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 Detailed Contents
Contributors
Preface
COMMON ICU PROBLEMS
Raghu Seethala
Hyperkalemia
Shock
Sepsis
Arrhythmias
Hypotension
Hypoxemia
Pericardial Tamponade
Tension Pneumothorax
Acute Mental Status Change
Low Urine Output—Acute Renal Failure
Fever in the ICU
MONITORING
Samuel M. Galvagno, Jr., Jonathan H. Chow
Noninvasive Monitoring
Invasive Monitoring
Minimally Invasive Hemodynamic Monitoring
AIRWAY MANAGEMENT
Tarun Bhalla, Tensing Maa, Amod Sawardekar
Introduction
Airway Assessment
Airway Devices
Difficult Mask Ventilation: Maneuvers to Maintain
Airway
Patency
Indications for Tracheal Intubation
Drugs
Airway Management: Orotracheal Intubation
Airway Management: Nasotracheal Intubation
Airway Management: Awake Flexible Fiberoptic
Intubation
ASA Difficult Airway Algorithm
Transtracheal Procedures
Tracheotomy
Complications of Laryngoscopy and Intubation
Extubation
ACID–BASE DISTURBANCES
Samuel Clark Berngard, Mary B. Rice, Atul Malhotra
Definitions
Workup
Management of Severe Acid–Base Disturbances in
Critical
Illness
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Assessing Oxygenation by Arterial Blood Gas
PAIN, AGITATION, AND DELIRIUM IN THE ICU
Nathan E. Brummel, Alessandro M. Morandi, Eugene
Wesley
Ely
General Principles
Pain/Analgesia
Agitation/Sedation
Delirium in the ICU
NUTRITION
Marcus D. Darrabie, Danny O. Jacobs
Significance
Nutritional Assessment
Nutrition Requirements
Nutritional Support Routes
Malnutrition Leading to Pulmonary Failure
Renal Failure Leading to Malnutrition
Hepatic Failure Leading to Malnutrition
Obesity and Malnutrition
SCORING SYSTEM FOR THE SEVERITY OF ILLNESS IN
CRITICAL CARE
Edward Kelly
APACHE (Acute Physiology and Chronic Health
Evaluation)
SAPS (Simplified Acute Physiology Score)
SAPS II
SAPS III
SOFA (Sequential Organ Failure Assessment)
MELD (Model for End-Stage Liver Disease)
STS Risk Calculator
Revised Trauma Score
qSOFA
PREVENTIVE STRATEGIES AND EVIDENCE-BASED
PRACTICE
Shannon S. McKenna
Introduction
Central Venous Catheter (CVC) Associated Blood
Stream
Infections (CABSI)
Ventilator-Associated Events (VAE)
Venous Thromboembolism (VTE)
Stress Ulcers
Pressure Ulcers
Catheter-Associated Urinary Tract Infections (CAUTI)
Nosocomial Transmission of Methicillin-Resistant
Staphylococcus Aureus (MRSA)
Daily Assessment: FAST HUGGS
ADVANCED CARDIAC LIFE SUPPORT (ACLS)
Samuel M. Galvagno, Jr., Jesse J. Kiefer
Advanced Cardiac Life Support (ACLS)
Cardiac Arrest Algorithm
Cardiac Arrest Circular Algorithm
Bradycardia
Bradycardia with Pulse Algorithm
Tachycardia
Tachycardia with Pulse Algorithm
Opioid Associated Life Threatening Emergency
Opioid Induced Arrest
Cardiopulmonary Resuscitation (CPR)
EMERGENCY DEPARTMENT TO ICU
COMMUNICATION
STRATEGIES
Peter C. Hou
Key Elements of Integrated Pre- and Intrahospital Care
Care and Communication Strategies for Specific
Disease
Conditions
Summary
INFORMED CONSENT, PROCEDURAL
STANDARDIZATION, AND SAFETY
Jennifer Hofer, Michael F. O’Connor
Informed Consent
Five Elements of Informed Consent
Procedural Standardization
OCCUPATIONAL AND PHYSICAL THERAPY
Bhakti K. Patel, John P. Kress
ICU-Acquired Weakness (ICU-AW)
Early Mobilization
PATIENT- AND FAMILY-CENTERED CARE
Mary Pennington, Patrice K. Nicholas
Introduction
Definitions
Objective
Rationale
Key Concepts
Patient- and Family-Centered Care Interventions
Flexible Visitation Policy
Family’s Level of Involvement
Family Presence during Codes
Cultural Issues
TRANSITIONING FROM ACUTE CARE TO
REHABILITATION
Shannon S. McKenna
The Need
Types of Post Acute Care Facilities
Outcomes
Evaluating Patients for Suitability of Transfer to an
LTAC
Steps to Ensuring a Successful Transfer
ETHICS, PALLIATIVE AND END-OF-LIFE CARE
Michael F. O’Connor, Allison K. Dalton
Decisional Capacity
Goals of Care
Palliative Care
Autonomy
Advanced Directives
Surrogate/Proxy
Withdrawal of Care
Doctrine of Double Effect
Comfort Measures
Substituted Judgment
Living Will
Durable Power of Attorney
Beneficence
Nonmaleficence
NURSING STANDARDS IN CRITICAL CARE
Mary Pennington, Vincent M. Vacca
Introduction
Critical Care Nursing Work Flow
Guide for Head-to-Toe Nursing Assessment
INTER- AND INTRAHOSPITAL TRANSPORT OF
CRITICALLY ILL PATIENTS
Michael G. Fitzsimons, Agnieszka Lesicka
Definitions
Risks
Assessment and Management
MECHANICAL VENTILATION AND PULMONARY
ISSUES
Rebecca M. Baron
Ventilation, Pulmonary Physiology, Ventilator
Management
Gas Exchange
Ventilation
Modes of Mechanical Ventilation
Acute Failure to Liberate from Ventilator Support
Respiratory Failure and Ventilator Management
Ventilator Management
Community Acquired Pneumonia and Atypical
Pneumonias
Types of Pneumonias and Pathogens
ACUTE RESPIRATORY DISTRESS SYNDROME
Ameeka Pannu, Daniel S. Talmor
Introduction
Pathophysiology
Diagnosis
Imaging
Treatment
Outcomes
Conclusion
CARDIOVASCULAR CONDITIONS IN THE ICU—ACUTE
CORONARY SYNDROMES AND OTHER COMMON
CARDIAC PROBLEMS
Patrick R. Lawler, David A. Morrow
Chest Pain
HTN Emergencies
Acute Coronary Syndromes
Cardiac Biomarkers
Unstable Angina (UA) vs. Non-ST Elevation MI
ST-segment Elevation MI
Inferior Myocardial Infarction (IMI)
Complications of Myocardial Infarction
Cardiomyopathy/Shock/Heart Failure
Valve Diseases
Pericardial Tamponade
Cardiogenic Shock and Tailored Heart Failure Therapy
Pacemakers and Defibrillators
Pharmacology of Cardiovascular Drugs
Antiplatelets/Anticoagulants
EXTRACORPOREAL MEMBRANE OXYGENATION AND
VENTRICULAR ASSIST DEVICES
Gaurav Budhrani, James M. Blum
Introduction to ECMO
Ventricular Assist Devices
Minimally Invasive Interventions
HEMATOLOGY, FLUID AND ELECTROLYTE
MANAGEMENT
Yasser El Kouatli, Lena M. Napolitano
Hematology
Transfusion and Transfusion Triggers in the ICU
Venous Thromboembolism and Pulmonary Embolism,
Prevention Strategies
Electrolytes
Fluid Resuscitation and IV Replacement Solutions
INFECTIOUS DISEASE, SEPSIS, AND THE SURVIVING
SEPSIS GUIDELINES
David Oxman, Ankit Gupta, Gyorgy Frendl
Evaluation of New Fever in the Critically Ill Patient
Nosocomial Infections
Principles for the Use of Antibiotics in the ICU
Sepsis and Septic Shock
Summary of Recommendations—Surviving Sepsis
Campaign 2012
Summary of National Quality Forum/Surviving Sepsis
Campaign Management Bundles/Milestones
Severe Acute Pancreatitis: Pancreatitis with Persistent
Organ Failure >48 Hours
ENDOCRINE DISORDERS AND RENAL ISSUES IN THE
ICU AND RENAL ISSUES
Ernest I. Mandel, Kenneth B. Christopher
Hyperglycemia—Diabetic Emergencies
Glycemic Control
Adrenal Insufficiency
Thyroid Disease
Renal Issues Encountered in the ICU
General Workup for Renal Problems Occurring in the
ICU
Renal Replacement Therapy
Electrolyte Abnormalities Most Commonly Associated
with
Renal Dysfunction
Issues Related to Osmolality and Osmoregulation
CARDIAC SURGICAL CRITICAL CARE
Matthew T. Dudley, Michael A. Gropper
Cardiac Surgery Operating Room to ICU Handoff
Postcardiac Surgery Fast-Track Care
Cardiopulmonary Bypass (CPB) and Extra Corporeal
Life
Support (ECLS) Sequelae
Common Postcardiac Surgery Management Issues
Postoperative Atrial Fibrillation (POAF)
Cardiac Surgical Procedures
Hybrid and Percutaneous Cardiac Procedures
Pulmonary Hypertension in Cardiac Surgery Patient
THORACIC SURGICAL CRITICAL CARE
Shannon S. McKenna
Introduction
Prevention/Treatment of Atelectasis and Secretion
Retention
Postoperative Hypotension
Postoperative Acute Respiratory Distress Syndrome
Massive Hemoptysis
Bronchopleural Fistula (BPF)
Pulmonary Hypertension Leading to Right Heart
Failure
Atrial Fibrillation
Pain Management
VASCULAR SURGICAL CRITICAL CARE
Louisa J. Palmer, Sheri Berg
Perioperative Risk
Carotid Artery Stenosis
Aortic Aneurysms
Acute Aortic Syndrome (80–90% aortic dissection)
Peripheral Vascular Disease
NEUROLOGIC CRITICAL CARE
Henrikas Vaitkevicius, Brian L. Edlow
Coma and Disorders of Consciousness
Brain Death
Hypoxic–Ischemic Injury after Cardiac Arrest
Therapeutic Hypothermia for Coma after Cardiac
Arrest
Therapeutic Hypothermia Protocol (May Vary by
Institution)
Intracranial Hypertension and Brain Edema
Mechanical Ventilation of Neurologic Patients
NEUROVASCULAR CRITICAL CARE
David Greer
Transient Ischemic Attacks
Ischemic Strokes
Dissections
Intracerebral Hemorrhage
SEIZURES
Galen V. Henderson, M. Brandon Westover
Differential Diagnosis of Seizures
Provoked Seizures: Etiologies
Workup of First Seizure
Antiepileptic Drugs
Status Epilepticus
WEAKNESS IN THE INTENSIVE CARE UNIT
Galen V. Henderson
Clinical Examination
Investigations/Tests
Muscle Disease
NEONATAL INTENSIVE CARE
Steven A. Ringer
Resuscitation in the Delivery Room
Common Neonatal Problems
Cardiovascular
Fluids and Electrolytes
Nutrition
Neurology
Gastroenterology
Hematology
Infectious Diseases
Syndromes and Associations
PEDIATRIC INTENSIVE CARE
Kelly B. Kromer, Traci A. Wolbrink
Key Principles for Pediatric Critical Care
Shock
Sepsis
Diabetic Ketoacidosis (DKA)
Status Asthmaticus
Bronchiolitis
Acute Respiratory Distress Syndrome (ARDS)
Extracorporeal Membrane Oxygenation
Acute Chest Syndrome
Tumor Lysis Syndrome
Syndrome of Inappropriate Secretion of Antidiuretic
Hormone (SIADH)
Cerebral Salt Wasting (CSW)
Central Diabetes Insipidus (DI)
Status Epilepticus
Pediatric Trauma
Pediatric Pain Management
OBSTETRIC CRITICAL CARE
Holly R. Ende, Dirk J. Varelmann
Introduction
Aortocaval Compression Syndrome
Tocolytic-induced Pulmonary Edema
Aspiration
Venous Air Embolism
Fetal Monitoring
Pregnancy-related Diseases
OLDER ADULTS WITH CRITICAL ILLNESS: SPECIAL
CONSIDERATIONS
Alessandro M. Morandi, Nathan E. Brummel, Eugene
Wesley
Ely
Introduction
Risk of Falling
Nutrition
Vision and Hearing
Depression
“FAST HUGS” Assessment
Geriatric Syndromes in the ICU
Assessing the Risk of Adverse–Drug Reactions (ADR)
OBESITY: SPECIAL CONSIDERATIONS
Ali A. El-Solh
Introduction
Metabolic Syndrome (MetS)
Airway Management
Approach to Intubation
Fluid Loading Poorly Tolerated
Diagnostic Imaging
Venous Thromboembolism (VTE) Prophylaxis
Nutrition
Pressure-Induced Rhabdomyolysis
Nursing Care
Trauma
Drug Therapy
OPERATING ROOM: CARING FOR THE EXTREMELY
CRITICALLY ILL PATIENT
Emily Nelson, Gyorgy Frendl
Preoperative Assessment of the Severely Critically Ill
Patient
Intraoperative Management of the Severely Critically
Ill
Patient
HEART AND LUNG TRANSPLANTATION
Antonio Coppolino III, Phillip Camp, Hari R. Mallidi
Heart and Lung Transplant Postoperative
Management
Single or Double Lung Transplantation
Immunosuppression
LIVER, KIDNEY, AND PANCREAS TRANSPLANTATION
Ashley E. Aaron, Stefan G. Tullius, Sayeed K. Malek
Liver Transplant Patient
Kidney Transplant Patient
Pancreas Transplant Patient
BONE MARROW AND STEM CELL TRANSPLANTATION
Brett E. Glotzbecker, Edwin Pascal Alyea
Background
Definitions
Other General Considerations
Indications
Complications
Posttransplantation
Infectious Complications
Hepatic Complications
Pulmonary Complications
Neurologic Complications
Renal Complications
Cardiac Complications
Transplant-Related Complications
GENERAL TRAUMA I
Alexandra B. Columbus, Joaquim M. Havens
Trauma Organization and Advanced Trauma Life
Support
(ATLS) Guidelines
General Approach to the Trauma Patient
Cervical Spine Clearance
Focused Assessment with Sonography for Trauma
(FAST)
Nutritional Support for Trauma Patients
Venous Thromboembolism (VTE) Prophylaxis in
Trauma
Training in Trauma
Scoring Systems in Trauma
Triage and Surveillance
Immediately Life-Threatening Trauma Conditions
GENERAL TRAUMA II
Peter J. Fagenholz, George Kasotakis, Kathryn L.
Butler,
Daniel Dante Yeh, George Velmahos
Airway Trauma
Thoracic Trauma
Abdominal Trauma
Extremity Injuries
HEAD TRAUMA AND SPINAL CORD INJURY
Viren S. Vasudeva, Hormuzdiyar H. Dasenbrock,
Wenya
Linda Bi, William B. Gormley, Ian F. Dunn
Traumatic Brain Injury
Spinal Cord Injury
BURN MANAGEMENT
Emily Z. Keung, Anupamaa J. Seshadri, Joaquim M.
Havens
Introduction
Anatomy and General Principles
Evaluation of the Burn Patient
Airway and Respiratory Management in Burns
Fluid Management in Burns
Dressings and Topical Antimicrobial Agents Used in
Burn
Care
Surgical Burn Wound Management
Metabolism and Nutrition
Complications
COMMON ICU PROCEDURES
Jennifer Hofer, Avery Tung
Endotracheal Tube Exchange
Central Venous Catheter Placement
Pulmonary Artery Catheter Insertion
Arterial Catheter (Line) Placement
Thoracentesis
Needle Thoracostomy
Paracentesis
Nasogastric and Duodenal Feeding Tube Placement
Lumbar Puncture
Urinary Catheter (Foley) Placement
BEDSIDE SURGICAL PROCEDURES IN THE ICU OR ED
Oveys Mansuri, Selwyn O. Rogers, Jr.
Introduction
Bedside Tracheostomy
Bedside PEG (Percutaneous Endoscopic
Gastrostomy)
Bedside Diagnostic Laparoscopy
Bedside Decompressive Laparotomies
Debridement
Emergent Thoracotomy (Emergency Department
Thoracotomy)
Wound V.A.C. Changes
Pericardiocentesis
ULTRASOUND-GUIDED THERAPY AND PROCEDURES
Sajid Shahul, Gyorgy Frendl
Echocardiography in the Management of Shock
Ultrasound-Guided Placement of Central Venous
Catheters
(CVC)
RADIOLOGIC IMAGING
Yuka Okajima A, Hiroto Hatabu
ICU Portable Chest X-Rays (CXR)
Chest CT
Radiographic Findings in Thoracic Diseases
Brain CT
TOXICOLOGY
Heikki Nikkanen
Decontamination
Metabolic Toxins
Neurotoxins
Cardiovascular Toxins
Hepatic and GI Toxins
DISASTER PREPAREDNESS
Geoffrey S.F. Ling
Basic Principles
Planning
Triage
Combat
APPENDIX: ICU CALCULATORS, CALCULATIONS,
DRUGS
Sujatha Pentakota
Hemodynamic Formulas
Respiratory Formulas
Acid-Base Equations
Delta Gap
Renal
ICU Medications and Dosing
Pulmonary Vasodilators
Drugs Used in Hypertensive Emergencies
Relative Potencies and Equivalent Doses of
Representative
Corticosteroids
Anticoagulants
New Anticoagulants
Pharmacologic Coumadin Reversal
Insulin Preparations
Diuretics
Sedatives
Dosage and Mode of Administration of Common
Nonopioid
Analgesics
Standard Equivalents of Selected Opioid Analgesics
Miscellaneous
APPENDIX: STATISTICS AND EVIDENCE-BASED
MEDICINE (EBM)
Sujatha Pentakota
Evaluation of Published Research
EBM Internet Sources
INDEX
 COMMON ICU PROBLEM

HYPERKALEMIA (also see Chapter 22)

Serum K >5.0 mmol/l, severe hyperkalemia >6.0
mmol/l
Causes
• Renal insufficiency
• Adrenal insufficiency
• Insulin deficiency
• Tissue damage from rhabdomyolysis, trauma, or
burns
• Medication related
• Acidosis
Clinical Manifestations
• Peaked T waves on ECG; hyperkalemia depolarizes
the
cardiac membrane leading to further ECG changes,
like
widening of QRS (sinusoidal wave forms) which can
progress
to asystole or ventricular fibrillation
• Muscular effects can include paresthesias,
weakness, or
f
laccid paralysis
Management
• Stabilize cardiac membrane
• Calcium gluconate (10%) 10 ml IV push over 2–3
min, can
repeat q5min
• Shift potassium intracellularly
• Insulin (regular) 10 U IV push with 25 g of Dextrose IV
push
(if not hyperglycemic)
• Albuterol 15–20 mg (β-agonist) nebulized over 10
min
• Sodium bicarbonate 50 mmol IV push or 150 mmol/l
IV at a
variable rate (only use if pt has a severe met acidosis)
• Potassium elimination from body
• Furosemide (Lasix) 40–80 mg IV push
• Sodium polystyrene sulfonate (Kayexalate) 15–30 g
in 15
30 ml (70% sorbitol PO)
• Do not administer in ileus or bowel obstruction
because of
risk of colonic necrosis
• Hemodialysis (if hyperkalemia is unresponsive to
conservative measures listed above)
SHOCK
Hypoperfusion causing tissue hypoxia resulting in
multiorgan dysfunction (also see Chapter 23 for
septic shock).
Differential Diagnosis
• Hypovolemic
• Hemorrhage (trauma, GI bleed, retroperitoneal
bleed)
• Dehydration (vomiting, diarrhea, GI fistula)
• 3rd spacing (burns, malnutrition, sepsis, septic
shock)
• Cardiogenic
• MI
• Myocarditis
• End-stage cardiomyopathy
• Valvular failure
• CHF
• Arrhythmia
• Distributive
• Sepsis
• Anaphylaxis
• Liver failure
• Neurogenic
• Adrenal insufficiency
• Drugs
• Obstructive
• Tension pneumothorax (PTX)
• Cardiac tamponade
• Constrictive pericarditis
• PE
• Aortic coarctation
Clinical Manifestations
• Hypotension
• Tachycardia
• Tachypnea
• Mottled skin
• Cool extremities
• Altered mental status
• Decreased urine output
Management
• Establish & maintain ABCs (airway, breathing,
circulation)
• Fluid resuscitation
• Blood & blood product transfusion
• Vasopressors
• Inotropes
• Hemodynamic monitoring (CVC, arterial line, PA
catheter,
echocardiogram)
• Consider the following resuscitation endpoints for
septic
shock (the most common type of shock)
• CVP 8–12 mm Hg, 12–15 mm Hg if mechanically
ventilated
• MAP ≥65 mm Hg
• Urine output (UOP) ≥0.5 ml/kg/hr
• ScVO2 ≥70% or MVO2 ≥65%
• Lactate clearance
• Identification & treatment of underlying problem
including
source control in septic shock
SEPSIS
Life-threatening organ dysfunction caused by a
dysregulated host response to infection (also see
Chapter 23; Singer M, et al. JAMA. 2016;315(8):801–
810).
Causes
• Pneumonia
• Catheter-related blood stream Infxn
• Sinusitis
• Clostridium difficile
• Intra-abd (cholecystitis, abscess, peritonitis)
• UTI, pyelonephritis
• Meningitis, encephalitis
• Cellulitis, necrotizing soft tissue Infxn, wound Infxn
• Septic arthritis, osteomyelitis
• Endocarditis
• Fungemia, fungal abscess
Investigations
• CBC, electrolytes, BUN/Cr, PT/INR, LFT
• Blood cx, urine cx, site-specific cx
• ABG/lactate
• Procalcitonin
• Imaging studies: CXR, site specific CT scan, US, etc.
Management (Dellinger RP, et al. Crit Care Med.
2013;41(2):580
637)

Find the Full Original Textbook (PDF) in the link

below:

CLICK HERE