Jennifer A LaRosa Editor Adult Critical Care Medicine A Clinical Casebook https://t.me/MBS_MedicalBooksStore 123 Adult Critical Care Medicine Jennifer A LaRosa Editor Adult Critical Care Medicine A Clinical Casebook Editor Jennifer A LaRosa Newark NJ USA ISBN 978-3-319-94423-4    ISBN 978-3-319-94424-1 (eBook) https://doi.org/10.1007/978-3-319-94424-1 Library of Congress Control Number: 2018956149 © Springer Nature Switzerland AG 2019 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland For the Fearsome Foursome, of course… Buon seme dà buoni frutti Italian Proverb Ní neart go cur le chéile Gaelic Proverb Preface The study of disease and the application of lifesaving interventions have undergone a meteoric rise in the mid-twentieth century Many important events have contributed to this growth, the following three of which are noteworthy examples: (1) The polio epidemic triggered the widespread use of mechanical ventilators (2) The standardization of transfusion and resuscitative protocols made survival from catastrophic injury possible (3) Organ transplant became a real and sustainable possibility for those dying of single organ dysfunction For patients with organ failure, trauma, or severe infection who would have invariably succumbed to their illness, critical care medicine offered an opportunity to change that inevitable fate This book is a state-of-the-art reference for many of the challenges the modern practitioner faces today The topics covered range from organ failure and transplantation to bioethical challenges and how we die Each chapter tells a story of a real patient Though this book is by no means all encompassing, it aims to be broad, comprehensive, and accessible for critical care providers It is the work of over two dozen authors from around the world with firsthand experience and expertise in their subspecialty Newark, NJ, USA Jennifer A. LaRosa vii Contents 1 Management of Intracranial Hypertension and Status Epilepticus�������������������������������������������������    1 Christopher Begley and Debra Roberts 2 Overcoming Conflicts in ICU Care of Surgical Patients�������������������������������������������������������   25 Anthony Dinallo, Jonathan Decker, and Adam M Kopelan 3 Perioperative Management of the Heart Transplant and Mechanical Circulatory Support Device Patient�����������������������������������������������   39 Mark Jay Zucker and Leeor M Jaffe 4 Damage Control in the Trauma ICU�������������������������   65 Yanjie Qi 5 Liver Failure in the ICU ���������������������������������������������   87 Priyanka Rajaram and Ram Subramanian 6 Harm and Quality in the ICU������������������������������������� 101 Jennifer A LaRosa 7 Surveillance and Prevention of Hospital-­Acquired Infections���������������������������������  121 Christian A Engell 8 Sepsis and Septic Shock�����������������������������������������������  147 Anand Kumar and Victor Tremblay ix x Contents 9 Advanced Practice Providers in the ICU: Models for a Successful Multiprofessional Team�����������������������������������������������  167 Heather Meissen and Aimee Abide 10 Critical Care Billing, Coding, and Documentation�����������������������������������������������������  179 Michael J Apostolakos 11 Shock and Vasopressors: State-of-the-Art Update ���������������������������������������������  193 Michael Kouch and R Phillip Dellinger 12 Brain Death�������������������������������������������������������������������  213 Margie Hodges Shaw and David C Kaufman 13 Nutrition Support Therapy During Critical Illness���������������������������������������������������������������  227 Jayshil Patel, Ryan T Hurt, and Manpreet Mundi 14 Advanced and Difficult Airway Management in the ICU���������������������������������������������  249 Jagroop S Saran and Joseph W Dooley 15 Hemodynamic Monitoring: What’s Out There? What’s Best for You? �����������������������������  267 Heath E Latham 16 Bleeding and Thrombosis in the ICU�����������������������  299 Donald S Houston and Ryan Zarychanski 17 Diagnosis and Management of Pulmonary Embolism in Pregnancy�����������������������������������������������  315 Lars-Kristofer N Peterson 18 Challenges in Oxygenation and Ventilation�������������  351 Julia West and Caroline M Quill 19 Poisoning and Toxicity: The New Age�����������������������  369 Kim Kwai and Patrick Hinfey Index���������������������������������������������������������������������������������������  391 Contributors Aimee  Abide, PA-C, MMSc Emory Critical Care Center, Emory Healthcare, Atlanta, GA, USA Michael  J.  Apostolakos, MD University of Rochester Medical Center, Rochester, NY, USA Christopher  Begley, DO University of Rochester Medical Center, Rochester, NY, USA Jonathan  Decker, DO  Newark Beth Israel Medical Center, Newark, NJ, USA R.  Phillip  Dellinger, MD, MCCM Critical Care Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA Anthony  Dinallo, MD, MPH Newark Beth Israel Medical Center, Newark, NJ, USA Joseph W. Dooley, MD  Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Christian  A.  Engell, MD Rutgers University New Jersey School of Medicine, Newark, NJ, USA Patrick  Hinfey, MD Newark Beth Israel Medical Center, Newark, NJ, USA Donald  S.  Houston, MD, PhD Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada xi xii Contributors Ryan  T.  Hurt, MD, PhD Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA Leeor  M.  Jaffe, MD Department of Medicine, Baystate Medical Center, Springfield, MA, USA David  C.  Kaufman, MD, FCCM Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Adam M. Kopelan, MD, FACS  Newark Beth Israel Medical Center, Newark, NJ, USA Michael  Kouch, MD, FAAEM Critical Care Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA Anand  Kumar, MD Section of Critical Care Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada Kim  Kwai, MD UC Davis Medical Center, Sacramento, CA, USA Jennifer A. LaRosa, MD, FCCM, FCCP  Newark, NJ, USA Heath  E.  Latham, MD  Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA Heather  Meissen, MSN, ACNP, CCRN, FCCM, FAANP  Emory Critical Care Center, Emory Healthcare, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA Manpreet  Mundi, MD  Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA Jayshil Patel, MD  Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Lars-Kristofer  N.  Peterson, MD Departments of Medicine and Emergency Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA 386 K Kwai and P Hinfey (a) Temporary cardiac pacing can be considered but usually unsuccessful in treating the severely ill, poisoned patient (b) Dialysis: antihypertensive agents are poorly dialyzed, though some studies have shown that atenolol, acebutolol, and sotalol may have some clearance through dialysis [41] This may or may not translate to better clinical outcomes and should only be considered if pharmacologic therapies have been exhausted (c) Intra-aortic balloon pump/left ventricular assist device/VA ECMO • Mobilize these therapies early if the patient is severely ill Case Conclusion The patient’s husband was able to find his wife’s medication list, which included diltiazem The patient received IV fluids, atropine, pressors, and glucagon (with no effect) and ultimately was placed on HIET with full recovery Key Points –– The undifferentiated toxicologic hypotensive bradycardic patient has a wide differential diagnosis Obtaining a comprehensive history is important and may help further guide management, but in the critically ill patient, starting the algorithm may help attain hemodynamic stability –– Given the elevated morbidity and mortality of calcium channel and beta-blocker overdoses, consider early aggressive decontamination –– In the undifferentiated patient, a digoxin level should strongly be considered Chapter 19.  Poisoning and Toxicity: The New Age 387 –– Not all calcium channel blockers and beta-blockers are equivalent In addition to hypotension and bradycardia, consider seizures and tachyarrhythmias in propranolol; consider QTc prolongation in sotalol –– In a severely ill patient, a single agent is not likely to help Starting multiple therapies, e.g., IV fluids + IV calcium + pressors + glucagon + high-dose insulin, is more likely to be successful in stabilizing the patient –– Insulin needs to be started at and is most effective at high doses (1–2 IU/kg) with frequent monitoring of electrolytes and glucose –– Consider intralipid therapy if all other pharmacologic therapies have failed –– Mobilize dialysis/IABP/LVAD/VA ECMO early in a critical patient References Stanek EJ, Nelson CE, DeNofrio D. Amlodipine overdose Ann Pharmacother 1997;31(7–8):853–6 [PubMed] Craig CR, Stitzel RE. Modern pharmacology with clinical applications 6th ed; Lippincott Williams & Wilkins, Philideplphia: 2004 p. 182–4 Wang DW, Mistry AM, Kahlig KM, Kearney JA, Xiang J, George AL Jr Propranolol blocks cardiac and neuronal voltage-gated sodium channels Front Pharmacol 2010;1:144 MacNeil DJ.  The side effect profile of class III antiarrhythmic drugs; 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BTG, a UK pharmaceutical company 2017 12 Bamshad MJ, Wasserman GS.  Pediatric clonidine intoxications Vet Hum Toxicol 1990;32:220–3 13 Seger D. Clonidine toxicity revisited Clin Toxicol 2002;40:145–55 14 Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone EXCLI J 2015;14:577–600 15 Seyler DE, Borowitz JL, Maickel RP. Calcium channel blockade by certain opioids Fundam Appl Toxicol 1983;3:536–42 16 Mintzer MZ, Griffiths RR. Flumazenil-precipitated withdrawal in healthy volunteers following repeated diazepam exposure Psychopharmacology 2005;178:259–67 17 Roberts T, Thompson J.  Illegal substances in anaesthetic and intensive care practices Contin Educ Anaesth Crit Care Pain Adv Access 2012;16(3):226–229 18 Waseem M, Perry C, Bomann S. Cholinergic crisis after rodenticide poisoning West J Emerg Med 2010;11(5):524–7 19 Vohra R.  Organophosphorus and carbamate insecticides In: Poisoning & drug overdose 7th ed;Lange, New York: 2017 20 Ito S, Nakazato Y, Ohga A. Further evidence for the involvement of Na+ channels in the release of adrenal catecholamine: the effect of scorpion venom and grayanotoxin I.  Br J Pharmacol 1981;72(1):61–7 21 Chan TYK.  Aconite poisoning Clin Toxicol 2009;47:279–85 https://doi.org/10.1080/15563650902904407 22 Lung D. Venlafaxine pharmacobezoar causing intestinal ischemia requiring emergent hemicolectomy J Med Toxicol 2011;7:232–5 23 Erickson CP, Olson KR. Case files of the medical toxicology fellowship of the California poison control system-San Francisco: Chapter 19.  Poisoning and Toxicity: The New Age 389 calcium plus digoxin-more taboo than toxic? J Med Toxicol 2008;4(1):33–9 24 Bailey B.  Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review J Toxicol Clin Toxicol 2003;41(5):595–602 Review PubMed PMID: 14514004 25 Kerns W II.  Management of beta-adrenergic blocker and calcium channel antagonist toxicity Emerg Med Clin North Am 2007;25(2):309–31 26 Kline JA, Raymond RM, Leonova ED, Williams TC, Watts JA. Insulin improves heart function and metabolism during non-­ ischemic cardiogenic shock in awake canines Cardiovasc Res 1997;34:289–98 https://doi.org/10.1016/S0008-6363(97)00022-9 27 Das UN. Insulin: an endogenous cardioprotector Curr Opin Crit Care 2003;9(5):375–83 28 Yuan TH, Kerns WP, Tomaszewski CA, Ford MD, Kline JA. Insulin-glucose as adjunctive therapy of severe calcium channel antagonist poisoning J Toxicol Clin Toxicol 1999;37:463–74 https://doi.org/10.1081/CLT-100102437 29 Jang DH, Nelson LS, Hoffman RS. Methylene blue for distributive shock: a potential new use of an old antidote J Med Toxicol 2013;9(3):242–9 https://doi.org/10.1007/s13181-013-0298-7 30 Gourlaine H, Buneaux F, Borron W, Gouget B, Levillain P.  Interference of methylene blue with CO-oximetry of hemoglobin derivatives Clin Chem 1997;43:1078–80 31 Roderique JD, Van Dyck K, Holman B, Tang D, Chui B, Spiess BD. The use of high-dose hydroxocobalamin for vasoplegic syndrome Ann Thorac Surg 2014;97:1785–6 32 Fueyo L, Robles J, Aguilar I. Hemolysis index to detect degree of hydroxocobalamin interference with common laboratory tests J Clin Lab Anal 2017;31 33 Sutter M, Tereshchenko N, Rafii R, et  al Hemodialysis complications of hydroxocobalamin: a case report J Med Toxicol 2010;6:165–7 34 Ciechanowicz S, Patil V. Lipid emulsion for local anesthetic systemic toxicity Anesthesiol Res Pract 2012;2012:11 https://doi org/10.1155/2012/131784.131784 35 Cave G, Harvey M.  Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review Acad Emerg Med 2009;16:815–24 36 Armenian P, French D, Smollin C, Olson K, Wu AHB. Prolonged absorption from sustained-release verapamil preparation with 390 K Kwai and P Hinfey documentation of serum levels and their response to intralipids Clin Toxicol 2010;48(6):646 37 Mirtallo JM, et al State of the art review: intravenous fat emulsions: current applications, safety profile, and clinical implications Ann Pharmacother 2010;44:688–700 38 Hayes BD, Gosselin S, Calello DP, et  al Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration Clin Toxicol 2016;54:365–404 39 Lee HM, Archer JR, Dargan PI, Wood DM.  What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol (Phila) 2015;53:145–50 40 St-Onge M, Dubé PA, Gosselin S.  Treatment for calcium channel blocker poisoning: a systematic review Clin Toxicol 2014;52:926–44 41 Weir MA, Dixon SN, Fleet JL, Roberts MA, Hackam DG, Oliver MJ, et al b-Blocker dialyzability and mortality in older patients receiving hemodialysis J Am Soc Nephrol 2015;26:987–96 Index A AbThera™ device, 26 Acute cardiac syndrome (ACS), 321, 322 Acute liver failure (ALF) case study, 89, 90 diagnostic testing, 88 differential diagnosis, 88–89 laboratory parameters, 88, 89 medical history, 88 patient history, 87 physical examination, 88 Adenosine triphosphate (ATP), 233 Advanced cardiac life support (ACLS), 168 Advanced practice provider (APP) ACLS, 168 additional work activity, 172 cardiopulmonary resuscitation, 168 clinical and financial outcomes, 174 critical care delivery models, 169 critical care staffing models, 170–172 high-quality care, 169 licensure and certification, 173 nurse practitioners, 169 orientation quality and structure, 173 physician assistants, 169 postgraduate training, 173, 174 residency and fellowship programs, 173 roles and responsibilities, 172 scope of practice, 172 telemedicine, 170 24-h intensivist staffing model, 170 Advanced Trauma Life Support (ATLS) protocol, 66, 68 ALF, see Acute liver failure Amniotic Fluid Embolism (AFE), 324 Anterior communicating artery aneurysm, Antiepileptic drug (AED) therapy, 18, 19 Apnea test, 215, 216 APP, see Advanced practice provider ARDS, 339, 362–366 Arrhythmias, 56, 199, 200, 206 Arterial Blood Gas (ABG), 180, 181, 319, 326, 357 B Bair Hugger forced-air warming system, 74 β-blockers (BB), 373 © Springer Nature Switzerland AG 2019 J A LaRosa (ed.), Adult Critical Care Medicine, https://doi.org/10.1007/978-3-319-94424-1 391 392 Index Billing, coding, and documentation case history, 179–182 CPT codes, 183, 184 critical care codes, 184 excluded common procedures, 186, 187 included services, 186, 187 by time, 185, 186 evaluation and management services, 184, 189, 190 high-level follow-up visit, 188 ICD codes, 183 medicare reimbursement, 191 relative value units (RVUs), 183, 190, 191 split/shared billing, 187, 189 Biomarkers, 234 Body mass index (BMI), 234 Brain death assessment, 216 autonomy, 224 beneficence, 224 case study, 214, 215 definition, 213 diagnosis, 216 ethics autonomy, 220, 222 beneficence, 220, 223 dead donor rule, 221, 222 death declaration, 223 death determination, 221 justice, 220 life-sustaining treatment, 223 nonmaleficence, 220 legal laws, 217–220 management, 224, 225 nonmaleficence, 220 Brain Natriuretic Peptide (BNP), 94, 326, 327, 330 C Calcium Channel Blockers (CCB) dihydropyridines, 372 L-type calcium channels, 373 nondihydropyridines, 372 Catecholamine-sparing effect, 203 Catheter-associated urinary tract infections (CAUTI) asymptomatic, 128–129 mortality rate, 129 NHSN data summary report, 129 prevention of, 129–132 symptomatic, 128 Catheter-directed thrombolysis (CDT), 337, 338 CAUTI, see Catheter-associated urinary tract infections Centers for Medicare and Medicaid Services (CMS), 108–110, 128, 184, 197 Central line associated bloodstream infections (CLABSI), 35, 106, 113, 129, 133–135 Central venous pressure (CVP), 41, 277, 278 Central-line bloodstream infection (CLABSI) definition, 133 morbidity, 133 prevention of, 134, 135 Chronic obstructive pulmonary disease (COPD), 122, 179, 182, 185, 352, 356, 362 ClearSight™ monitoring, 284 Clostridium difficile infection, 135–140 Coagulopathy bleeding management, 304–306 causes, 300 differential diagnosis, 300, 301 Communication and culture, 114, 116 Comprehensive Unit-based Safety Program (CUSP), 111, 113–115 Index Convulsive status epilepticus (CSE), 15 Critical illness, 230 diagnoses and initial management, 230 nutrition support (see Nutrition) past medical history, 229 CT Angiogram (CTA), 4, 97, 328, 329 Current Procedural Terminology (CPT) codes, 183, 184 D Damage control resuscitation (DCR), 75, 76 Damage control surgery (DCS), 72, 73 Dead donor rule, 221, 222 Diazepam IV, 16 Difficult Airway Response Team (DART), 262 Digoxin acute toxicity, 375 chronic toxicity, 376 clinical appearance, 374 indications, 374 intracellular Na +, 374 peak absorption, 374 Disseminated intravascular coagulation (DIC), 300, 301, 303, 305, 306, 309, 311 Dobutamine, 44, 50, 156, 158, 204, 206 Duplex Ultrasound (US), 328 E Electrocardiogram (ECG), 327, 328 Endotracheal intubation airway management airway exchange catheter, 260 393 anesthesiology team and ICU team, 256 bronchial blocker placement, 256 critical care setting, 256 double-lumen tube, 255 fiber-optic bronchoscopy, 259 laryngoscopes, 258 lighted stylet, 259 LMA, 261, 262 patient factors, 254 respiratory distress/ventilator dependence, 254 respiratory failure, 253 retrograde wire, 262 society guidelines, 254 special equipment, 257, 258 surgical factors, 254 urgent/emergent airway management, 257 video laryngoscopy, 258, 259 bag-mask ventilation, 253 DART, 262 difficult airway management, 251–253 direct laryngoscopy, 264 double-lumen tube, 251 incidence of, 249 laryngoscopy, 250 thoracoabdominal aneurysm, 250 video laryngoscope, 264 End-tidal carbon dioxide (ETCO2), 276 Enteral nutrition (EN) commensal bacteria, 238 defined, 236, 237 functional integrity, 237 metabolic stress, 240 non-nutritional benefits, 237 nutritional risk, 240 refeeding syndrome, 240 stress ulcer prophylaxis, 238, 239 394 Index Epoprostenol, 50, 94 Estimated continuous cardiac output (esCCO™) monitoring, 284 External ventricular drains (EVDs), 3, Extracorporeal Membrane Oxygenation (ECMO), 337–339 F Fiber-optic intraparenchymal monitors, FloTrac/Vigileo™ device, 281 H Harm case study, 101–105 evidence-based safe care, 106 medication management, 106 morbidity, 105 real-time error-reporting system, 106 Swiss cheese model, 106 Harvard Brain Death criteria, 223 Heart transplantation allograft dysfunction, 57–59 anticoagulation considerations, 44–46 case study, 40, 41 fever and leukocytosis, 55 hematologic abnormalities, 55, 56 hemodynamic considerations, 52, 53 post-operative bleeding, 53, 54 post-operative considerations, 42–44 post-operative medical interventions, 40 post-readmission considerations, 47, 48 posttransplant arrhythmias, 56, 57 pre-operative considerations, 41, 42 pressure gradient, 46 renal insufficiency, 54, 55 right heart failure, 49–51 shortness of breath and dyspnea, 46 Hemicraniectomy, Hemodynamic monitoring arterial pressure waveform analysis, 280, 282 bioreactance-based technology, 282, 283 chronic respiratory failure, 267 CVP, 277, 278 differential diagnosis, 270–272 fingertip device, 283, 284 laboratory examination, 268–270 mild nausea, 268 objective assessment, 272 treatment, 272, 285 US, 278–280 volume responsiveness assessment, 273 blood pressure, 276 Frank-Starling curve, 272 lactate-guided resuscitation, 276 resuscitation algorithm, 273–275 stroke volume, 274 Hepatic artery thrombosis case study, 97, 98 differential diagnosis, 96, 97 laboratory parameters, 96 medical history, 96 patient history, 95 physical examination, 96 Hepatorenal syndrome (HRS) case study, 92–93 diagnosis, 91–92 laboratory parameters, 91 medical history, 91 patient history, 90 physical examination, 91 Index HFNC, 361 Hospital-acquired conditions (HACs), 105, 108–110 Hospital-acquired infections (HAIs), 108, 123–124 CAUTI (see Catheter-­ associated urinary tract infections (CAUTI)) CLABSI (see Central-line bloodstream infection (CLABSI)) Clostridium difficile infection, 135–140 definition, 121 incidence, 121 mortality, 121 prevalence survey, 121 VAE (see Ventilator-­associated events (VAE)) HRS, see Hepatorenal syndrome Hyperosmolar therapy, 3, 9, 10, 12 Hypothermia, 11, 12, 19, 72, 73, 75, 77, 78 Hypovolemia, 149 Hypovolemic shock, 300 I ICU care for abdominal aortic aneurysm, 25–28 CLABSI, 35 closed vs open ICUs, 31–34 communication, 29, 30, 33, 34 covenant to cure, 32, 35 emotional intelligence, 32 surgeon-patient relationship, 28, 29 surgical vs medical intensivist, 30, 31, 35 Imminent death, 222 International Statistical Classification of Diseases and Related Health Problems (ICD) codes, 183, 184 395 Intracranial hemorrhage (ICH), 6, 336 Intracranial hypertension barbiturate therapy, 11 clinical presentation, definition, etiologies, EVDs, fiber-optic intraparenchymal monito, hemicraniectomy, hyperosmolar therapy, 3, 9, 10 intubation and mechanical ventilation, patient positioning, pentobarbital infusion, surgical decompression, 12 temperature management, 11 Irreversible coma, 213, 214, 217 K Klebsiella pneumonia, 161 L Laryngeal mask airway (LMA), 261, 262, 264 Lithium dilution cardiac output (LiDCO™) monitor, 281 Lorazepam, 13, 14, 16 Low tidal volume ventilation (LTVV), 364 Low-molecular weight heparin (LMWH), 311, 335, 339 M Mannitol, 3, 9, 10, 12 Mechanical circulatory support device, see Heart transplantation Midazolam, 16, 18, 19 Model Definition of Death Act, 218 396 Index N National Conference of Commissioners on Uniform State Laws (NCCUSL), 218 National Patient Safety Foundation, 105 National Quality Forum (NQF), 108 NJ Declaration of Death Act, 219 Non-convulsive status epilepticus (NCSE), 14–16 Noninvasive cardiac output monitoring (NICOM™/ Starling™) devices, 282 Nutrition ASPEN/SCCM guideline, 241 caloric deficits, 231 EN commensal bacteria, 238 defined, 236, 237 functional integrity, 237 metabolic stress, 240 non-nutritional benefits, 237 nutritional risk, 240 refeeding syndrome, 240 stress ulcer prophylaxis, 238, 239 exogenous nutrient delivery, 232 hypocaloric feeding, 232 increased survival, 241 lean body mass, 232 metabolic stress, 230 nutrition management strategy, 243 metabolic stress, 231 provision, 233 nutritional risk anthropometric variables, 234 biomarkers, 234 malnutrition and severity, 234 NUTRIC score, 235 outcomes, 234 past medical history, 242 screening tools, 234–235 validated scoring systems, 235–236 permissive underfeeding, 232 PN defined, 236, 237 non-nutritional benefits, 237 role of, 238, 240 protein, 241, 242 RCTs, 233 recommendation, 241 rectus femoris cross-sectional area, 231 starvation hinges, 232 trophic EN vs full EN, 233 uncontrolled catabolism, 231 Nutrition Risk in the Critically ill (NUTRIC) score, 228, 235, 236 Nutritional Risk Screening (NRS), 235 O Oculocephalic testing, 215 Oral sildenafil, 51 Organ donation, 217, 218, 224 Organophosphate (OP), 378, 379 P Parenteral nutrition (PN) defined, 236, 237 non-nutritional benefits, 237 role of, 238, 240 Passive leg raise (PLR), 275, 280 Patient safety indicators (PSIs), 108, 110–111 Peripartum cardiomyopathy (PPCM), 323 Phenytoin/fosphenytoin, 17 Pleth variability index (PVI), 284 Positive end-expiratory pressure (PEEP), 8, 103, 122, 123, 181, 362, 363, 366 Index Portopulmonary hypertension (POPH) case study, 94–95 diagnostic testing, 94 differential diagnosis, 94 laboratory parameters, 94 medical history, 93 patient history, 93 physical examination, 93 Pregnancy ABG, 319, 326 ACS, 321, 322 AFE, 324 asthma, 320 BNP, 326 D-dimer, 327 diagnosis and treatment, 325, 331 dyspnea critical care service, 316 differential diagnosis, 317 family and social history, 316 fetal heart rate monitoring, 315 history, 316 increased respiratory drive, 319 nonpregnant patients, 318, 319 past medical and surgical history, 316 physical examination, 316, 317 portable chest X-ray, 317 pneumonia, 320, 321 PPCM, 323, 328, 330 pre-eclampsia, 321 pulmonary embolism, 324, 325 CTA, 328, 329 duplex US, 328 massive PE, 336, 337 TTE, 330 VQ scan, 329 treatment anticoagulation, 334, 335 397 CDT, 337, 338 ECMO, 338, 339 supportive critical care, 331–334 troponin, 327 vascular injury, 330 The Premature Burial, 222 Pulmonary embolism (PE), 271, 279, 324, 325, 329, 330, 336, 352, 354 Pulse index continuous cardiac output (PiCCO™) monitor, 282 Pulse pressure variation (PPV), 273 R Randomized controlled trials (RCTs), 233 Respiratory failure abnormal ventilation, 352 acute infection, 359 acute ventilatory dysfunction, 353 ARDS, 364–366 aspiration pneumonitis, 359 attentive supportive care, 366 BIPAP support, 357 bronchoalveolar lavage, 361 chest imaging, 354 chronic fibrotic disease, 360 COPD, 362 critical care evaluation and ICU admission, 352 diagnosis, 359 dyspnea and fever, 357 HFNC, 361 high-flow nasal cannula, 355 hypercapnic/hypoventilatory respiratory failure, 355 hypercapnic/ventilatory respiratory failure, 355 hypoventilation secondary, 353 inflammatory lung disease, 363 long-term management, 356 LTVV, 364 398 Index Respiratory failure (cont.) lung masses, 359 management, 360 PEEP, 362 pneumothorax, 353, 354 respiratory support, 361 secondary bacterial pneumonia, 367 symptoms, 351 tachypneic, 351 type 1, 358 type 2, 352 S Sepsis/septic shock bedside ultrasonography, 152 classification of, 150–151 clinical diagnosis, 160, 161 clinical presentation and investigation, 149 definition, 148 diagnosis, 148, 149 laboratory results, 152 management of adjunctive therapies, 159, 160 de-escalation, 160 early antimicrobials, 153–155 hemodynamic management, 155–158 source control, 158, 159 mortality, 148 SIRS criteria, 148 SOFA score, 148 Septic shock, see Hemodynamic monitoring Shewhart cycle, 112 Shock definition, 270 diagnosis, 194, 195 differential diagnosis, 195, 300 distributive shock, 271 obstructive shock, 271 persistent hypotension, 199 resuscitation algorithm, 273–275 systemic inflammatory response syndrome, 271 treatment (see Vasopressors) Six Sigma program, 112, 113 Society of Critical Care Medicine (SCCM), 32, 170, 233 Status epilepticus (SE) AED therapy, 18, 19 causes of, 19 clinical manifestations, 15 convulsive status epilepticus, 15 definition, 15 diagnosis, 21 etiologies, 20 first-line treatment, 16 fosphenytoin, 14 infection and sepsis, 20 morbidity and mortality, 15 non-convulsive status epilepticus, 15 pentobarbital infusion, 19 pharmaceutical options, 17 propofol, 15 second-line treatments, 17, 18 treatment protocols and guidelines, 16 Strattice™, Lifecell, 26 Streptococcus pneumoniae, 307 Stroke volume variation (SVV), 273 Subarachnoid hemorrhage, Surviving Sepsis Campaign (SSC), 196, 197, 200, 202–205 Swiss cheese model, 106 Systemic inflammatory response syndrome (SIRS) criteria, 148 Systolic pressure variation (SPV), 273 T Telemedicine, 170 Thrombocytopenia bleeding management, 304–307 causes, 302 Index differential diagnosis, 302 factors, 301 pathophysiological processes, 303 septic shock, 305 therapeutic anticoagulants, 310 Thrombosis baseline aPTT, 310 inflammatory bowel disease/ hepatic dysfunction, 309 intravenous unfractionated heparin, 309 outcomes, 311 pulmonary embolus, 310 risk factors, 308, 309 vasopressors, 307 Tissue plasminogen activator (tPA), 337 Total peripheral resistance (TPR), 283 Toxicology, hypotension and bradycardia alpha agonism, 376 BB, 373 CCB, 372, 373 digoxin, 371, 373–376 EKG, 371 hypoglycemia, 373 management, 379–386 opioids, 377 organophosphates and carbamates, 378, 379 physical exam, 370 plants, 379 propranolol, 373 sedative-hypnotics, 377 sotalol, 373 urine drug screen, 372 vital signs, 370 Train-of-four testing, 215 Transthoracic echocardiogram (TTE), 330 Trauma surgery and resuscitation admission laboratory results, 69–70 399 ATLS protocol, 66–68 DCR, 75, 76 DCS, 72, 73 home medications, 68 ICU course and abdominal closure, 81–83 acidosis/circulatory support, 77, 78 emergent reoperation, 80 hypothermia, 75, 77 TIC, 78–80 initial and final arterial blood gas, 72 massive transfusion protocol, 70 past medical/surgical history, 68 prehospital course, 66 social history, 68 splenectomy, 71 Trauma-induced coagulopathy (TIC), 71, 77–80 Trendelenburg procedure, 216 24-h intensivist staffing model, 170 U Ultrasonography (US), 151, 152, 157, 161, 278–280 Unfractionated heparin (UFH), 335 Uniform Anatomical Gift Act, 218 Uniform Brain Death Act (UBDA), 218 Uniform Determination of Death Act (UDDA), 218, 219 US President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 218 400 Index V VAE, see Ventilator-associated events Valproic acid, 17 VANISH trial, 197 Vasoplegia, 52 Vasopressors angiotensin II, 207, 208 catecholamine-sparing effect, 203 dobutamine, 206 dopamine, 206 early vs delayed vasopressor, 199 end-organ perfusion, 195 epinephrine, 196, 198, 202–205 extravasation, 201 flow diagram, 196, 197, 209 low-dose vasopressin, 196–197, 206 mean arterial pressure, 196, 199, 200 mortality, 199 norepinephrine, 196, 198, 201–204, 206 peripheral IV, 200, 201 phenylephrine, 205 SSC recommendations, 196 VANISH trial, 197 VASST trial, 203 VASST trial, 203 Ventilation-perfusion (VQ) scan, 329 Ventilator-associated events (VAE) classification, 123, 124 definition, 123 endotracheal tubes with subglottic secretion drainage, 126 head of bed elevation, 126 incidence of, 124 physical conditioning, 126 prevention, 125 sedation minimization, 125 surveillance definition algorithm, 123 VAP, 123 ventilator circuit, 127 Ventilator-associated pneumonia (VAP), 123 Ventriculostomy catheters, .. .Adult Critical Care Medicine Jennifer A LaRosa Editor Adult Critical Care Medicine A Clinical Casebook Editor Jennifer A LaRosa Newark NJ USA ISBN... Christopher_begley@urmc.rochester.edu; Debra_roberts@urmc.rochester.edu © Springer Nature Switzerland AG 2019 J A LaRosa (ed.), Adult Critical Care Medicine, https://doi.org/10.1007/978-3-319-94424-1_1 C Begley and... Center, Newark, NJ, USA e-mail: adam.kopelan@rwjbh.org © Springer Nature Switzerland AG 2019 J A LaRosa (ed.), Adult Critical Care Medicine, https://doi.org/10.1007/978-3-319-94424-1_2 25 26 A Dinallo