized Management of AWS in the ICU......Page 396
Bibliography......Page 399
Evaluations of Patients with a History of Antibiotic Allergy......Page 400
Skin Testing for Beta-Lactam Antibiotics......Page 402
Indications for Skin Testing......Page 403
Evaluation of Allergies to Cephalosporins and Other Non–Beta-Lactam Antibiotics......Page 404
Management of Patients with Positive Skin Test Results to Penicillin......Page 407
Bibliography......Page 411
Approach to the Patient Presenting with a Bradyarrhythmia......Page 413
Sinus Node Dysfunction......Page 415
First-Degree Atrioventricular Block......Page 416
Second-Degree Atrioventricular Block......Page 417
Third-Degree Heart Block......Page 418
After Cardiac Surgery......Page 419
Obstructive Sleep Apnea......Page 421
Digoxin Toxicity......Page 422
Electrolyte Disturbances......Page 423
Heart Transplant......Page 424
Acute Management......Page 425
Chronic Management......Page 426
Pacemaker Troubleshooting......Page 427
Summary......Page 428
Bibliography......Page 429
Diagnostic Tools......Page 430
The “When in Doubt, Knock It Out” Rule......Page 433
Atrial Fibrillation and Atrial Flutter......Page 434
AV Reentrant Tachycardia over a Bypass Tract......Page 438
Other Atrial Tachycardias......Page 439
Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome......Page 440
Wide Complex Tachycardias......Page 441
Monomorphic Ventricular Tachycardia......Page 443
Polymorphic VT with Normal QT Duration......Page 444
Ventricular Tachycardia in the Absence of Structural Heart Disease......Page 445
Polymorphic VT with Prolonged QT Duration......Page 447
Digoxin Toxicity......Page 448
Postoperative Cardiac Patients......Page 449
Implantable Cardioverter-Defibrillators......Page 450
Bibliography......Page 451
Manifestations of Barotrauma......Page 452
Insertion Technique: Traditional Chest Tubes (20-40 Fr)......Page 454
Drainage Systems......Page 455
Chest Tube Management and Removal......Page 457
Bibliography......Page 461
Definition......Page 462
Causes of Mental Status Change......Page 463
Infection......Page 464
Toxins AND Metabolic and Endocrine Disorders......Page 466
Miscellaneous Causes......Page 467
Diagnosis and Initial Management......Page 470
Prognosis......Page 471
Bibliography......Page 472
Diagnosis......Page 473
Nonpharmacologic and Pharmacologic Treatment Interventions......Page 474
Conclusion......Page 481
Bibliography......Page 483
Secretory Diarrhea......Page 485
Antibiotic-Associated Diarrhea......Page 486
Intestinal Ischemia......Page 487
Drug-Related Diarrhea......Page 488
Diagnostic Evaluation......Page 489
Management and Treatment......Page 492
Clinical Pearls and Pitfalls......Page 493
Bibliography......Page 494
Hyperkalemia......Page 495
Clinical Manifestations......Page 496
2......Page 497
Clinical Manifestations......Page 499
Treatment......Page 500
Calcium Disorders......Page 501
Clinical Manifestations......Page 502
Hypocalcemia......Page 503
Treatment......Page 504
Clinical Manifestations......Page 505
Clinical Manifestations......Page 506
Phosphate Disorders......Page 508
Clinical Manifestations......Page 509
Hyperphosphatemia......Page 510
Clinical Manifestations......Page 511
Treatment......Page 512
Bibliography......Page 514
Causes of Ileus in the Intensive Care Unit......Page 516
Diagnostic Evaluation of the ICU Patient with Ileus......Page 518
Management and Discussion of Therapies......Page 519
Summary......Page 520
Bibliography......Page 521
Physiology......Page 522
Pathophysiology and Differential Diagnosis......Page 524
Cerebral Edema......Page 525
Herniation Syndromes......Page 526
Diagnosis......Page 527
Therapy......Page 528
Bibliography......Page 530
Staging......Page 532
Repositioning......Page 534
Moisture Management......Page 535
Wound Bed Preparation......Page 536
Pain......Page 538
Bibliography......Page 539
Contact Dermatitis......Page 540
Herpes Zoster......Page 543
Morbilliform Drug Rash......Page 544
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)......Page 545
Erythema Multiforme/Stevens-Johnson Syndrome......Page 546
Vasculitis......Page 547
Purpura Fulminans......Page 548
Necrotizing Fasciitis......Page 549
Bibliography......Page 550
Normal Sleep......Page 551
Ambient Noise......Page 552
Procedures and Patient Interactions......Page 553
Immune Function......Page 554
Ventilation and Respiratory Function......Page 555
Nonbenzodiazepine Hypnotics......Page 556
Conclusions......Page 557
Bibliography......Page 558
45 - Thrombocytopenia......Page 559
Thrombotic Thrombocytopenic Purpura......Page 560
Disseminated Intravascular Coagulation......Page 561
Disorders of Increased Platelet Destruction by Immune Mechanisms......Page 562
Heparin-Induced Thrombotic Thrombocytopenia (HITT)......Page 563
Disorders of Decreased Platelet Production......Page 564
Platelet Transfusion Therapy......Page 565
Clinical Pearls......Page 566
Bibliography......Page 568
Acute Hemolytic Transfusion Reactions (AHTR)......Page 569
Allergic and Anaphylactic Reactions......Page 570
Differential Diagnosis......Page 571
Diagnostic Evaluation......Page 572
Management and Discussion of Therapies......Page 573
Clinical Pearls and Pitfalls......Page 575
Bibliography......Page 576
Types of Ventilator Alarms......Page 577
High and Low Airway Pressure Alarms......Page 580
High and Low Respiratory Rate Alarms......Page 581
Low Exhaled Volume Alarm......Page 582
High Inspired and Exhaled Tidal Volume Alarms......Page 583
Built-in Ventilatory Safety Devices......Page 584
Responding to Ventilator Alarms......Page 585
Bibliography......Page 586
48 - Weakness Developing in the Intensive Care Unit Patient......Page 587
Critical Illness Polyneuropathy......Page 589
Critical Illness Myopathy......Page 590
Treatment and Prognosis of CIP and CIM......Page 591
Bibliography......Page 592
49 - Advanced Cardiac Life Support (ACLS) and Therapeutic Hypothermia......Page 593
Monitoring the Quality of CPR......Page 594
Defibrillation......Page 595
CPR Interactions with Defibrillation......Page 596
Epinephrine......Page 597
Amiodarone......Page 598
Patient Selection for Hypothermia Treatment......Page 599
Hypothermia: Adverse Effects......Page 600
Practical Issues of Therapeutic Hypothermia......Page 601
Resuscitation Team Leadership/Human Factors......Page 602
Bibliography......Page 604
Pathophysiology of Myocardial Ischemia and Acute Coronary Syndromes......Page 606
Symptoms......Page 607
Repolarization Abnormalities......Page 609
Arrhythmias (see Chapters 33 and 34 for more details)......Page 610
Chest Radiography......Page 611
THROMBOLYSIS IN MYOCARDIAL INFARCTION (TIMI) Risk Score......Page 612
Echocardiography......Page 613
Oxygen......Page 614
Beta-Blockers......Page 615
Aspirin......Page 616
Unfractionated Heparin......Page 617
Reperfusion Therapy......Page 618
Cardiogenic Shock......Page 619
Conduction Blocks......Page 620
Ventricular Septal Defect and Cardiac Rupture......Page 621
Stress-Induced Cardiomyopathy (Takotsubo Cardiomyopathy)......Page 622
Considerations for the Patient Undergoing Noncardiac Surgery......Page 623
Bibliography......Page 624
Complications......Page 625
Treatment......Page 627
Diagnosis......Page 629
Medical Management (Box 51.4)......Page 631
End-Organ Evaluation......Page 633
Pain Management......Page 634
Bibliography......Page 635
Prognosis......Page 636
Cardiac Output and Mean Arterial Pressure......Page 637
Clinical Presentation and Initial Assessment......Page 639
Laboratory and Non-Invasive Testing......Page 643
De Novo Acute Heart Failure (or an Abrupt Decline in Stable Chronic Heart Failure)......Page 644
Non-Invasive Ventilation......Page 645
Diuretic Therapy......Page 646
Ultrafiltration......Page 647
Vasodilators......Page 648
Nitroglycerin......Page 649
Inotropic Therapy......Page 650
Dobutamine......Page 651
Levosimendan......Page 652
Role of Invasive Hemodynamic Monitoring......Page 653
Phases II and III: In-Hospital and Predischarge Phases......Page 654
Bibliography......Page 655
Pathophysiology and Clinical Characteristics......Page 657
Autoregulation......Page 658
Volume Depletion......Page 659
History and Physical Examination......Page 660
Neurologic Presentations......Page 661
Cardiovascular Presentations......Page 662
Hydralazine......Page 663
Clevidipine......Page 664
Thiocyanate Toxicity......Page 665
Initial Therapy......Page 666
Bibliography......Page 668
Function of the Pericardium......Page 669
Diagnosis......Page 670
Physical Examination......Page 671
Chest Radiography......Page 672
Pulmonary Artery (Swan-Ganz) Catheterization......Page 674
Differential Diagnosis of Tamponade......Page 675
Percutaneous Approach (Pericardiocentesis)......Page 676
Conclusion......Page 677
Bibliography......Page 678
Clinical Manifestations......Page 679
Management......Page 680
Hyperthermia......Page 682
Pathophysiology......Page 683
Clinical Pearls and Pitfalls......Page 685
Bibliography......Page 686
Toxin-Mediated Lung Injury......Page 687
Carbon Monoxide......Page 688
Clinical Manifestations......Page 689
Delayed Clinical Findings......Page 690
Initial Evaluation......Page 691
Carbon Monoxide Poisoning......Page 692
Hydrogen Cyanide Poisoning......Page 693
Outcomes......Page 694
Bibliography......Page 695
Direct Drug Effects......Page 696
Therapeutic Approach......Page 697
Acetaminophen......Page 698
Alcohols......Page 700
Cocaine......Page 701
Digoxin......Page 702
Cyclic Antidepressants......Page 703
Salicylates......Page 704
Serotonergic Agents......Page 705
Bibliography......Page 707
Clinical Presentation......Page 708
Differential Diagnosis......Page 709
Prognosis......Page 711
Management......Page 712
Pearls......Page 715
Bibliography......Page 716
Etiology of Acute Liver Failure......Page 717
Diagnosis and Initial Evaluation......Page 718
Predicting Prognosis in Acute Liver Failure......Page 719
Hypoglycemia......Page 720
Hypotension......Page 721
Cerebral Edema and Intracranial Hypertension......Page 722
Conclusion......Page 723
Bibliography......Page 724
History and Causes......Page 725
Management......Page 727
Radionuclide Imaging......Page 728
Surgical Interventions......Page 729
Clostridium difficile Colitis......Page 730
Ischemic Colitis......Page 731
Bibliography......Page 733
Focused History......Page 734
Focused Physical Examination and Laboratory Evaluation......Page 735
General Care......Page 736
Endoscopic and Angiographic Interventions......Page 737
Gastric and Duodenal Peptic Ulcers......Page 738
Stress Ulcer and Gastritis......Page 739
Esophageal and Gastric Varices......Page 740
Other Causes of Upper Gastrointestinal Bleeding......Page 742
Bibliography......Page 743
Red Blood Cell Membrane Disorders......Page 745
Red Blood Cell Enzyme Disorders......Page 746
Globin Chain Production and Structure Disorders......Page 747
Warm Antibody Autoimmune Hemolytic Anemia......Page 748
Drug-Induced Hemolytic Anemia......Page 750
Microangiopathic Hemolytic Anemia......Page 751
Other Hemolytic Conditions......Page 752
Bibliography......Page 753
Mechanism and Diagnosis......Page 754
Treatment......Page 756
Mechanism and Diagnosis......Page 757
Associated Disorders......Page 759
Summary......Page 760
Bibliography......Page 761
Bacterial Central Nervous System Infections......Page 762
Clinical Presentation and Complications......Page 763
General Diagnostic Approach......Page 764
Approach to the Patient with a Presumed Nonbacterial Central Nervous System Infection......Page 767
Approach to the Patient with a Presumed Bacterial Central Nervous System Process......Page 768
Adjunctive Therapy......Page 770
Bibliography......Page 771
Atypical versus Typical Pneumonia......Page 772
Gram Stain and Culture of Sputum......Page 773
Other Diagnostic Tests......Page 775
Antibiotic Selection......Page 776
Nonresolution or Recurrence of Community-Acquired Pneumonia......Page 778
Clinical Pearls......Page 779
Bibliography......Page 780
Layers of Soft Tissue......Page 782
Pathogenesis......Page 783
Skin Infections......Page 784
Fascial Cleft and Deep Fascial Infections......Page 785
Approach to Diagnosis......Page 786
Treatment......Page 787
Bibliography......Page 790
Need for Ventilatory Support......Page 791
Differential Diagnosis......Page 792
Clinical Presentation and Symptomatic Management......Page 794
Diagnostic Approach to Suspected GBS......Page 795
Treatment of GBS......Page 796
Myasthenic Crisis......Page 797
Therapy......Page 798
Bibliography......Page 800
Medical History......Page 801
Coma......Page 802
Confirmatory Testing in Brain Death......Page 803
Loss of Homeostatic Mechanisms......Page 805
Endocrine and Fluid-Electrolyte Changes......Page 806
Involving the Regional Organ Procurement Organization......Page 807
Bibliography......Page 808
States of Consciousness after Cardiac Arrest......Page 809
Determination of Neurologic Prognosis after Cardiac Arrest......Page 810
Brain Stem Function......Page 811
Breathing Patterns......Page 812
The Levy Criteria......Page 814
Prognostication after Therapeutic Hypothermia......Page 817
Caveats for Prognostication......Page 820
Bibliography......Page 822
Epidemiology......Page 823
Pathophysiology......Page 826
Management and Therapy......Page 827
Prognosis and Outcomes......Page 830
Bibliography......Page 833
Stroke Mimics......Page 834
Initial Diagnosis and Management......Page 835
Acute Reperfusion Strategies......Page 838
Supportive Therapy......Page 839
Management of Cerebral Edema......Page 840
Predictors of Hematoma Expansion......Page 841
Correction of Coagulation Defects......Page 843
Management of Seizures......Page 845
Management of Subarachnoid Hemorrhage......Page 846
Bibliography......Page 848
Laboratory Evaluation......Page 850
Management......Page 851
Physical Examination and Laboratory Findings......Page 852
Laboratory Abnormalities......Page 853
Management......Page 854
Clinical Manifestations......Page 855
Clinical Presentation......Page 856
Management......Page 857
Bibliography......Page 859
Pathogenesis and Precipitating Causes......Page 861
Differential Diagnosis......Page 863
Hypoxemia......Page 864
Increased Minute Ventilation......Page 865
Clinical Management: Specific Therapy......Page 866
Mechanism of Action......Page 867
Pressure Control and Inverse Ratio Ventilation......Page 869
Prone Positioning......Page 872
Extracorporeal Methods of Gas Exchange......Page 873
Pressure-Control-Inverse Ratio Ventilation (PC-IRV)......Page 874
Hemodynamic, Fluid, and Diuretic Therapy......Page 876
Long-Term Sequelae in Survivors......Page 877
Bibliography......Page 878
Nomenclature and Description......Page 880
APRV Concept, Indications, and Potential Advantages......Page 881
Disadvantages and Potential Limitations of APRV Use......Page 882
APRV and Human Clinical Studies......Page 884
Setting Pressure Low (PL)......Page 885
Setting Time Low (TL)......Page 887
Adjusting APRV Parameters and Arterial Blood Gas Management......Page 888
Liberation from APRV......Page 890
Bibliography......Page 892
Clinical Signs and Symptoms......Page 893
Overview......Page 894
Bronchodilators......Page 895
Other Pharmacologic Interventions......Page 896
Corticosteroids......Page 897
Dynamic Hyperinflation......Page 898
Extraordinary Therapies......Page 900
Bibliography......Page 901
Etiology and Pathophysiology......Page 902
Clinical Evaluation......Page 903
Bronchodilators......Page 904
Oxygen......Page 906
Mechanical Ventilatory Support......Page 907
Prevention......Page 908
Bibliography......Page 910
Pathophysiology......Page 912
Clinical Presentation......Page 913
Clinical Prediction Rule: Wells Criteria......Page 915
Echocardiography......Page 916
Chest Radiograph and Chest Computed Tomography......Page 917
Risk Assessment......Page 919
Supportive Care: Oxygen, Fluid, and Vasoactive Therapy......Page 920
Heparin Alternatives......Page 922
Risk of Bleeding and Treatment......Page 923
Thrombolytic Therapy......Page 924
VENA CAVAL INTERRUPTION......Page 925
Duration of Therapy......Page 926
Bibliography......Page 927
Radiology......Page 929
Surgical Lung Biopsy......Page 930
Differential Diagnosis of DAH......Page 931
Treatment of Diffuse Alveolar Hemorrhage......Page 932
Bone Marrow Transplantation (BMT)......Page 933
Drug-Associated DAH......Page 934
Bibliography......Page 936
Infections......Page 938
Trauma......Page 940
Radiographic Studies......Page 941
Acute Management......Page 942
Summary......Page 943
Bibliography......Page 944
Obstructive Sleep Apneas (OSAs)......Page 945
Central Sleep Apneas (CSAs)......Page 948
Obesity Hypoventilation Syndrome (OHS)......Page 949
Diagnosis......Page 951
TherapY......Page 952
Bibliography......Page 955
Prerenal Acute Kidney Injury (AKI)......Page 957
Postrenal Acute Kidney Injury (AKI)......Page 959
Acute Tubular Necrosis (ATN)......Page 960
Intratubular Obstruction......Page 962
Prerenal Acute Kidney Injury (AKI)......Page 963
Supportive Measures......Page 964
Acute Glomerulonephritis......Page 965
Etiology and Clinical and Laboratory Features......Page 966
Clinical Pearls and Pitfalls......Page 967
Bibliography......Page 969
Pathogenesis......Page 970
Evaluation......Page 972
Volume Resuscitation......Page 973
Inhibition of Ketogenesis......Page 975
Hyperglycemic Hyperosmolar State......Page 976
Evaluation......Page 977
Hypertonicity......Page 978
Diagnosis......Page 979
Treatment......Page 980
Bibliography......Page 987
Acid-Base Physiology......Page 988
Respiratory Compensation for Metabolic Disorders......Page 989
The Anion Gap and Elevated Gap Acidoses......Page 990
Normal Anion Gap Metabolic Acidoses......Page 992
Metabolic Alkaloses......Page 993
Chloride-Resistant Metabolic Alkaloses......Page 994
Diagnostic Evaluation......Page 995
Metabolic Acidosis......Page 997
Metabolic Alkalosis......Page 998
Bibliography......Page 999
Principles of Body Water......Page 1000
1. Does the Patient Have Hypotonic Hyponatremia......Page 1003
3. Why Is Renal Diluting Ability Impaired (as Evidenced by an Inappropriately Elevated Urine Osmolality)......Page 1005
4. If EABV Is Adequate, What Is Causing the Nonosmotic and Nonhemodynamic Stimulation of ADH Release......Page 1007
Asymptomatic Hyponatremia......Page 1008
Symptomatic Hyponatremia......Page 1009
Definition, Presentation, and Clinical Manifestations......Page 1010
Euvolemic Hypernatremia......Page 1011
Treatment of Hypernatremia......Page 1012
Conclusion......Page 1015
Bibliography......Page 1016
Epidemiology and Etiology......Page 1018
Etiology......Page 1019
Diagnosis......Page 1020
Treatment......Page 1022
Clinical Features......Page 1023
Preexisting Adrenal Insufficiency......Page 1024
Clinical Features......Page 1025
Diagnosis......Page 1026
Treatment......Page 1027
Bibliography......Page 1028
Hypermetabolic Phase......Page 1029
Postoperative Issues......Page 1031
Preoperative Issues: Preparing the High-Risk Patient for Surgery......Page 1032
Optimizing Cardiac Performance......Page 1034
Pulmonary Dysfunction......Page 1037
Renal Dysfunction......Page 1038
Electrolyte Abnormalities (Chapter 40)......Page 1040
Conclusion......Page 1041
Bibliography......Page 1043
Undermedicating Postoperative Pain......Page 1044
Rationale for Using Preemptive Analgesia......Page 1045
Dexmedetomidine......Page 1046
Local Anesthetics in Neuraxial Analgesia......Page 1049
Nausea and Vomiting......Page 1051
Somnolence......Page 1052
Conclusion......Page 1053
Bibliography......Page 1055
Effects of Cardiopulmonary Bypass......Page 1056
Invasive Hemodynamic Monitoring......Page 1058
Wires and Drains......Page 1059
Respiratory Problems......Page 1060
Neurologic Problems......Page 1061
Gastrointestinal Problems......Page 1062
Conclusion......Page 1063
Bibliography......Page 1064
Hematomas......Page 1065
Aneurysms and Arteriovenous Malformations......Page 1066
Subarachnoid Hemorrhage......Page 1067
Clinical Manifestations and Diagnosis......Page 1068
General PostCraniotomy Care......Page 1069
Bibliography......Page 1071
Pancreatic Resections......Page 1073
Esophagogastrectomy......Page 1075
Fluid Management......Page 1076
Nasogastric Tubes......Page 1078
Nutrition......Page 1080
Pulmonary Complications......Page 1081
Urinary Tract Infection......Page 1083
Ileus......Page 1085
Intra-abdominal Sepsis......Page 1086
Bibliography......Page 1088
Complications of Flap Surgery......Page 1089
Capillary Refill......Page 1091
Pulse......Page 1092
Flow Monitoring......Page 1093
Aspirin......Page 1094
Experimental Monitoring Techniques......Page 1095
Other Interventions......Page 1096
Surgical Maneuvers......Page 1097
Bibliography......Page 1098
Respiratory Dysfunction......Page 1099
?Procedure-Specific Care: Abdominal Aortic Reconstruction......Page 1101
Procedure-Specific Care: Carotid Artery Surgery......Page 1105
Conclusion......Page 1107
References......Page 1109
Preoperative Evaluation......Page 1111
Obesity Hypoventilation Syndrome (see Chapter 80)......Page 1112
Hypercoagulability......Page 1113
Airway and Ventilation......Page 1114
Hemodynamics......Page 1115
Fluids/Electrolytes/Nutrition......Page 1116
Conclusion......Page 1117
Bibliography......Page 1118
Intraoperative......Page 1119
Initiating Enteral Feeding......Page 1121
Management of Secretions......Page 1122
Antibiotics......Page 1123
Management of Chest Tubes......Page 1124
Specific Issues Surrounding the Care of Esophagectomy Patients......Page 1126
Conclusion......Page 1128
Bibliography......Page 1129
Initial Management of the Trauma Patient......Page 1130
Evaluation of the Trauma Patient upon Arrival to the Intensive Care Unit......Page 1134
Secondary Complications......Page 1135
Conclusion......Page 1136
Bibliography......Page 1138
Approach to the Patient with Multiple Orthopedic Injuries......Page 1140
Open Fractures......Page 1141
Open Fracture Care......Page 1143
Occult Blood Loss......Page 1145
Fat Embolism Syndrome......Page 1148
Pelvic Ring Injuries......Page 1149
Fracture Blisters......Page 1150
Traumatic Amputations......Page 1151
Bibliography......Page 1154
Initial Assessment......Page 1155
Computed Tomography......Page 1157
Computed Tomography (CT)......Page 1158
Diagnostic Evaluation of the Patient with Penetrating Abdominal Trauma......Page 1159
Blunt Abdominal Trauma......Page 1160
Diagnostic Peritoneal Lavage......Page 1161
Damage Control......Page 1162
Infection......Page 1163
Summary......Page 1164
Bibliography......Page 1165
Diagnosis......Page 1166
Operative Interventions......Page 1167
Categories of Nerve Injuries......Page 1168
Diagnosis......Page 1170
Diagnosis......Page 1171
Diagnosis and Treatment......Page 1172
Postoperative Care......Page 1173
Bibliography......Page 1175
Skull Injury......Page 1176
Diffuse Brain Injury......Page 1178
Meningeal Injury......Page 1179
Physical Examination......Page 1180
Computed Tomography......Page 1182
Primary and Secondary Injury Prevention......Page 1184
Steroid Use in TBI......Page 1185
Outcomes......Page 1186
Cerebral Blood Flow and Oxygenation Monitoring......Page 1187
Bibliography......Page 1189
Chest Wall Injuries......Page 1190
Aortic Disruption......Page 1191
Emergency Department Thoracotomy......Page 1192
Air Embolism......Page 1193
Bronchopleural Fistula......Page 1194
Bibliography......Page 1195
Pathophysiology and Biomechanics of Spinal Injury......Page 1196
Sensory Examination......Page 1197
Reflex Examination......Page 1199
Stabilization of the Injured Spine......Page 1200
Decompression......Page 1202
Venous Thromboembolism Prophylaxis......Page 1204
Bibliography......Page 1207
Medical Decision Making for the Patient Lacking Capacity......Page 1208
Overview......Page 1210
Frequent and Timely Communication......Page 1211
Overview......Page 1212
A Recommended Approach for Facilitating the Meeting to Discuss a Change in the Goals of Care......Page 1213
Conflict Resolution: Clinical Ethics Consultation and Bioethics Mediation......Page 1215
The Health care Providers and Unresolved Conflict......Page 1216
An Approach to Withholding or Withdrawing Life-Sustaining Interventions......Page 1217
Emotional and Spiritual Support of the Patient and Family......Page 1219
Bibliography......Page 1220
What Are the Benefits of Collaborative Practice in the ICU......Page 1222
Simulation in the Promotion of Teamwork and Collaborative Practice......Page 1225
Conclusions......Page 1227
Bibliography......Page 1228
104 - Family-Centered Care and Communication with Families of Intensive Care Unit Patients......Page 1229
A Recommended Approach for Conducting Family-Centered Rounds......Page 1230
During Rounds......Page 1231
Responding to the Disruptive Family......Page 1232
Incorporating Teaching into Rounds in the Presence of Family Members......Page 1233
Bibliography......Page 1235
Cultural Competency: Ongoing Self-Awareness......Page 1237
Use of Language Interpreters......Page 1238
Cultural Competency: Ongoing Acquisition of Knowledge of Cultural Norms and Health-Related Disparities......Page 1239
Incorporating Culture in End-of-Life Decision Making......Page 1240
Effectively Engaging Patients and Families Related to Their Spirituality and Religion......Page 1241
Bibliography......Page 1243
Characteristics of Normal Sleep......Page 1245
Sleep-Related Determinants of Performance......Page 1246
Effects on Residents......Page 1247
Additional Countermeasures for Housestaff......Page 1248
Conclusions......Page 1249
Bibliography......Page 1250
Key Patient Safety Concepts and Definitions......Page 1252
Errors in Complex Systems......Page 1253
Tools for Error Analysis in the ICU......Page 1255
Error Disclosure......Page 1256
Conclusion: Establishing a Culture of Safety in the ICU......Page 1257
Bibliography......Page 1258
Origins of Malpractice......Page 1259
Why Are Intensivists Sued......Page 1260
Electronic Medical Records (EMRs)......Page 1261
Electronic Medical Records and the Standard of Care......Page 1262
Clinical Pearls......Page 1263
Bibliography......Page 1264
Evolution of Long-Term Acute Care and the LTAC Hospital......Page 1265
Geographic Distribution of LTACs......Page 1266
Current Medicare Rules Governing Reimbursement for LTACs......Page 1267
Patient Populations in the Long-Term Acute-Care Environment......Page 1268
Clinical Outcomes......Page 1269
The Future of LTACs: Their Role in the Continuum of Care......Page 1270
Bibliography......Page 1272
Terms and Definitions......Page 1274
Building the Team......Page 1275
Obstacles to Implementation of Rapid Response Systems......Page 1277
Future Research......Page 1278
Conclusion......Page 1279
Bibliography......Page 1280
111 - Telemedicine Applied to the Intensive Care Unit......Page 1282
Comprehensive Tele-ICU Services......Page 1283
ICU Telemedicine in Community and Rural Hospitals......Page 1284
Bibliography......Page 1285
The Airway in Transporting the ICU Patient......Page 1286
Blood Pressure Management in Transporting the ICU Patient......Page 1287
Acute Respiratory Distress Syndrome......Page 1289
The Neonatal Patient......Page 1290
Bibliography......Page 1293
Appendix A - Oxygen-Hemoglobin Dissociation Curves......Page 1294
Appendix B - Tidal Volume Ratios (Vd/Vt)......Page 1296
Appendix C - Palliative Drug Therapy for Terminal Withdrawal of Mechanical Ventilation......Page 1298
Appendix D - Advanced Cardiac Life Support (ACLS) Algorithms
......Page 1306
Appendix E - Tables of Height, Predicted Body Weight (PBW), and Tidal Volumes of 4-to-8 mL/kg PBW for Females and Males......Page 1309