Fundamental Critical Care Support Fifth Edition Copyright © 2012 Society of Critical Care Medicine, exclusive of any U.S Government material All rights reserved No part of this book may be reproduced in any manner or media, including but not limited to print or electronic format, without prior written permission of the copyright holder The views expressed herein are those of the authors and not necessarily reflect the views of the Society of Critical Care Medicine Use of trade names or names of commercial sources is for information only and does not imply endorsement by the Society of Critical Care Medicine This publication is intended to provide accurate information regarding the subject matter addressed herein However, it is published with the understanding that the Society of Critical Care Medicine is not engaged in the rendering of medical, legal, financial, accounting, or other professional service and THE SOCIETY OF CRITICAL CARE MEDICINE HEREBY DISCLAIMS ANY AND ALL LIABILITY TO ALL THIRD PARTIES ARISING OUT OF OR RELATED TO THE CONTENT OF THIS PUBLICATION The information in this publication is subject to change at any time without notice and should not be relied upon as a substitute for professional advice from an experienced, competent practitioner in the relevant field NEITHER THE SOCIETY OF CRITICAL CARE MEDICINE, NOR THE AUTHORS OF THE PUBLICATION, MAKE ANY GUARANTEES OR WARRANTIES CONCERNING THE INFORMATION CONTAINED HEREIN AND NO PERSON OR ENTITY IS ENTITLED TO RELY ON ANY STATEMENTS OR INFORMATION CONTAINED HEREIN If expert assistance is required, please seek the services of an experienced, competent professional in the relevant field Accurate indications, adverse reactions, and dosage schedules for drugs may be provided in this text, but it is possible that they may change Readers must review current package indications and usage guidelines provided by the manufacturers of the agents mentioned Managing Editor: Katie Brobst Printed in the United States of America First Printing, May 2012 Society of Critical Care Medicine Headquarters 500 Midway Drive Mount Prospect, IL 60056 USA Phone +1 (847) 827-6869 Fax +1 (847) 827-6886 www.sccm.org ePub International Standard Book Number: 978-0-936145-99-0 QED stands for Quality, Excellence and Design The QED seal of approval shown here verifies that this eBook has passed a rigorous quality assurance process and will render well in most eBook reading platforms For more information, please visit the QED Seal Web page Fundamental Critical Care Support Fifth Edition Editor David J Dries, MD, FCCM Regions Hospital Saint Paul, Minnesota, USA No disclosures FCCS Fifth Edition Planning Committee Marie R Baldisseri, MD, FCCM University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, USA No disclosures Thomas P Bleck, MD, FCCM Rush Medical College Chicago, Illinois, USA No disclosures Gregory H Botz, MD, FCCM University of Texas MD Anderson Cancer Center Houston, Texas, USA No disclosures Edgar Jimenez, MD, FCCM Orlando Regional Medical Center Orlando, Florida, USA No disclosures Keith Killu, MD Henry Ford Hospital Detroit, Michigan, USA No disclosures Rodrigo Mejía, MD, FCCM University of Texas MD Anderson Cancer Center Children’s Cancer Hospital Houston, Texas, USA No disclosures Rahul Nanchal, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures Don C Postema, PhD Regions Hospital Gillette Children’s Specialty Healthcare Bethel University Saint Paul, Minnesota, USA No disclosures Mary J Reed, MD, FCCM Geisinger Medical Center Danville, Pennsylvania, USA No disclosures Sophia C Rodgers, ACNP, FCCM University of New Mexico School of Medicine Albuquerque, New Mexico, USA No disclosures John B Sampson, MD Johns Hopkins Hospital Baltimore, Maryland, USA No disclosures Babak Sarani, MD George Washington University Washington, DC, USA No disclosures Janice L Zimmerman, MD, FCCM Methodist Hospital Houston, Texas, USA No disclosures Contributors Kent Blad, DNP, ACNP-BC, FNP-c, FAANP, FCCM Brigham Young University Provo, Utah No disclosures Steven M Hollenberg, MD, FCCM Cooper University Hospital Camden, New Jersey, USA No disclosures Sabrina D Jarvis, DNP, ACNP-BC, FNP-BC, FAANP College of Nursing Brigham Young University Provo, Utah No disclosures Zahid P Khan, MBBS, FCCM City Hospital NHS Trust Birmingham, UK No disclosures Gagan Kumar, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures Patti L Kunkel, CNP Henry Ford Hospital Detroit, Michigan, USA No disclosures Joshua M Levine, MD University of Pennsylvania Philadelphia, Pennsylvania, USA No disclosures Jayshil Patel, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures F Elizabeth M Poalillo, CCRN, MSN, RN, ARNP Pulmonary Practice of Orlando Orlando, Florida, USA No disclosures Bruce M Potenza, MD University of California San Diego San Diego, California, USA No disclosures Nitin Puri, MD Inova Fairfax Hospital Falls Church, Virginia, USA No disclosures Amit Taneja, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures Contents Preface Chapter Recognition and Assessment of the Seriously Ill Patient Chapter Airway Management Chapter Cardiopulmonary/Cerebral Resuscitation Chapter Diagnosis and Management of Acute Respiratory Failure Chapter Mechanical Ventilation Chapter Monitoring Oxygen Balance and Acid-Base Status Chapter Diagnosis and Management of Shock Chapter Neurologic Support Chapter Basic Trauma and Burn Support Chapter 10 Acute Coronary Syndromes Chapter 11 Life-Threatening Infections: Diagnosis and Antimicrobial Therapy Selection Chapter 12 Management of Life-Threatening Electrolyte and Metabolic Disturbances Chapter 13 Special Considerations Chapter 14 Critical Care in Pregnancy Chapter 15 Ethics in Critical Care Medicine Chapter 16 Critical Care in Infants and Children: The Basics Appendix Rapid Response System Appendix Endotracheal Intubation Appendix Airway Adjuncts Appendix Advanced Life Support Algorithms Appendix Defibrillation/Cardioversion Appendix Intraosseous Needle Insertion Appendix Temporary Transcutaneous Cardiac Pacing Appendix Thoracostomy Appendix Brain Death and Organ Donation Appendix 10 Infection Control Measures Appendix 11 Unfractionated Heparin Anticoagulation Appendix 12 Thromboprophylaxis for Venous Thromboembolism PREFACE This is the fifth edition textbook publication of the Fundamental Critical Care Support (FCCS) program of the Society of Critical Care Medicine Reflecting the continued growth of the FCCS program since its inception in 1994, this edition will be available in multiple languages, at hundreds of sites, in over 30 countries, and with a growing volume of online resources As with previous editions, the success of the program is built on the efforts of individuals who have volunteered their time and talents to present the important concepts and principles of fundamental critical care Our volunteers’ energy and compassion has been guided by key members of the SCCM staff: Gervaise Nicklas, MS, RN, Program Development Manager for FCCS; and Ms Katie Brobst, Managing Editor, Books, both of whom diplomatically kept the contributors on task We have expanded the disciplines represented among chapter contributors Major input to this fifth edition came from the FCCS, Fifth Edition Planning Committee In addition, the total list of contributors reflects input from approximately half of the international FCCS Program Committee As in the fourth edition, we have increased the emphasis on case-based education, with scenarios presented throughout the chapters and considerations highlighted in text boxes Online skill station materials, which accompany the text, also feature an interactive and case-based format Our goal is to present our students with problems that mirror clinical reality rather than emphasize the artificial confines of lecture topics The FCCS program continues to be a cornerstone of the Society of Critical Care Medicine’s education mission It is a concrete manifestation of our goal to provide the Right Care, Right Now™ David J Dries, MSE, MD Editor 2010-2012 Chair, FCCS Program Committee ... to this fifth edition came from the FCCS, Fifth Edition Planning Committee In addition, the total list of contributors reflects input from approximately half of the international FCCS Program... is the fifth edition textbook publication of the Fundamental Critical Care Support (FCCS) program of the Society of Critical Care Medicine Reflecting the continued growth of the FCCS program... Fundamental Critical Care Support Fifth Edition Editor David J Dries, MD, FCCM Regions Hospital Saint Paul, Minnesota, USA No disclosures FCCS Fifth Edition Planning Committee Marie R Baldisseri,