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Core Topics in Critical Care Medicine

Details

  • 91 b/w illus. 105 colour illus.
  • Page extent: 408 pages
  • Size: 246 x 189 mm
  • Weight: 1.2 kg

Library of Congress

  • Dewey number: 616.028
  • Dewey version: 22
  • LC Classification: RC86.7 .C667 2010
  • LC Subject headings:
    • Critical care medicine
    • Critical Care--methods

Library of Congress Record

Hardback

 (ISBN-13: 9780521897747)

Core Topics in Critical Care Medicine
Cambridge University Press
9780521897747 - Core Topics in Critical Care Medicine - Edited by Fang Gao Smith and Joyce Yeung
Index

Index

ABCDE approach to patient assessment 1

abdomen

CT scanning 54–5

abdominal X-ray 53

acid–base balance

bicarbonate buffer system 150

Boston approach to diagnosing disorders 151–2

buffering responses 150–1

compensatory responses 151–2

disorders in critical care patients 148

factors that affect [H+] homeostasis 149–50

haemoglobin as a blood buffer 151

hydrogen ion concentration and pH 148–9

normal controls 148

phosphate buffer system 150–1

physico-chemical (Stewart’s) theory 149–50

responses to acid–base changes 150–2

role of carbonate and phosphate salts in bone 151

standard base excess 150

strong ion gap 149–50

traditional theory 149–50

acid–base disturbances

definition of acidaemia and acidosis 152

definition of alkalaemia and alkalosis 152

metabolic acidosis 153–6

metabolic alkalosis 156–7

physiological effects 152–3

respiratory acidosis 157

respiratory alkalosis 157

underlying cause 152

acute asthma

mechanical ventilation strategy 224–5

acute coronary syndromes (ACS)

adjunctive therapy 191–2

biomarkers 189

classification 185

complications 192–3

creatine kinase (CK-MB) biomarker 189

definition of myocardial infarction (MI) 185

diagnosis 185–90

diagnostic criteria 185

ECG 186–9

imaging 190

laboratory tests 189, 190

management of non-ST-elevation ACS 191

management of ST-elevation ACS 190–1

pathophysiology of MI 185

patient history and examination 185

risk stratification 190

troponin biomarkers 189

acute epiglottitis in children 365

acute gastrointestinal bleeding

common presentations 257

complications associated with 257

haematemesis 257

haematochezia 257

lower GI bleeding 262–3

management of a large GI bleed 257–8

melaena 257

non-variceal upper GI bleeding 259–60

prevention of upper GI bleeding on ICU 262

upper GI bleeding 259–62

variceal bleeding 260–2

acute heart failure

aetiology 202

cardiogenic shock 202

clinical evaluation 204

clinical syndromes and classifications 202

coronary angiography 206

CT angiogram 206

definition 202

ECG 204

endomyocardial biopsy 206

imaging techniques 204–5

invasive monitoring 206

laboratory investigations 205–6

pathophysiology 202–3

presentation 202–3

prognosis 211

pulmonary oedema 202

acute heart failure treatment

analgesia 207

diuretics 209

future agents 211

haemodynamic support 207–8

heart transplantation 210

immediate resuscitation 207

intra-aortic balloon pump (IABP) 208–9

mechanical assist devices 208–9

natriuretic peptides 209

prognosis 211

respiratory support 207

treatment of underlying disease and co-morbidities 209–10

ultrafiltration 209

vasodilators 209

ventricular assist devices (VADs) 209

acute liver failure

acute-on-chronic liver disease 290

adrenal dysfunction 289

auxiliary or partial liver transplantation 289

causes 284–6

complications 286–9

general supportive care 286

hepatic encephalopathy (HE) 286–7

hepatitis infections 286

intracranial hypertension (ICH) 287–8

liver transplantation 289–90

living related lobe donation 289

management 284

paracetamol poisoning 284–6

presentation 284

prognostication 289–90

renal failure complication 288

acute lung injury (ALI) 236–8

mechanical ventilation strategy 222–4

acute pancreatitis.

See severe acute pancreatitis

acute renal failure

aetiological classification 292–5

definitions 292

diagnosis and assessment 295–6

intrinsic causes 294–5

management 296–8

outcome 298

physiological considerations 292

postrenal causes 295

prerenal causes 292–4

susceptibility of kidneys to failure 292

acute respiratory distress syndrome (ARDS) 236–8

mechanical ventilation strategy 222–4

prone positioning during ventilation 251

use of high-frequency oscillatory ventilation (HFOV) 252–3

use of recruitment manoeuvres 252

adaptive support ventilation (ASV) 243–4

adrenaline.

See epinephrine

advance decision (end of life care) 88–9

advance directives 19

advanced airway management

cricothyroidotomy 14–15

extubation/weaning protocols 9–12

intubation 6–9

mini tracheostomy 15

requirements of critically ill patients 6

tracheostomy 12–15

weaning.

See extubation/weaning protocols, respiratory weaning

Advanced Life Support™ courses 1

Advanced Trauma Life Support™ courses 1

airway assessment

predicting a difficult intubation 6

airway support.

See advanced airway management

AIS (Abbreviated Injury Scoring) 27

albumin 131

ALERT™ (Acute Life threatening Events – Recognition and Treatment) courses 3

alfentanil 74

Allen’s test 41

alpha-1 (α1) receptors 59

amikacin 127

aminoglycosides 127

amniotic fluid embolism 355–6

amphotericin B 129,

analgesia.

See pain control, sedation

antibiotic therapy

post-operative critical care 162, 167

antibiotics

bacteriocidal mode of action 125

bacteriostatic mode of action 125

methicillin-resistant Staphylococcus aureus (MRSA) 125

multi-resistant organisms 125–6

pharmacokinetics 125

post antibiotic effect (PAE) 125

prescribing in renal failure 125

principles of rational antibiotic testing 124

prophylaxis 126

vancomycin-resistant Enterococci (VRE) 125, 127

antibiotics used in the ICU 126–9

amikacin 127

aminoglycosides 127

antifungal drugs 128–9

beta-lactams 126–7

carbapenems 127

cephalosporins 126–7

ciprofloxacin 127–8

clarithromycin 128

erythromycin 128

gentamicin 127

glycopeptides 127

imipenem 127

levofloxacin 127–8

linezolid 128

macrolides 128

meropenem 127

metronidazole 128

nitroimidazoles 128

oxazolidinones 128

penicillins 126–7

quinolones 127–8

rifampicin 128

teicoplanin 127

vancomycin 127

antifungal drugs 128–9

APACHE (Acute Physiology and Chronic Health Evaluation) 27, 28,

versions 32

APACHE II score 30

use in severe acute pancreatitis 270–1

arterial blood gas sampling 1

arterial pulse contour analysis 46–7

arteriovenous CO2 removal (AVCO2R) 254

ASCOT scoring system 33

asplenia

infection risk 122

assessment

ABCDE approach 1

initial assessment of the critically ill patient 1

physiology monitoring systems 2–3

atracuronium 8

auditory evoked potentials 78

Awakening and Breathing Control (ABC) Trial 83

bacteraemia

definition 99

balloon tamponade 261

bedside charting 34–5

electronic chart systems 35

ICU chart 34

paper chart 34

requirements of an electronic chart 34–5

Bentham, Jeremy 85

benzodiazepines 81

benzylpenicillin 126

best interests

and consent 88

beta receptors 59

beta-1 (β1) receptors 59

beta-2 (β2) receptors 59

beta-lactams 126–7

bicarbonate buffer system 150

bispectral index (BIS) 78

bleeding and clotting

normal coagulation 177–8

normal haemostasis 177–8

bleeding disorders

acquired 180–3

congenital 179–80

disseminated intravascular coagulation (DIC) 181–2

drug induced 136

haemolytic uraemic syndrome (HUS) 182

haemophilia A 179–80

haemophilia B 179–80

heparin-induced thrombocytopenia (HIT) 183

major haemorrhage and massive transfusion 182–3

microangiopathic haemolytic anaemia 182

thrombocytopenia 180–1

thrombotic thrombocytopenia purpura (TTP) 182

von Willebrand disease 179–80

blood gas analysis 234

blood pressure monitoring.

See invasive blood pressure monitoring

blood sugar control

post-operative critical care 167

Bloomsbury scale 78

brain injury

mechanical ventilation strategy 225

See also traumatic brain injury

brainstem death 92–3

bronchiolitis

in children 365–6

bronchiolitis obliterans organizing pneumonia (BOOP) 120

burns 338–41

calcium levels 144–7

hypercalcaemia 146–7

hypocalcaemia 145–6

plasma calcium 144–5

cancer patients

neutropenia and infection risk 117–19

‘can’t intubate, can’t ventilate’ situation 58, 60

capacity

and consent 87–8

capnography 234

carbapenems 127

cardiac arrest

incidence 170

organ donation following brainstem death 173

outcomes 170

post resuscitation care 170–3

post resuscitation syndrome 170

prognostication 173

cardiac arrhythmias

anti-arrhythmia drugs 199

arrhythmogenic mechanisms 194–5

atrial fibrillation 194,

atrial flutter 194

automaticity 194

bradyarrhythmias 195–6, 200

classification 195–8

contributory arrhythmogenic factors 195

in the intensive care setting 194

management in the ICU 199–201

post-operative 167

re-entry 194

sinus node automaticity 194

tachyarrhythmias 196–8

tachyarrhythmias with adverse signs 200

tachyarrhythmias without adverse signs 200–1

triggered activity 194–5

ventricular tachyarrhythmia 194

cardiac output monitoring 44–8

arterial pulse contour analysis 46–7

clinical parameters 44

dye dilution technique 45

Fick’s principle 46

lithium dilution technique 45

methods of measuring cardiac output 44

pulse-induced contour cardiac output (PiCCO) 46–7

thermodilution technique 44–5,

transoesophageal Doppler 45–6

transoesophageal echocardiography 47

cardiac risk stratification 164–5

cardiogenic pulmonary oedema

use of non-invasive ventilation 246–7

cardiogenic shock 202

cardiorespiratory arrest in children 362–4

cardiovascular system

post-operative critical care 164–7

caspofungin 129,

catheters and tubes

X-ray assessment of positioning 51–2

CCRISP™ (Care of the Critically Ill Surgical Patient) courses 3

ceftazidime 126

cefuroxime 126

central venous catheters

X-ray assessment of positioning 52

central venous pressure monitoring 42–4

advantages of central venous catheterization 43

cannulation sites 43

catheter-over-guidewire cannulation technique 43–4

changes in central venous pressure 43

complications 44

insertion of central venous catheter in IJV 43–4

Seldinger’s cannulation technique 43–4

cephalosporins 126–7

cervical spine

CT scan 54

Chain of Survival 170

chest disease

CT scanning 54

chest drains

X-ray assessment of positioning 52

chest X-ray 50–3

Child–Pugh Score (liver failure) 27

chlorpromazine 83

chronic liver disease

acute on chronic liver disease 290

chronic obstructive pulmonary disease (COPD)

mechanical ventilation strategy 224

use of non-invasive ventilation 246

cilastatin 127

ciprofloxacin 127–8

clarithryomycin 128

clavulinic acid 127

clindamycin 128

clinical decision making

applications for scoring systems 29

potential drawbacks of scoring systems 29–30

use of scoring systems 29–30

clinical record keeping

electronic medical records 35

clinical scoring systems 29–30

assessment of sedation level 78

clonidine 79–80, 81–2

Clostridium difficile 124

coagulation

normal process and regulation 177–8

coagulation disorders.

See bleeding disorders

codeine 74

colloid fluids 131

colloid vs. crystalloid fluid 132

coma.

See unconscious patient

competency based training in intensive care medicine in Europe (CoBaTrICE) initiative 22

consciousness

definition of normal state 312

spectrum of abnormal levels 312

See also unconscious patient

consent 87–8

best interests 88

capacity 87–8

Mental Capacity Act 2005 87–8

necessity principle 87

organ donation 95–6

COPD.

See chronic obstructive pulmonary disease

coronary artery stent

post-operative management of patients with 165

creatine kinase (CK-MB)

ACS biomarker 189

cricoid pressure 7

cricothyroidotomy 14–15

Critical Care Network 21

critical care outreach (CCO) 3–4, 17

critical care team

indications for patient referral 4

routes of referral 4

critical care unit

cost of care 16

use of available resources 16

critical illness

definition 1


croup in children 365

crystalloid fluids 130–1

crystalloid vs. colloid fluid 132

CT pulmonary angiography (CTPA) 54

CT scanning 53–5

basic principles 49–50

CT abdomen 54–5

CT cervical spine 54

CT chest 54

CT head 54

iodinated intravenous contrast 53

cytopathic hypoxia 109

data storage and archiving 38

dead space

hypoxia caused by 235

decision support information

bedside level 37

information systems 37

organizational level 37

ward level 37

deep vein thrombosis (DVT)

obstetric emergencies 351–2

post-operative prophylaxis 167

deontology 85

dexmedetomidine 82

dextrose-containing solutions 130–1

diabetes insipidus 136

diamorphine 74

difficult airway situation 9

diffuse alveolar haemorrhage 119

diffusion impairment

hypoxia caused by 235–6

disseminated intravascular coagulation (DIC) 181–2

‘Do not resuscitate’ order 82

dobutamine 61

dopamine 61

dopaminergic (D1 and D2) receptors 59–60

drug-induced bleeding disorders 136

drug overdose.

See poisoning

DVT.

See deep vein thrombosis

dye dilution technique

cardiac output monitoring 45

early warning scoring systems 31

features 31

MEWS (modified early warning score) 31

eclampsia.

See pre-eclampsia and eclampsia

electrocardiogram (ECG)

acute coronary syndromes 186–9

acute heart failure 204

electroencephalogram (EEG)

assessment of level of sedation 78

unconscious patient 316

electrolytes.

See fluid and electrolyte disorders

electromagnetic flow measurement 153

electronic chart systems 35

electronic medical records 35

electronic prescribing (physician order entry) 35–7

encephalitis.

See viral encephalitis

end-of-life care 88–9

advance decision 88–9

Independent Mental Capacity Advocate (IMCA) 89

refusal of life-prolonging care 88–9

welfare attorney 89

witholding and withdrawing life-prolonging care 88

endotracheal intubation 9

X-ray assessment of positioning 51

engraftment syndrome 119

enteral feeding (EF) 67–9, 71

complications 71

types of feeds 68–9

See also nutritional support

enteral tubes

X-ray assessment of positioning 52

Entonox™ 75

epidural analgesia 75–6

epinephrine (adrenaline) 60–1

erythromycin 128

ethical decision making 86–7

ethical framework for critical care

ethical theories 85–6

practical approach to decision making 86–7

ethical obligations of doctors 85

ethical theories 85–6

deontology 85

principlism 85–6

utilitarianism 85

ethics

organ donation 95–6

etomidate 8, 81

examinations in intensive care medicine

European Diploma in Intensive Care (EDIC) 370–3

example multiple choice questions 374–6

example viva questions 376–7

Intercollegiate Diploma in Intensive Care Medicine (DICM) 369–70

multiple choice answers 377–8

useful websites 373

viva answers 378–9

extracorporeal carbon dioxide removal (ECCO2R) 254–5

extracorporeal lung assist (ECLA) 254

extracorporeal membrane oxygenation (ECMO) 253–4

extravascular lung water (EVLW) 47

extubation/weaning protocols 9–12

criteria for spontaneous breathing trials 11

extubation criteria 11–12

weaning assesment 11

weaning techniques 11

See also respiratory weaning

failed airway situation 9

fentanyl 74

Fick’s principle 46

fluconazole 129,

fluid and electrolyte disorders

albumin 131

calcium levels 144–7

colloid fluids 131

colloid vs. crystalloid fluid 132

crystalloid fluids 130–1

dextrose-containing solutions 130–1

gelatins 131

Hartmann’s solution 130

hetastarch solutions 131

magnesium levels 141–3

measurement of fluid balance 130

normal (isotonic) saline 130

phosphorus in the body 143–4

potassium balance 137–40

sodium balance 132–7

starch solutions 131

types of fluid used in treatment 130–1

fluid balance

post-operative critical care 161–2, 165

fungal infection

antifungal drugs 128–9

gastrointestinal bleeding.

See acute gastrointestinal bleeding, gastrointestinal perforation

gastrointestinal perforation 263–4

bowel perforation 263–4

causes 263

lower GI perforation 263–4

upper GI perforation 263

gelatins 131

gentamicin 127

Glasgow Coma Scale (GCS) 27

Glasgow Outcome Scale 333

Glasgow score (Imrie score) 270

glycopeptides 127

gut hypothesis of multiple organ failure 68


Haemacue™ 1

haematological malignancies

neutropenia and infection risk 117–19

haematopoietic stem cell transplant (HSCT) recipients

post HSCT complications 119–20

haemodynamics monitoring

cardiac output monitoring 44–8

central venous pressure monitoring 42–4

essential considerations in critically ill patients 40

invasive blood pressure monitoring 40–2

haemoglobin

as a blood buffer 151

haemolytic uraemic syndrome (HUS) 182

haemophilia A 179–80

haemophilia B 179–80

haemorrhage

antepartum 356–7

postpartum 356–7

haemostasis

normal processes 177–8

haloperidol 79–80, 83

Hartmann’s solution 130

head

CT head scan 54

head injury.

See traumatic brain injury

heart-beating donation (HBD) 91–3

heart failure.

See acute heart failure

heart transplantation 210

HELLP syndrome 344, 347

Henderson–Hasselbach equation 149

heparin-induced thrombocytopenia (HIT) 183

hetastarch solutions 131

high-resolution CT (HRCT ) 54

highly active antiretroviral therapy (HAART) 121–2

HIV and AIDS patients

complications of HIV and its therapy 121–2

HL7 (Health Level 7) standard for information exchange 37

Human Tissue Act 2004 95

hydrogen ion concentration.

See acid–base balance

hypercalcaemia 146–7

hyperkalaemia 139–40

hypermagnesaemia 142–3

hypernatraemia 135–7

hyperphosphataemia 144

hypocalcaemia 145–6

hypokalaemia 138–9

hypomagnesaemia 141–2

hyponatraemia 133–5

hyponatraemic encephalopathy 134

hypotension

post-operative critical care 165

hypoventilation 235

hypoxia pathophysiology 235–6

dead space 235

diffusion imparment 235–6

hypoventilation 235

shunt 235

ventilation/perfusion (V/Q) mismatch 235

hypoxic hypoxia 109

ICU chart 34

idiopathic pneumonia syndrome 120

imaging

acute coronary syndromes 190

acute heart failure 204–5

choice of technique 49

general considerations 49

patient and staff safety issues 49

picture archiving and communication system (PACS) 49

risks to the critically ill patient 49,

imaging modalities

CT scanning 53–5

magnetic resonance imaging (MRI) 55–6

nuclear medicine investigations 56

ultrasound imaging 56–7

X-ray imaging 49–53

imipenem 127

immunocompromised patient

use of non-invasive ventilation 247

immunonutrients 69–70

immunosuppressed patients

antiretroviral therapy in ICU 121–2

asplenia 122

cancer and haematologcial malignancies 117–19

causes of immunosuppression 116

highly active antiretroviral therapy (HAART) 121–2

infections 116–17

patients with HIV and AIDS 121–2

post haematopoietic stem cell transplant (HSCT) 119–20

respiratory failure 117

solid organ transplant recipients 120–1

Imrie score 270

Independent Mental Capacity Advocate (IMCA) 89

induction agents 7–8

induction cardiography 48

infection control

post-operative critical care 162, 167

infections

immunosuppressed patients 116–17

See also sepsis

information management

challenges in critical care 34

implementation of a critical care information system 38–9

information system functions

bedside charting 34–5

clinical record keeping 35

data access for audit and research 38

data access for quality and financial management 38

data mining 38

data storage and archiving 38

data warehousing 38

decision support 37

electronic medical records 35

electronic prescribing (physician order entry) 35–7

HL7 (Health Level 7) standard for interoperability 37

integration with other hospital systems 37

multi-site communication 37–8

remote access 37–8

simulated environments 38

training and education 38

usability of the system 35–7

virtual ICU 37–8

inhalational induction 8–9

initial assessment and resuscitation 1–2

aim of intensive care 1

assessment of the critically ill patient 1

definition of critical illness 1

general considerations 1

importance of early intervention 1, 2

monitoring progress of resuscitation 2

organ failure 1

resuscitation 1–2

signs suggesting severe illness 1

inotropes

complications and considerations

intensive care

aim of 1

Intensive Care National Audit and Research Centre (ICNARC) UK 30

intra-aortic balloon

X-ray assessment of positioning 52

intra-aortic balloon pump (IABP) 208–9


intrathoracic blood volume (ITBV) 47

intubation 6–9

airway assessment 6

‘can’t intubate, can’t ventilate’ situation 58, 60

difficult intubation situation 9

endotracheal 9

failed intubation situation 9

indications for 6

induction agents 7–8

inhalational induction 8–9

muscle relaxants 8

predicting a difficult intubation 6

rapid sequence induction (RSI) 6–7

invasive blood pressure monitoring 40–2

advantages of intra-arterial cannulation 40

Allen’s test 41

calibration of the monitoring system 42

cannulation sites 40

catheter-over-needle cannulation technique 41

catheter-over-guidewire cannulation technique 41–2

complications 42

components of the monitoring system 42

damping of the measuring system 42

Seldinger technique for cannulation 41–2

techniques for radial artery cannulation 41–2

isoflurane 81

ISS (Injury Severity Score) 27

Kant, Immanuel 258

ketamine 75, 80–1

levofloxacin 127–8

levosimendan 62

linezolid 128

liquid ventilation (LV) 255–6

lithium dilution technique

cardiac output monitoring 45

liver failure.

See acute liver failure, chronic liver disease

lorazepam 79–80, 81

Lundberg waves 329

lungs

appearance on chest X-rays 52–3

lusitropy 60

macrolides 128

magnesium levels 141–3

hypermagnesaemia 142–3

hypomagnesaemia 141–2

magnetic resonance imaging (MRI)

basic principles 55–6

Mallampati score 6

malnutrition risk in critical care 66

mechanical ventilation

epidemiology of patients 212

history and development 212

hypercarbic (Type 2) respiratory failure 213–14

hypoxaemic (Type 1) respiratory failure 213

indications for initiation 212–13

purpose 212

respiratory failure 213–14

strategy for acute asthma 224–5

strategy for acute lung injury (ALI) 222–4

strategy for brain-injured patient 225

strategy for COPD 224

strategy for each individual patient 222

strategy for early ARDS 222–4

See also respiratory weaning

mechanical ventilation adjuncts

extracorporeal carbon dioxide removal (ECCO2R) 254–5

extracorporeal membrane oxygenation (ECMO) 253–4

high-frequency oscillatory ventilation (HFOV) 252–3

liquid ventilation (LV) 255–6

prone positioning 251

recruitment maneouvres 252

transtracheal gas insufflation (TGI) 256

use of inhaled nitric oxide (NO) 251–2

mechanical ventilation complications

haemodynamic effects 220–1

ventilator-associated pneumonia (VAP) 221

ventilator-induced lung injury 221

mechanical ventilation modes 214–19

airway pressure release ventilation (APRV) 219

bilevel ventilation 217

classification and nomenclature 214–15

continuous mandatory ventilation (CMV) 216–17

continuous positive airway pressure (CPAP) 218

inverse ratio ventilation (IRV) 218–19

mandatory breaths and spontaneous breaths 216–17

positive end expiratory pressure (PEEP) 218

pressure control ventilation (PCV) 216

pressure support ventilation (PSV) 218

proportional assist ventilation (PAV) 219

support during expiration 218

supporting spontaneous breaths and PSV 218

synchronized intermittent mandatory ventilation (SIMV) 216–17

triggers 217–18

volume control ventilation (VCV) 215–16

mechanical ventilation procedure

endotracheal tubes 219–20

gastric protection 220

humidification 220

sedation 220

thromboprophylaxis 220

tracheal intubation 219

tracheostomy 220

mechanical ventilators

airway pressure 214

design and function 214

flow and delivered volume 214

medical emergency teams (METs) 3–4

meningitis

aetiology 319

clinical features 320

definition 319

incidence 319–20

infective bacteria 319–20

investigations 320

management 321–2

mortality 320

pathophysiology 319

public health issues 322

Mental Capacity Act 2005 87–8

meropenem 127

metabolic acidosis 153–6

anion gap 153–6

osmolar gap 153

metabolic alkalosis 156–7

methicillin-resistant Staphylococcus aureus (MRSA) 125

metronidazole 128

MEWS (modified early warning score) 31

microangiopathic haemolytic anaemia 182

microcirculatory and mitochondrial distress syndrome (MMDS) 109, 112


midazolam 79–80, 81

Mill, John 85

mini tracheostomy 15

Modelflow 47

morphine 74

MPM (mortality probability model) 27, 32–3

multiple organ dysfunction syndrome (MODS) 40

definition 108

See also multiple organ failure

multiple organ failure (MOF)

clinical presentations of MODS 111

cytopathic hypoxia 109

definition 108

genetic disposition 108

gut hypothesis 210

hypoxic hypoxia 109

management of MOF 111

mechanisms and managements of MODS 111–14

microcirculatory and mitochondrial distress syndrome (MMDS) 109, 112

multiple organ dsyfunction syndrome (MODS) 108

pathophysiology 108–10

possible predictors of poor outcome in MODS 110–11

prevention of MOF 114–15

secondary MODS 108

multiple systems organ failure (MSOF)

definition 108

muscle relaxants 8

myocardial infarction (MI).

See acute coronary syndromes

necessity principle in consent 87

neck

CT cervical spine 54

neuraxial blockade 75–6

neuromuscular blockade 83

nitric oxide (NO)

inhalation during mechanical ventilation 251–2

nitroimidazoles 128

nitrous oxide

analgesic properties 75

non-heart-beating donation (NHBD) 93

non-invasive ventilation (NIV) 162–4

complications and troubleshooting 249–9

conditions for NIV initiation 247

contraindications 247–8

definition 246

indications 246–7

instituting NIV 248

mechanism of action 246

patient selection 247–8

practical tips for successful NIV 248

role in respiratory weaning 243

use in acute exacerbation of COPD 246

use in cardiogenic pulmonary oedema 246–7

use in failure to wean from ventilation 247

use in the immunocompromised patient 247

non-ketotic hyperglycaemia 136

non-steroidal anti-inflammatory drugs (NSAIDs) 73

norepinephrine (noradrenaline) 61

normal (isotonic) saline 130

nuclear medicine investigations

basic principles 56

potential risks for the critically ill 56

nutrition

post-operative critical care 167

nutritional status assessment 66

anthropometric measurements 66

biochemical tests 66

body mass index (BMI) 66

subjective global assessment 66

nutritional support

enteral feeding (EF) 67–9

estimating nutritional requirements 66–7

goal for critical care patients 66

immunonutrients 69–70

malnutrition risk in critical care 66

parenteral nutrition (PN) 69

pharmaco/immunonutrition 69–70

routes of administration 67–9

nutritional support complications

electrolyte imbalances 71

enteral feeding complications 71

hyperglycaemia 70–1

micronutrient deficiencies 71

overfeeding 70

parenteral nutrition complications 71

refeeding syndrome 70

obstetric emergencies

amniotic fluid embolism 355–6

antepartum haemorrhage 356–7

deep vein thrombosis (DVT) 351–2

incidence of ITU admissions 349

maternal physiology 349–50

mortality rates (maternal and neonatal) 349

obstetric haemorrhage 356–7

ovarian hyperstimulation syndrome (OHSS) 357–8

particular challenges for management 349

postpartum haemorrhage 356–7

pulmonary embolism 350–5

sepsis 358

thromboembolism 350–5

venous thromboembolism (VTE) 350–5

See also pre-eclampsia and eclampsia

oesophageal Doppler probes

X-ray assessment of positioning 52

opioids

analgesic properties 74

sedative agents 81

organ donation

brainstem death 92–3

brainstem death after cardiac arrest 173

consent 95–6

contraindications and exclusion criteria 93

corneal donation 94–5

development of transplant services in England 91

early organ and tissue transplants 91

epidemiology 91

ethical issues 95–6

heart-beating donation (HBD) 91–3

management of the potential donor 95

need for organs and tissues 91

non-heart-beating donation (NHBD) 93

Organ Donor Register (NHS) 95

organs and tissues that can be donated 93–4

transplantation success rates 91

types of donation 91–3

Organ Donation Taskforce (ODTF) 96–7

organ failure in the critically ill patient 1

outcome probabilities

development of outcome probability model 28

limitations of outcome probability model 28

outcome measures 28

use of scoring systems 28

ovarian hyperstimulation syndrome (OHSS) 357–8

overdose.

See poisoning

oxazolidinones 128

oxygen cascade 232

oxygen delivery (DO2) equation 58


oxygen delivery and shock 58

oxygenation

blood gas analysis 234

monitoring gas exchange 232–4

pulse oximetry 202

oxygenation failure

acute lung injury (ALI) 236–8

acute respiratory distress syndrome (ARDS) 236–8

pathophysiology of hypoxia 235–6

pulmonary embolism (PE) 238–9

pacing wires

X-ray assessment of positioning 31, 52

paediatric emergencies

acute epiglottitis 365

anatomy of children 360–1

approach to paediatric emergencies 361–2

bronchiolitis 365–6

cardio-respiratory arrest in children 362–4

common paediatric emergencies 364–6

croup 365

differences between children and adults 360–1

non-accidental injury 366

paediatric intensive care admission rate 360

parental support 362

physiology of children 361

preparation for transfer to PICU 366–8

recognizing the sick child 361

shock 364–5

stabilizing the child for retrieval 366–8

status epilepticus 366

weight determination for a child 360

pain control

assessment of pain severity 72

health benefits of pain relief 72

importance of pain relief 72

occurrence of pain in critical care patients 72

post-operative critical care 159–61

severity of pain 72

sources of pain 72

types of pain 72

See also sedation

pain relief modalities

adjuncts to acute pain management 76

alfentanil 74

anxiolysis 76

chronic pain management 76

codeine 74

diamorphine 74

epidural analgesia 75–6

fentanyl 74

ketamine 75

morphine 74

multimodality approach to analgesia 72

neuraxial blockade 75–6

nitrous oxide 75

non-steroidal anti-inflammatory drugs (NSAIDs) 73

opioids 74

paracetamol 73

peripheral nerve blocks 76

regional analgesia 75–6

remifentanil 74

spinal analgesia 75

systemic analgesia 73–5

tramadol 73

pancreatitis

See severe acute pancreatitis

pancreatitis outcome prediction (POP) score 271

paracetamol 73, 279–80

parenteral nutrition (PN) 69, 71

complications 71

See also nutritional support

Parsonnet score 30

partial liquid ventilation (PLV) 255

patient admission

admission procedure 19

classification of patient dependency 16

criteria for provision of critical care 16–17

decision not to admit 19

decision to admit 17

degree of dependency of patients 16

indications for admission to critical care 16

lack of available bed on the unit 17–19

patient management when the unit is full 17–19

use of critical care resources 16

use of scoring systems to help decide 16–17

patient discharge

discharge criteria 20

discharge procedure 20

outcomes of premature discharge 19–20

risks of delayed discharge 19

use of critical care resources 16

patient transfer.

See transfer of the critically ill

penicillins 126–7

peripheral nerve blocks 76

pH.

See acid–base balance

pharmaco/immunonutrition 69–70

phenylephrine 62

phosphate buffer system 150–1

phosphodiesterase enzyme inhibitors (PDEI) 60, 62

phosphorus levels in the body 143–4

hyperphosphataemia 144

hypophosphataemia 143–4

physician order entry (electronic prescribing) 35–7

physiological scoring systems (PSS) 2–3

physiology monitoring systems 2–3

piperacillin 127

poisoning

arterial blood gases investigation 277

clinical examination 276

deliberate self-poisoning 275,

diagnosis 275

drug identification 275

drug manipulation 278

drug screening 277–8

ECG investigation 276

general supportive care 278

ICU admissions 275

incidence 275

initial assessment and resuscitation 275–6

investigations 276–7

mortality rates 275

patient history 275

principles of care 275

radiology investigations 277

stimulant overdose 282

toxicology search engines and databases

poisoning (specific management)

acetaminophen 279–80

alcohols 282

amphetamines 282

aspirin 279

barbiturates 281

benzodiazepines 281

beta-blockers 283

calcium channel blockers 283

carbon monoxide 281

cocaine 282

digitalis (digoxin) 282

lithium 282–3

MDMA (ecstasy) 282

opioids 281

organophosphates 282

paracetamol 279–80

phencyclidine 282

salicylates 279

sedatives 281

serotonin reuptake inhibitors (SSRIs) 282–3

theophylline 282

tricyclic antidepressants (TCAs) 280–1

post resuscitation care

ABCDE assessment of the patient 171

control of seizures 173

correction of acidosis 172–3

glycaemic control 172

incidence of cardiac arrest 170

organ donation after brainstem death 173

outcomes of cardiac arrest 170

prognostication 173

role in the Chain of Survival 170

support for cardiac dsyfunction 172

therapeutic hypothermia 171–2

post resuscitation syndrome 170

post-operative critical care

analgesia 159–61

antibiotic therapy 162, 167

blood sugar control 167

cardiac arrhythmias 167

cardiovascular system 164–7

care of drains and wound 167

confused patient 167

deep vein thrombosis (DVT) prophylaxis 167

delirious patient 167

early mobilization 168

early post-operative period 159–67

fluid balance 161–2, 165

handover from the surgical team 159

hypotension 165

infection control 162, 167

late post-operative period 167–8

monitoring of vital parameters 159

non-invasive ventilation (NIV) 162–4

nutrition 167

orientation of the patient 167

pain management 159–61

patients with coronary artery stents 165

prevention of pressure ulcers 168

pulmonary system 162–4

urine output 162

ventilatory support 162–4

potassium balance 137–40

hyperkalaemia 139–40

hypokalaemia 138–9

pseudohyperkalaemia 139

pre-eclampsia and eclampsia

aetiology 342

assessment 342–4

control of blood pressure 345

definition of eclampsia 342

definition of pre-eclampsia 342

eclampsia 346

fluid balance 346

HELLP syndrome 344, 347

incidence 342

management 345–7

mortality 342

multi-disciplinary approach to care 342

pathogenesis 342

planning the delivery 346

postpartum care 346–7

prevention of convulsions 345–6

pressure support ventilation (PSV) 11

pressure ulcers

prevention 168

principlism 85–6

prognosis

applications for scoring systems 29

potential drawbacks of scoring systems 29–30

use of scoring systems 29–30

prone positioning during mechanical ventilation 251

propofol 8, 79–80,

proportional assist ventilation (PAV) 243

proton pump inhibitors (PPI) 259–60

pseudohyperkalaemia 139

pseudohyponatraemia 133

pulmonary artery (Swan–Ganz) catheter

X-ray assessment of positioning 52

pulmonary embolism (PE) 238–9

obstetric emergencies 350–5

pulmonary system

post-operative critical care 162–4

pulse-induced contour cardiac output (PiCCO) 46–7

pulse oximetry 202

PulseCO 46

pumpless extracorporeal lung assist (PECLA) 254

quality and performance assessment

Parsonnet score 30

SMR (standardized mortality ratio) 30

quinolones 127–8

Ramsay Scale 78

Ransom Score (pancreatitis) 27

Ranson scoring system 270

rapid sequence induction (RSI) 6–7

recruitment manoeuvres

use with mechanical ventilation 252

refeeding syndrome 70

referral to the critical care team

indications for referral 4

routes of referral 4

remifentanil 74, 79–80

analgesic-based sedation 81

renal failure.

See acute renal failure

renal replacement therapy (RRT)

anticoagulation 304

associated therapeutic options 303

convection 300

CVVH (continuous veno-venous haemofiltration) 301

CVVHD (continuous veno-venous haemodialysis) 301–2

CVVHDF (continuous veno-venous haemodiafiltration) 302

diffusion 299–300

fluid prescriptions 303–4

future possibilities in critical care 304–5

haemoperfusion 303

HVHF (high-volume haemofiltration) 303

indications for RRT 300–1

intermittent vs. continuous 302–3

kidney functions replicated 299–300

modes of RRT 301–3

plasmapheresis 303

principles 299–300

role in critical care management 299

SCUF (slow continuous ultrafiltration) 301

ultrafiltration 299

research

use of scoring systems 31–2

resource allocation

use of scoring systems 30–1

respiratory acidosis 157

respiratory alkalosis 157

respiratory failure

immunosuppressed patients 117

respiratory support.

See advanced airway management

respiratory weaning

adaptive support ventilation (ASV) 243–4

assessment of readiness to wean 241–2

criteria for readiness to wean 241–2

definitions 241

difficult weaning 241

failure of attempts at weaning 243

goals of weaning 241

knowledge-based expert system 244

methods of weaning 243

newer modalities for weaning 243–4

prolonged weaning 241

proportional assist ventilation (PAV) 243

role of non-invasive ventilation (NIV) 243

role of tracheostomy 243

simple weaning 241

specialized weaning units (SWU) 244

spontaneous breathing trial (SBT) 242–3

stages in the mechanical ventilation process 241

time required for 241

use of non-invasive ventilation 247

See also extubation/weaning protocols

resuscitation

assessing adequacy of resuscitation 2

importance of early intervention 2

initial treatment of the critically ill patient 1–2

methods 2

monitoring patient progress 2

purpose 1–2

Revised Trauma Score (RTS) 27

rifampicin 128

Rigler’s sign 53

rocuronium 8

SAPS (Simplified Acute Physiology Score) 27, 32

scoring systems

anatomical types 27

functional types 27

generic types 27

physiological types 27

purpose and uses 27

specific types 27

systems used in critical care 32–3

types of 27

scoring systems applications 27–32

clinical decision making 29–30

early warning of ‘at risk’ and ‘deteriorating’ patients 31

outcome probabilities 28

pre-ICU patient screening 31

prognosis 29–30

quality and performance assessment 30

research 31–2

resource allocation 30–1

secondary multiple organ dysfunction syndrome (MODS) 108

sedation

aims in critical care 77

appropriate use in critical care 77

ideal properties of sedatives 79

importance in the critical care environment 77

loading dose 79

pharmacokinetic considerations 80

pharmacological management 79

pharmacology of commonly used sedatives 79–80

protocol-driven approach 83

required level of sedation 77

side effects of sedatives 79

use of daily sedation breaks 83

use of neuromuscular blockade 83

sedation level assessment 77–8

auditory evoked potentials 78

bispectral index (BIS) 78

clinical scoring systems 78

EEG 78

sedative agents

α2-receptor agonists 247–48

benzodiazepines 81

chlorpromazine 83

clonidine 79–80, 81–2

dexmedetomidine 82

etomidate 81

haloperidol 79–80, 83

intravenous anaesthetic agents 80–1

ketamine 80–1

lorazepam 79–80, 81

midazolam 79–80, 81

neuroleptic agents 83

opioids 81

propofol 79–80,

remifentanil 79–80, 81

thiopentone 80

volatile anaesthetic agents 81

Seldinger technique for cannulation 41–2, 45–4

Sellick’s manoeuvre 7

sepsis

definition of sepsis 99

definition of septic shock 99

definition of severe sepsis 99

diagnostic criteria 99

goals for resuscitation 2

management 103–6

obstetric emergencies 358

pathophysiology 99–103

resuscitation 103–6

signs and symptoms of infection (SSI) 100

Surviving Sepsis Campaign 99

systemic inflammatory response syndrome (SIRS) 99

septic shock

definition 99

severe acute pancreatitis (SAP)

aetiology 266–7

APACHE II score 270–1

common complications 266

diagnosis 268–9

early and late phases of mortality 269–70

Glasgow Score (Imrie score) 270

incidence 266

mortality rate 266

pancreatitis outcome prediction (POP) score 271

pathophysiology 266

prognostic factors 269–71

Ranson criteria 270

severity of illness scores 270–1

treatments 271–3

severe sepsis

definition 99

shock

and oxygen delivery 58

causes of 58

choice of vasoactive drug treatment 62

definition 58

in children 364–5

indications that resuscitative therapy is working 64

inotropes, complications and considerations 65

management of 62–3

monitoring the patient 64–5

role of vasoactive drugs 62–3

vasoactive drug treatment and responses 63–4

vasoactive drug treatment complications 65

shunt

hypoxia caused by 235

simulated environments

role in staff training 38

sodium balance 132–7

diabetes insipidus 136

hypernatraemia 135–7

hyponatraemia 133–5

hyponatraemic encephalopathy 134

non-ketotic hyperglycaemia 136

pseudohyponatraemia 133

SOFA (Sequential Organ Failure Assessment) 27, 33, 100

solid organ transplant patients

infection and complications 120–1

spinal analgesia 75

standard base excess 150

standardized mortality ratio (SMR) 30

starch solutions 131


status epilepticus

aetiology 306

barbiturates 310

benzodiazepines 309

classification 306

definition 306

fosphenytoin 310

generalized convulsive status epilepticus (GCSE) 306

incidence 306

long-term anti-epileptic drug (AED) therapy 310–11

mortality and morbidity 306

non-convulsive status epilepticus (NCSE) 306

occurrence in critical care 306

outcome 311

paediatric 366

pathophysiology 306–8

phenytoin 309–10

propofol 310

refractory status epilepticus 310

terminating seizure activity 308–10

treatment of acute status epilepticus 308–10

stroke volume 58

strong ion gap 149–50

suxamethonium 8

synchronized intermittent mandatory ventilation (SIMV) 11

tazobactam 127

teicoplanin 127

therapeutic hypothermia

post resuscitation care 171–2

thermodilution technique

cardiac output monitoring 44–5,

thiopentone 8, 80

thoracic electrical bioimpedance 48

thrombocytopenia 180–1

thromboembolism

obstetric emergencies 350–5

thrombotic thrombocytopenia purpura (TTP) 182

ticarcillin 126

TISS (Therapeutic Intervention Scoring System) 27, 30–1

total liquid ventilation (TLV) 255

total parenteral nutrition (TPN) 69

toxicology.

See poisoning

tracheostomy 12–15

complications 12–13

contraindications 12

cricothyroidotomy 14–15

indications for 12

mini tracheostomy 15

percutaneous tracheostomy 12

surgical tracheostomy 12

techniques 12

timing 12

tracheostomy tubes 13–14

tracheostomy tube

X-ray assessment of positioning 52

‘track and trigger’ scores 43–44

training and education

simulated environments 38

tramadol 73

transfer of the critically ill

air transfer 22

considerations during patient transfer 24–6

Critical Care Network 21

equipment required 23–4

handover to the admitting team 26

indications for transfer 21

inter- and intra-hospital transfers 21

modes of transport 22

monitoring during transfer 23, 24–6

patient care during transfer 24–6

patient preparation for transfer 23

patient transfer record sheet 24

personnel 22

post transfer 26

preparation prior to transfer 23

primary transfers 21

risks associated with transfer 21

road transfer by ambulance 22

secondary transfers 21

specialist transfer team 22

training of the transfer team 22

transfer due to lack of capacity 21

transjugular intrahepatic portosystemic shunt (TIPS) 261

transoesophageal Doppler 45–6

transoesophageal echocardiography 47

transtracheal gas insufflation (TGI) 256

trauma

ABCDE approach to primary survey 334–8

airway with cervical spine control 334–5

breathing 335–6

circulation with haemorrhage control 336–8

clearance of the cervical spine 338

definition of the ‘golden hour’ 334

disability and exposure 338

pattern of trauma mortality 334

secondary survey 334

trauma scores 33

traumatic brain injury (TBI)

cerebral contusions 326

classification 325

diffuse injury 326

extradural haematoma 325

focal injuries 325–6

incidence 325

initial assessment and resuscitation 327

intensive therapy management of TBI 330–3

intracerebral haematoma 325

monitoring the injured brain 328–30

mortality and morbidity 325

outcome 333

pathophysiology 325–6

pathophysiology of intracranial pressure 328

primary and secondary injury 325–6

subdural haematoma 325

TRISS (Trauma and Injury Severity Score) 27, 33

troponins (I and T)

ACS biomarkers 189

tubes and catheters

X-ray assessment of positioning 51–2

ultrasound imaging

basic principles 56

use in the critically ill 57

unconscious patient

abnormal levels of consciousness 312

assessment 314–15

AVPU score 315

brainstem death 312

causes of unconsciousness 312–13

EEG 316

examination 315

Glasgow Coma Score (GCS) 314

history 315

immediate assessment 314

investigations 315–16

locked-in syndrome 312

lumbar puncture 316

management 316–18

minimally conscious state 312

neurological conditions imitating coma 312

radiological tests 315–16

vegetative state 312

unconsciousness

causes of 312–13

herniation of brain tissue 313

urine output

post-operative critical care 162

utilitarianism 85


vancomycin 127

vancomycin-resistant Enterococci (VRE) 125, 127

vasoactive drug mechanisms 59–60, 61–2

alpha-1 (α1) receptors 59

beta receptors

beta-1 (β1) receptors 59

beta-2 (β2) receptors 59

dopaminergic (D1 and D2) receptors 59–60

phosphodiesterase enzyme enzyme inhibitors (PDEI) 60

vasopressin receptors 61–2

vasoactive drug treatment

deciding which drug to use 62

indications that resuscitative therapy is working 64

inotropes, complications and considerations

monitoring the patient 64–5

patient responses 63–4

role in management of shock 62–3

use of vasoactive drugs 63–4

vasoactive drugs

definitions 59

effects of inotropes 58, 59

effects of vasopressors 59

vasoactive drugs commonly used

dobutamine 61

dopamine 61

epinephrine (adrenaline) 60–1

levosimendan 62

norepinephrine (noradrenaline) 61

phenylephrine 62

phosphodiesterase enzyme inhibitors (PDEI) 62

vasopressin 61–2

vasopressin 61–2

venous thromboembolism (VTE)

obstetric emergencies 350–5

ventilation

alveolar ventilation 228

expiratory reserve volume (ERV) 226

flow volume loop 227–8

functional residual capacity (FRC) 226

inspiratory reserve volume (IRV) 226

lung volumes and capacities 226

monitoring pulmonary function 227–8

residual volume (RV) 226

respiratory control system 226–7

spirometry 227

tidal volume (VT) 226

total lung capacity (TLC) 226

vital capacity (VC) 226

See also advanced airway management, mechanical ventilation, non-invasive ventilation

ventilation disorders

hyperventilation syndromes 230–1

hypoventilation syndromes 228–30

ventilation/perfusion (V/Q) mismatch 235

ventricular assist devices (VADs) 209

viral encephalitis

aetiology 322

clinical features 322

definition and characteristics 322

investigations 322–3

management 323–4

prognosis 324

virtual ICU 37–8

von Willebrand disease 179–80

voriconazole 129

weaning.

See extubation/weaning protocols, respiratory weaning

welfare attorney (end-of-life care) 89

X-ray imaging 49–53

abdominal X-ray 53

appearance of lungs 52–3

assessment of tubes and catheters 51–2

basic principles 49–50

chest X-ray 50–3

detector 49

interpretation of the antero-posterior chest X-ray 51

radiation dose to the patient 50

X-ray source 49




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