Critical Care Emergency Medicine Notice Medicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work Readers are encouraged to confirm the information contained herein with other sources For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs Critical Care Emergency Medicine David A Farcy, MD, FAAEM, FACEP, FCCM Medical Director of the Surgical Intensivist Program Director of Emergency Department Critical Care Mount Sinai Medical Center Miami Beach, Florida William C Chiu, MD, FACS, FCCM Associate Professor of Surgery Director, Fellowship Programs in Surgical Critical Care and Acute Care Surgery R Adams Cowley Shock Trauma Center University of Maryland School of Medicine Baltimore, Maryland Alex Flaxman, MD, MSE Director, Emergency Medicine Critical Care Emergency and Critical Care Attending St Joseph’s Regional Medical Center Paterson, New Jersey Attending Intensivist Pittsburgh Critical Care Associates, Inc Staff Intensivist Upper Allegheny Health System Olean, New York John P Marshall, MD, FACEP Chair Department of Emergency Medicine Maimonides Medical Center Brooklyn, New York New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2011 by The McGraw-Hill Companies All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-163981-1 MHID: 0-07-163981-0 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-162824-2, MHID: 0-07-162824-X All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in 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mechanical error by our sources, McGraw-Hill, or others, McGraw-Hill does not guarantee the accuracy, adequacy, or completeness of any information and is not responsible for any errors or omissions or the results obtained from the use of such information TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc (“McGrawHill”) and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise To my father Dr Jean Pierre Farcy for his love and for sharing and instilling in me the passion for medicine, to Dr Thomas M Scalea for teaching me to have compassion and to always put patients first, to Dr Amy Church and Dr John P Marshall for believing in me To my mother, Poe, Eve, Frederic, and Sarah for always being there for me, and all my patients and their families, who have helped me become a better doctor and believed in me during their most difficult moments — David A Farcy — To all those who have been influential to me: Terri, Anthony, Katherine, Victoria, and the extended Shock Trauma family — William C Chiu — To all those who helped, worked, and sacrificed, to get me to where I am: Mom, Dad, Sally, grandparents, great grandparents, cousins, aunts and uncles, great aunts and uncles, and great great uncle, this effort is for you — Alex Flaxman — To my wife, Seriti, and my three boys, Sahm, Siahvash, and Kianoosh Your love, patience, and support make everything possible — John P Marshall — This page intentionally left blank CONTENTS Contributors xi Foreword xix Preface xxi SECTION I INTRODUCTION The Emergency Department Intensivist Scott D Weingart SECTION II AIRWAY AND VENTILATORY SUPPORT Approach to the Difficult Airway Timothy B Jang and Jason C Wagner The Failed Airway 21 David R Gens, David A Farcy, and Dale J Yeatts Mechanical Ventilation 31 David A Farcy, Paul L Petersen, Dennis Heard, and Peter DeBlieux Weaning and Extubation 41 Alex Flaxman Noninvasive Ventilation 55 Brian J Wright and Todd L Slesinger Extracorporeal Cardiopulmonary Membrane Oxygenation 71 David A Farcy, David Rabinowitz, and Paola G Pieri SECTION III PULMONARY DISORDERS Acute Respiratory Failure 81 Imoigele P Aisiku Acute Respiratory Distress Syndrome (ARDS) 89 Isaac Tawil and Megan L Garcia viii CONTENTS 10 Severe Asthma and COPD 99 Michael T Dalley and Triminh Bui 11 Pulmonary Embolism 109 Rayan A Rouhizad and Beth A Longenecker SECTION IV CARDIOVASCULAR DISORDERS 12 Hemodynamic and Perfusion Monitoring 117 Elizabeth Lea Walters and H Bryant Nguyen 13 Acute Coronary Syndrome 127 John P Marshall and Jonathan Rose 14 Hypertensive Crises 139 Christopher M Perry, Qiuping Zhou, and Todd L Slesinger 15 Post-Cardiac Arrest Management 149 Alan C Heffner 16 Vasopressors and Inotropes 159 Amber Rollstin, John P Marshall, and William C Chiu 17 Management after Cardiac Surgery 167 Justin T Sambol and LaMont C Smith 18 Pericardial Diseases 181 Joseph R Shiber SECTION V GASTROINTESTINAL AND RENAL DISORDERS 19 Gastrointestinal Bleeding 195 Marie-Carmelle Elie-Turenne, Carrie A Cregar, and Selwena Brewster 20 Acute Liver Failure: How to Orchestrate Emergency Critical Care Interventions 207 Thomas H Kalb and Jennifer A Frontera 21 Acid–Base Disorders 221 Kevin M Jones and William C Chiu 22 Electrolyte Disorders 231 Kevin M Jones, Samantha L Wood, and William C Chiu 23 Acute Renal Failure and Renal Replacement Therapy 247 Alex Flaxman and Deborah M Stein SECTION VI NEUROLOGIC AND NEUROSURGICAL DISORDERS 24 Alterations in Mental Status 261 Nestor D Tomycz and David W Crippen 25 Management of Acute Intracranial Hypertension 269 Asma Zakaria and Imoigele P Aisiku CONTENTS ix 26 Stroke 275 Alex M Barrocas and Beth A Longenecker 27 Intracranial Hemorrhage 285 Alex M Barrocas and Beth A Longenecker 28 Traumatic Brain Injury and Spinal Cord Injury 293 Jason A Ellis, Kiwon Lee, and Dorothea Altschul SECTION VII HEMATOLOGIC AND ENDOCRINE DISORDERS 29 Transfusion in Critical Care 307 Julie A Mayglothling and Therese M Duane 30 Deep Venous Thrombosis 315 Amy Tortorich and David R Gens 31 Hyperglycemic Emergency 327 Grace S Lee and Shyoko Honiden 32 Glucose Management in Critical Care 333 Ari J Ciment and Joseph Romero 33 Adrenal Insufficiency 343 Evie G Marcolini and William C Chiu SECTION VIII INFECTIOUS DISORDERS 34 Approach to Fever in Critical Care 349 Marnie E Rosenthal 35 Principles of Antimicrobial Use in Critical Care 359 Anu Osinusi and Manjari Joshi 36 Sepsis and Septic Shock 371 David A Farcy, John Yashou, and Emanuel Rivers 37 Nosocomial and Health Care-Associated Pneumonia 383 Michael T McCurdy 38 Infectious Endocarditis 391 Joseph R Shiber 39 Clostridium Difficile Infection (CDI) 401 Claudio D Tuda SECTION IX TOXICOLOGIC CONDITIONS 40 Approach to Poisoning 409 Mohan Punja and Robert J Hoffman 41 The Critically Ill Poisoned Patient 419 Robert J Hoffman INDEX Note: Page numbers followed by f or t indicate figures or tables, respectively A Acetaminophen overdose, 208, 435–444 acute vs chronic, 436t background of, 435–436 clinical presentation and progression of, 440 epidemiology of, 436 health care system, 436 hepatic failure, 442 history of, 439 laboratory data and studies, 440, 441f metabolism, 438f pathophysiology of, 436–439 physical examination, 440 poisoned patients outcome of, 439f prevention, 444 renal insufficiency in, 442 special considerations for, 442–444 toxicity, stages of, 439f, 440 treatment guidelines in, 440–442, 443f, 444 Acetazolamide, in renal disorders, 226 Acid–base analysis, five steps of, 223–225, 223t Acid–base disorders differential diagnosis of metabolic acidosis anion gap (AG), 226–227 nonanion gap (Non-AG), 227 metabolic alkalosis, 225–226 respiratory acidosis, 225 respiratory alkalosis, 225 exogenous bicarbonate, acidosis treatment, 227–229 Henderson–Hasselbalch equation, 221 interpretation of, 222–225 status, measurement of arterial blood gas (ABG), 222 serum bicarbonate in, 221–222 Acidemia, 32, 33, 218, 219t, 222, 234t, 420t, 423 Acidosis, 24, 37, 38, 62, 106, 222 lactic, 222, 223, 224, 226 metabolic, 66, 218, 219, 222, 223t, 224, 226, 227, 228, 239, 410t, 514, 522 organic, 228 renal tubular, 228 respiratory, 63 treatment with exogenous bicarbonate, 227–229 Acquired immune deficiency syndrome (AIDS), 64, 311, 363, 366, 392, 393 ACS See Acute coronary syndrome (ACS) Activated partial thromboplastin time (aPTT), 281t, 309, 309t, 322, 372t Activated protein C, in treatment of sepsis, 378 Acute coronary syndrome (ACS), 127 diagnostic approach in, 129–131 disposition, for patients, 135 epidemiology in, 127 pathophysiology in, 127–128 potential complications in, 134–135 presentation of, 128 treatment of, 131 anticoagulant therapy, 132–133 anti-ischemic therapy, 131 antiplatelet therapy, 131–132 reperfusion therapy, 133–134 Acute DVT of leg, main therapy, 321–322 fondaparinux, 322 IV unfractionated heparin, 322 low-molecular-weight heparin, 322 SC unfractionated heparin, 322 treatment strategies of thrombus removal, 322–323 catheter-directed thrombolysis, 322 operative venous thrombectomy, 322 systemic thrombolytic therapy, 322 Acute Physiology and Chronic Health Evaluation (APACHE) score, 250, 340, 378, 397 Acute respiratory distress syndrome (ARDS), 4, 33, 71, 81, 89–96, 502, 524 alternative ventilatory strategies, 95–96 β-agonists in, 94 diagnosis of acute lung injury (ALI), 89 diffuse alveolar infiltrates of, 91f lung injury scoring, 90t positive end-expiratory pressure (PEEP), 89 diffuse alveolar infiltrates of chest x-ray, 91f fluid and hemodynamic management in, 93–94 incidence/risk factors, 92 mechanical ventilatory support, 94–95 methylprednisolone therapy, use of, 94 mortality/prognosis, 92 nutritional support in, 94 pathophysiology of, 91–92 pharmacotherapy of, 94 risk factors for, 92 supportive systemic care, 93 treatment of, 92–93 ventricular pressures in, 96 Acute tubular necrosis (ATN), 174 Acute UE DVT, treatment of, 323–324 Adam’s apple, 22 Adrenal gland, 343, 344 Adrenal hyporesponsiveness, 210 Adrenal insufficiency, 343 Adrenergic (sympathomimetic), 410 Adrenocorticotropic hormone (ACTH), 342–344, 344f, 345t Adult respiratory distress syndrome, 73, 173 Aerosol tracheostomy collar trials (TCT), 537 AHA/ACC stemi diagnostic criteria, for coronary heart disease, 129t AHA/ASA guidelines early surgical intervention in patients with cerebellar hemorrhage, 288 to maintain euvolemia, 291 for management of hypertension, 278 no indication for rVIIa in unselected patients, 287 for the use of rt-PA, 281 for the use of thrombolytics, 282 Airway pressure release ventilation (APRV), 95 patients’ spontaneous breathing, maintenance of, 96 Airways, 501, 502 alveolar septa, 100 compromise, 419 considerations in, 199 management of, 3–4 communication with staff, 12 equipment for, 12 preparation, 12 nasal/oral, 550 in neck, framework, 530f oropharyngeal, 550 pediatric vs adult, 551t resistance in, 56 techniques in, upper and lower, 529 AKI See Kidney injury, acute Albumin, 514 578 INDEX Alcohol consumption, 208 Alcoholic ketoacidosis, 228 Alcoholism, 392 ALF See Liver failure, acute ALI See Lung injury, acute Alkalemia, 32, 222, 223t, 236t, 239, 420 Alkalinization shifts equilibrium, 448f Altered mental status (AMS), 261 brain death, 265–266 brain failure, 265 consciousness and the examination, 261–262 differential diagnosis of, 262–263 locked-in syndrome (LIS), 264 minimally conscious state (MCS), 264–265 nonconvulsive status epilepticus, 263–264 persistent vegetative state, 264–265 septic encephalopathy, 263 Alveolar–arterial oxygen gradient, 81, 172 Alveolar capillary membrane (ACM), 82, 91 Alveolar fracture, 33 Alveolar gas, equilibration of, 82 Amanita mushroom, 208 American academy of neurology (AAN) define concussion as trauma-induced alteration in mental status, 296t American College of Chest Physicians (ACCP), 321, 323, 371 guidelines on therapy for VTE, 321 American college of critical care medicine international task force, 345 recommendations, 345t American Diabetes Association (ADA), 333, 340, 520 American–European Consensus Committee (AECC) criteria, 89, 90t definition for ARDS, 91 AMI See myocardial infarction, acute Amniotic fluid embolism, 113 Amyotrophic lateral sclerosis (ALS), 83 Anaphylaxis, 557 immune system, 164 manifestations of, 557t Anemia in critical illness, 307, 309 Angiography, 202 advantages of, 202 Angiotensin-converting enzyme (ACE) inhibitors, 142–144, 146, 147, 152 Anion gap, 226, 226t Anion gap metabolic acidosis, 227 common causes, 227t confirmatory tests, 227t Anterior cord syndrome, 296 Anthropometrics, 519 Anticholinergic, 411 Anticoagulant therapy, 132, 285, 287 duration, in acute episode of VTE, 323 for DVT, 321, 322, 323 intensity of, 323 treatment of critical patient with ACS, 132 Anticoagulation, 73t, 75, 76, 169, 186, 253–254, 321, 323, 397 for percutaneous dilatational tracheostomy, 531–532 situations where not required, 254 Antidiuretic hormone (ADH), 232 Antifungal therapy in critical care, 366–368 Antihypertensive therapy, 141, 142, 176 Anti-ischemic therapies, 131 Antimicrobial agents, 360 factors considering in choosing, 360 drug factors, 360–361 host factors, 360 microbial factors, 360 pharmacodynamic properties, 361 pharmacokinetic properties, 361 Antimicrobial combination, in critical care, 363–365 Antimicrobial prophylaxis by procedure and likely infecting organisms, 367t for surgical procedures, 366 Antimicrobial resistance in critical care, 365–366 features of antimicrobial stewardship, 366 strategies to prevent for, 366 Antimicrobial therapy approach to a patient with suspected infection, 363f evaluation, 362 initial selection of, 362–363 for selected pathogens, 364t–365t variables for decision making, 362f Antimicrobial use in critical care, general principles of, 359 Antioxidants, 211, 212, 514, 523, 524, 525 Antiplatelet medications, 131 Antipseudomonal cephalosporin in nosocomial and health care-associated pneumonia, 386 Antivenom, 416 Antivirals in critical care, 366 spectrum of selected antivirals, 367t Aortic dissection, 144 Apnea test, 265 ARF See Renal failure, acute; Respiratory failure, acute Arterial blood gas (ABG), 44, 59, 84, 209t, 222, 255, 413, 422, 430, 484, 499, 554, 565 analysis in acute respiratory failure, 85f to determine degree of acidemia., 329 measurement, 104 Arterial blood pressure, 117 invasive measurement, 118–119 noninvasive measurement palpation, 118 sphygmomanometry, 118 Arterial catheter, placement indications, 119t Arterial oxygen saturation (SvO2), 496 Arterial waveform, 118 Arteriovenous fistula (AVF), 289 Arteriovenous malformations (AVMs), 198, 289 Aspartate aminotransferase (AST) level, 436 Aspirin, 131, 447 in cardiovascular disorders, 128t, 131, 132, 152 GI bleeding result from use of, 200 and hypophosphatemia, 243t to reduce the frequency of subsequent ischemic events, 281 and risk factors for ICH, 285 in toxin-induced hyperthermia, 428 Asthma, 99 exacerbation severity, 104–106 arterial blood gas (ABG) measurement, 104 formal evaluation of, 103 management of, 105f pathophysiology of, 106 severe attack, 102 characteristic of, 102 clinical presentation, 100–101 diagnosis of, 102 epidemiology of, 99 pathophysiology of, 99–100, 101f, 106 risk factors for, 102f therapy, β-agonists for, 107 Asthmatic patients airways, inflammation, 100 intubated, ventilator settings for, 107t Asymptomatic hypotension, 423 Asymptomatic patient chest radiograph of, 188 Atelectasis, 172 Atrial fibrillation (AF), 168 Atrial/pulmonary venous pressure pulmonary dysfunction, 173 Atrioventricular (AV), 159 Atropine, 106, 553 management of pediatric septic shock, 559f osmolality, liquid medications, 524t in pediatric resuscitation, 550t in poisoning, 410t in RSI medications, 553t to treat cardiovascular depression with, 424 use of, 424 Automatic tube compensation (ATC), 43 Average body temperature, 349 B Bacterial etiologies, 558 Bacterial pericarditis, 183 Bacterial resistance, of antimicrobials, 366, 385 Bag–mask ventilation, Barbiturate therapy, 154, 215, 272, 301, 431, 432, 553 causing hypoventilation, 421t reducing ICP, 272 Barotrauma, 108 Basal metabolic activity, 350 Base deficit, 222 Base excess (BE), 222 Benzodiazepines, 154, 268, 410t, 420t, 421, 426, 427, 429, 430, 431, 545, 552, 553 Bernard trial outcomes, 543f β-hydroxybutyrate, in ketoacidosis, 226 Bicarbonate concentration, 221 Bicarbonate deficit, calculation, 228 Bilevel positive airway pressure (BiPAP), 56f, 104 Bivalirudin, 133 Bleeding, 11, 14, 28, 92, 133, 168, 169–171, 172, 175, 184 lower gastrointestinal, 197, 198t management of gastrointestinal bleeding, 199–203 INDEX mediastinal re-exploration, 170–171 risk of bleeding, 311, 322 surgical bleeding control, 516t upper gastrointestinal, 195, 196t Blood–brain barrier, 141, 263, 272, 337, 351, 360 Blood coagulation cascade, 318f Blood component therapy, indications for, 307 Blood gas analysis, 412 Blood gas instrumentation, 44 Blood oxygenation, 81 Blood pressure, 50, 106, 131, 140, 142, 146, 555, 559f acute severe elevations, 140 arterial blood pressure monitoring, 117–118 diastolic blood pressure (DBP), 161 management, 278, 287 orthostatic, 509–510 systolic, 102, 176, 197, 203, 373, 496, 509, 510 Blood transfusions, 176, 565 Blood urea nitrogen (BUN), 199, 248 Blue food, 523 Body fluid compartments, composition of, 508t Body mass index (BMI), 122, 366, 488, 519, 530 Bowel sounds, 523 Boyle’s law, 563 Bradycardia, 85, 145t, 152, 161, 164, 420t, 509, 522, 557 drugs and medications causing, 424t Brain death, 265–266 Brain failure, 261, 265 Brain injury See Traumatic brain injury (TBI) Brain natriuretic peptide (BNP) levels, 291 Brain oxygen, monitoring, 301 Brainstem lesions, 285 Breathing, 501 Breath stacking, 450 Bridging therapies, 212 Bronchitis, chronic, 99, 100 Bronchoalveolar lavage (BAL), 385, 386 Bronchoscopy, 535 Brown-Séquard syndrome, 296 Bypass surgery, 176 C Caffeine, 421 Calcium channel antagonists, 423–425 Calcium channel–blocking activity, 144 Candida albicans, 184 Captopril as ACE inhibitor, 140, 142, 147 Carboxyhemoglobin, 422 Cardiac arrest, 109 acute precipitant of, 151 Cardiac catheterization, 191 Cardiac computed tomography (CCT), 130 Cardiac CT angiography (CCTA), 130 Cardiac dysfunction, acute, 151 Cardiac dysrhythmia, 152 Cardiac index (CI), 119, 168 Cardiac magnetic resonance imaging (CMR), 130 Cardiac output (CO), 117, 494 noninvasive/minimally invasive measurement esophageal Doppler ultrasound (EDUS), 122 pulse pressure waveform analysis, 123 thoracic electrical bioimpedance (TEB), 122 transcutaneous Doppler ultrasound (TCDUS), 123 Cardiac surgery, management bleeding, 169–171 mediastinal re-exploration, 170–171 drugs for, 168t endocrine role in, 176–177 gastrointestinal tract postoperative care, 175 heart hemodynamic, 167–169 rate and rhythm, 169 atrial fibrillation, 169 lung early vs delayed extubation, 171–172 pulmonary complications, 172 pleural effusions, 173 postoperative pulmonary dysfunction (PPD), 172–173 pulmonary edema, 173 pulmonary management following extubation, 172 neurologic complications incidence, 175–176 patients, at risk, 176 postoperative care, 176 overview of, 167 renal, 173–175 prognosis, 174–175 protection, 174 ulmonary complications in, 172t Cardiac tamponade, 134, 186f, 484 RV compression, 190 Cardiogenic shock, 165, 497, 499, 501 diagnosis of, 498 treatment of, 165 Cardiopulmonary bypass (CPB), 168 Cardiopulmonary resuscitation (CPR), 542 Cardiopulmonary support (CPS), 71 Cardiotoxicity, 424 Catheter-directed thrombolysis (CDT), 320 Centers for Disease Control and Prevention (CDC), 293 Central cord syndrome, 296 Central nervous system (CNS) infection, 353 salicylates affect, 447 Central transfer flow diagram, 566f Central venous catheter (CVC), 93, 479f, 511 intravenous fluid flow rate, 511t Central venous lines, complications of, 121t Central venous oxygen saturation (SCVO2 ) measurement, 123, 124 Central venous pressure (CVP), 93, 119, 151, 167, 201, 299, 309, 498, 512 factors affecting, 119t invasive measurement, 120 noninvasive measurement jugular venous pulsation (JVP), 119 ultrasonography, 119–120 579 waveform, 120f Cephalosporins, 202, 373, 374t, 386 Cerebellar hemorrhage, 288 Cerebral autoregulation, 269–270 Cerebral blood flow (CBF), 215, 269, 294 Cerebral blood volume (CBV), 215 Cerebral edema, 141, 212, 214, 234, 235, 299, 331 Cerebral perfusion pressure (CPP), 210, 300 Cerebral salt wasting syndrome (CSW), 232, 291 Cerebral spinal fluid (CSF), 215, 269 Cervical spinal cord injury, 81, 83, 531 Chest, CT of IVDA patient, 394f Chest pain, EKG of, 188f Chest pain units (CPU), 135 Chest radiographs, 104 Chest trauma, 84, 186, 462 Chest tube, 170 Chest x-ray (CXR), 170 Chloride deficit, 225 Chloride-resistant metabolic alkalosis, 225 Chloride-responsive metabolic alkalosis, 225 Cholinergics, 411, 420t, 440 Chronic obstructive pulmonary disease (COPD), 56, 99, 243, 392 clinical presentation of, 100–101 epidemiology of, 99 history of, 101–102 impending respiratory failure, 104 intubation/mechanical ventilation criteria for, 106 medical management, 107 technique of, 106 treatment complications, 107–108 ventilator, setting, 106–107 laboratory studies in, 104 lung function, assessment of, 102–104 noninvasive positive pressure ventilation, 104–106 pathophysiology of, 99–100 physical examination, 101–102 premorbid conditions, 172 treatment of, 104 Chvostek’s signs, 241 Clevidipine, 146 Clinical pulmonary infection score (CPIS), 385 Clonidine, 134, 146–147, 421t, 426, 427t Clopidogrel, 132, 169, 410t Clostridium difficile infection (CDI), 401 clincal presentation of, 402–404 denudation of colonic mucosa with, 403f dilatation of colon, 403f pancolitis in descendent colon, 404f severe C difficile colitis, 404f variegated appearance of the colonic mucosa, 403f diagnosis in, 402–404 epidemiology of, 401–402 pathophysiology of, 402 risk factors for, 402f treatment guidelines, 404–405, 404f Clotting cascade, 315 Clozapine, 234 Coagulopathy, 75t, 76, 169, 200, 210, 309, 311, 480, 514 mild to moderate, 309–310 580 INDEX Cocaine toxicity, 426 Collagen, 316 Colloid oncotic pressure (COP), 508 Colloid solutions, 514 Colonoscopy, 202 Combination therapy antifungals in critical care, 368t antimicrobial therapy for, 365t in nosocomial and health care-associated pneumonia, 386 Combitube, 18f Community-acquired pneumonia (CAP), 383 Complete blood count (CBC), 499 Concomitant brain injury, 515, 516t Congenital heart disease (CHD), 555 Congestive heart failure, 81, 130, 142, 393 Continuous arteriovenous renal replacement therapy (CAVRRT), 250, 251 Continuous positive airway pressure (CPAP), 55, 56f, 96, 104, 552 Continuous renal replacement therapy (CRRT), 248, 525 APACHE II scores, 250 slow continuous ultrafi ltrate (SCUF), 250 Continuous venovenous hemodiafi ltration (CVVHDF), 255, 256f Continuous venovenous hemodialysis (CVVHD), 252, 252f Continuous venovenous hemofiltration (CVVH), 211 Continuous venovenous hemofi ltration (CVVHF), 251f, 253f Continuous venovenous renal replacement therapy (CVVRRT), 250 Conus medullaris syndrome, 297 COPD See Chronic obstructive pulmonary disease (COPD) Coronary artery bypass grafting (CABG), 131, 169 effect of age, 176f Coronary artery disease (CAD), 162 history of, 200 Coronary heart disease (CHD), 127, 398, 555, 556 Corticosteroids insufficiency, 344–345 management of asthma exacerbations, 105f and the septic patient, 377–378 Corticotropin-releasing hormone (CRH), 343 Cortisol level, 344 Cranial nerve (CN) function, 295 C-reactive protein, 372 Creatine kinase-myocardial band (CK-MB), 130 Creatine phosphokinase (CPK), 429 Creatinine, 248 CRF See Renal failure, chronic Cricoid cartilages, 22 Cricothyroid membrane, 22 anatomy, 23f location, 23f Cricothyroidotomy, 21, 25 approach, 25 open technique, 25–26 rapid four-step technique, 26 Seldinger technique, 26 contraindications, 22 contraindications of, 22 rapid four-step technique, 26 Seldinger technique, 26 surgical, 24 equipment for, 24t Cricothyroidotomy conversion, 28 Cricothyroid puncture, 17f Critical care (CC), Critical care patients end-of-life care, 569–574 transportation of air transport considerations, 563–564 history of, 561–562 military system acute lung rescue team (ALRT), 565 critical care air transport teams (CCATT), 564 USAISR BFT, history of, 564–565 regional systems, 563 risk vs benefit, 562 transfer centers, 565–566 Critical care support therapies, evidencebased, 154t Critical illness on glucose metabolism, 334f Critical illness–related corticosteroid insufficiency (CIRCI), 345 Critically ill patients, 3, 4, 31, 309, 310t, 334, 344, 345, 359, 366, 455, 525, 546, 573 in compensated shock, 509 randomized trials of glycemic control among, 336t CRRT catheters, 251 Cryoprecipitate, 171t, 199, 309, 311 Cryptic shock, 499 data supporting, 500f Crystalloid, use of, 201 CSF drainage, 300 CT angiography, 111f bilateral central filling defects, 111f CT hypertensive hemorrhage, 286f CT lobar hemorrhage, 286f CT pulmonary angiography, 111 CT venography, to diagnosis DVT, 319–320 Cuff-leak, 48–49 test, 44 Cushing’s syndrome, 226, 329, 344 Cushing’s triad, 290 Cyanide antidote kit use of, 423 Cyanide antidote therapy, 423 Cyanide toxicity, 423 Cyclic adenosine monophosphate (cAMP), 159 Cyproheptadine, 428, 429 Cysteine, 436 Cysteine protease, 315–316 Cytokines, 351t D Dantrolene, 428 Dapsone toxicity, 422 D-dimer (DD), 317 D-dimer assays, 110 Death notification families, guidelines, 572t Decompressive craniectomy, 273 Decontamination, 414 Deep venous thrombosis (DVT), 109, 159, 315 computed tomography (CT) to diagnosis, 319–320 contrast venography, 320 emergency physicians’ role in US diagnosis of DVT, 319 home versus in-patient treatment for, 324 magnetic resonance (MR) venography diagnostic accuracy of, 320 prevention in, 288 ultrasound for, 318–319, 319f Dehydration, 439 Delphi’s definition, lung injury scoring, AECC criteria, 90t Diabetes and Insulin–Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial, 337 Diabetes insipidus (DI), 234 Diabetes mellitus (DM), 280, 327 Diabetic ketoacidosis (DKA), 222, 327, 549 complications, 331–332 definition of, 327 diagnosis, 328–330 pathophysiology of, 327–328 treatment, 330–331 Dialysis, 143, 174, 185, 235, 248, 249, 257, 415t, 522, 573 Dialysis-associated pericarditis, 185 Diarrhea, 353, 403 Difficult airway, See also Airways Cormack–Lehane grading, 12f factors determined, hyomental distance, 10f intergingival gap, 10f LEMON mnemonic, 10 Mallampati score assessment, 10, 11f MOANS mnemonic, 11 neck mobility assessment, 11 obstruction assessment, 10 3-3-2 rules, 10 thyrohyoid distance, 11f Diffuse alveolar damage (DAD), 89 Diffuse brain injury, Marshall classification of, 297t Diffuse subarachnoid hemorrhage, CT scan, 290f Direct laryngoscopy (DL), 12–13, 21 Disseminated intravascular coagulation (DIC), 311 Distributive shock, 163 anaphylaxis, 164 cardiogenic shock, 165 neurogenic shock, 164–165 septic shock, 163–164 Diuretics, 239 DKA See Diabetic ketoacidosis (DKA) Dobutamine, 161, 168, 556t in cardiac surgery, 150t, 168t Do-not-intubate (DNI), 57 Do not resuscitate (DNR) orders, 288, 569 Dopamine, 160, 164 in cardiac surgery, 168t Dopaminergic (DA), 159 Doppler echocardiography, 464, 469 velocity–time integral (VTI) of left ventricular outflow, 469 INDEX Doppler interrogation, 464 Drotrecogin alfa, 254 Drug packets, ingesting, 414f DVT See Deep venous thrombosis (DVT) Dyperosmolar hyperglycemic state (HHS), 327 complications in, 331–332 definition of, 327 diagnosis of, 328–329 pathophysiology of, 327–328 treatment in, 330–331 Dyspnea, 58, 61, 64, 106, 109, 190, 462, 509, 574 Dysrhythmias, 121, 122, 228, 412, 544, 556t E Early goal-directed therapy (EGDT), Eastern Association for the Surgery of Trauma (EAST), 533 Echocardiography, 111, 187, 456 See also Point-of-care echocardiography EDCC program, Effective circulating volume (ECV), 508 EKG of a patient with ESRD on chronic hemodialysis with, 189f Electrocardiogram, 110, 128, 165 Electroencephalography (EEG), 154, 263, 264, 266, 288, 431 Electrolyte disorders, 231, 449 calcium, disorders of hypercalcemia effects of, 242 treatment of, 242 hypocalcemia causes of, 241–242 effects of, 241 treatment of, 242 magnesium, disorders of magnesium deficiency causes of, 240 diagnosis of, 240 effects of, 239–240 treatment of, 240–241 magnesium excess, 241 phosphorus, disorders of, 242–244 hyperphosphatemia, 244 hypophosphatemia causes of, 243 effects of, 243 treatment of, 243 potassium, disorders of hyperkalemia, 237–239 hypokalemia definition of, 236 treatment of, 237 sodium, disorders of hypernatremia evaluation of, 234–235 presentation of, 234 treatment of, 235 hyponatremia evaluation of, 231–233 presentation of, 231 treatment of, 233–234 Electro-physiology (EP), 186 Emergency cardiopulmonary bypass (ECPB), 543 Emergency department (ED), 31, 58, 129, 371, 493 extubation in, 41 volume trends, 494f Emergency Department Critical Care (EDCC), Emergency Department Intensive Care Unit (ED-ICU), Emergency Department Intensivist (EDI), Emergency department (ED) setting, 21 Emergency medical services (EMS), 439, 561 agency, 21 Emergency Medicine Critical Care (EMCC), Emergency Physician Intensivist (EPI), Emergency physicians (EPs), resuscitation, Emesis, 414 Emphysema, 99, 100 Enalaprilat for lowering blood pressure, 146 Encephalopathy, 214 Endocarditis, 391 End-of-life care, in emergency critical care, 569–574 advance directives for decision-making capacity, determining, 569–570 incapacitated patients, surrogate decision making, 570 care discussions/communication, goals of, 570–571 death issues in bad news, delivery of, 571–572 death notification, 571–572 family witnessed resuscitation, 572 goal of, 569 life support, withdrawal of, 572–573 optimal symptom management, 573–574 palliative care, 573–574 Endogenous antipyretics, 351 Endoscopy, 107, 199, 202, 413, 414 Endotracheal intubation (ETI), 55, 421 indications for, 551t Endotracheal tubes, 32, 41, 552 End-stage kidney disease, 174t Energy requirements, calculation, 521 Enteral nutrition (EN), 523 Enteroviridae, 183 Enzyme immunoassay (EIA) testing, for C difficile toxins A and B, 403 Enzyme-linked immunosorbent assay (ELISA), 110, 317 Epinephrine, 49, 51, 160t, 161, 163t, 164, 165, 377t, 557, 559f in cardiac surgery, 168t Erythrocytes, 316 Esmolol, in hepatic and renal failure, 146 Esophageal Doppler ultrasound (EDUS), 122 Esophageal varices, 196 Esophago gastroduodenoscopy (EGD), 197 Euvolemic hypernatremia, 234 Euvolemic hyponatremia, 233 Evidence-based aggressive care, Exercise, 48, 92, 100f, 124f, 130, 197, 233t, 350t, 427 Expiratory positive airway pressure (EPAP), 55, 552 Extended focused assessment for trauma (EFAST), 499 581 extracorporeal cardiopulmonary resuscitation (ECPR), 71 Extracorporeal CO2 removal (ECCOR), 71 Extracorporeal lung assist (ECLA), 71 Extracorporeal membrane oxygenation (ECMO), 71, 72 CESAR trial, 72 complications in, 75, 76t mechanical, 75–76 contraindications to, 73t course and weaning, 75 history, 71–72 indications in, 72, 73t adult, 73 neonatal, 72 pediatric, 72 patient complications, 76–77 patient selection, 73 technique & methods, 73 V-A ECMO, 74f V-A vs V-V ECMO, 75t V-V double-lumen ECMO, 74f V-V ECMO, 74f Extracorporeal treatment, for correcting fluid, electrolyte abnormalities, 450 Extubation, 46 close-up of equipment needed for, 50f, 51f complications of, 50 equipment needed for, 49f NIV as treatment for respiratory insufficiency following, 47 to noninvasive ventilation, 46 physical act of, 49–50 planned extubation to NIV, 46–47 criteria for extubating patient, 47t postextubation stridor, 47–48 treatment in pre-extubation and postextubation, 49 F Factor XII, 315 Factor XIIIa, 317 Failed airway, 21 Failed extubation, 41 Family conference guidelines, 571t Family witnessed resuscitation (FWR), 569 Femoral vessels, transverse image of, 483f Fenoldopam mesylate, in renal vasodilator, 144 Fever, 349 causes of fever in the ICU, 350t cytokines involved in temperature regulation, 351t definition, 349 EKG of, 188f epidemiology, 349–350 in ICU, diagnosis and management of antipyresis, 355 diagnostic approach, 354–355 pathophysiology of, 350–351 in patients requiring RRT, 257 Fiberoptic bronchoscopeaided intubations, Fiberoptic laryngoscope, 15f Fiberoptic stylets, 15–16 Fibrin formation, 316 Fibrinolytics, contraindications, 133t 582 INDEX Fidaxomicin, 404 for treatment of CDI, 404 Filter configurations, for CVV, 255 Fish oil, 94 Flexible bronchoscopes, 15f, 16 Fluid estimate, maintenance, 516t Fluid management burn resuscitation, 515–516 clinical presentation in, 509 blood pressure, 509 heart rate, 509 orthostatic blood pressure, 509–510 shock index (SI), 510 signs and symptoms, 509 empirical volume challenge, 511–512 fluid resuscitation in indications, 510 intravenous access, 510–511 resuscitation, endpoints of, 511 fluid selection for albumin, 514 colloid resuscitation, 515 colloid solutions, 514 crystalloid, 513–514 dextran solutions, 515 gelatin solutions, 514–515 hydroxyethyl starch, 514 hypertonic saline, 515 fluid therapy, maintenance, 516 hemorrhagic shock resuscitation, type of, 515 pathophysiology in, 508 principles of distribution and movement, 507–508 effective circulating volume (ECV), 508 volume responsiveness, 512 dynamic indices of, 512–513 prediction, 512 Fluid resuscitation, goal of, 513 Fluid therapy prioritized endpoints of, 511t in treatment of severe sepsis, 375 Fluoroquinolone, in nosocomial and health care-associated pneumonia, 386 Fondaparinux, 133 Food and Drug Administration (FDA), 441, 442, 523 Forced expiratory volume in second (FEV1) measurements, 99 Forced vital capacity (FVC), 84, 102 Foscarnet, 234 Frank–Starling mechanics, 181 Fresh frozen plasma, 309 FFP:PRBC ratio, 310 prophylactic transfusion of, 310 Fresh frozen plasma (FFP), 307 G Gas exchange abnormalities, 172 Gastric balloon, 201 Gastric lavage, 450 Gastric lymphomas, 197 Gastric tube, placement of, 199 Gastroenterology, 199 Gastrointestinal bleeding, 195, 203 lower causes of, 198t, 199 clinical presentation, 198 definition of, 197 etiologies of, 198 AIDS/HIV, 198–199 angiodysplasia, 198 diverticular disease, 198 management of airway considerations, 199 balloon tamponade, 201 blood product administration, 200 coagulopathy, 200 colonoscopy, 202 endoscopy esophagogastroduodenoscopy, 202 gastric tubes and lavage, 199–200 hepatic cirrhosis, 201–202 laboratories, 199 massive blood transfusion, 200 octreotide/somatostatin, 200–201 proton pump inhibitors, 200 radiology, diagnostic angiography, 202 bleeding scan, 202–203 transjugular intrahepatic portosystemic shunt (TIPS), 203 resuscitation, 199 surgery LGIB, 203 UGIB, 203 vasopressors, 201 triage/admission, 203 upper causes of, 196t clinical presentation, 195 etiology of esophageal varices, 196–197 Mallory–Weiss (MW) syndrome, 197 peptic ulcer disease (PUD), 195–196 UGIB, causes of, 197 vascular anomalies/angiodysplasia, 197 Gastrointestinal decontamination, 441 Gastrointestinal lavage, 414 Gastrointestinal stromal tumors, 197 Gastrointestinal (GI) tract, 175 lymphoid tissue blood flow, 175 Gastrointestinal tract, postoperative care, 175 Gelatin polypeptides, 514–515 Genetic syndromes, 289 Glasgow-Blatchford scoring system, 203 Glasgow Coma Scale, 286, 295, 419 on hospital discharge, 309 for initial neurologic examination brain/ spinal cord injury, 295t Glomerular filtration rate (GFR), 174t, 248, 361 Glomerulonephritis, 394 Glucagon, empirical dose of, 424 Glucagon-like peptide-1, 340 Glucocorticoids, 94, 140, 243t, 343, 345, 351t Glucose See also Diabetes mellitus (DM) management of, 280 AHA/ASA guidelines, 280 GIST-UK trial, 280 randomized controlled trials (RCTs), 280 rigid control of, 288 Glutamate dehydrogenase (GDH), 404 Glycemia in acute stroke (GLIAS), 337 Glycemic control, in the ICU, 340 Glycoprotein IIb/IIIa inhibitors, 132, 169 Griggs technique, 535 Guillain–Barré syndrome (GBS), 83 H HACA trial outcomes, 544f Hagen–Poiseuille equation, 510t Hampton’s Hump sign, 110 Hamwi method, 519 Hartmann’s solution, 514 Health care-associated pneumonia (HCAP), 383 clinical diagnosis of, 385t management algorithm, 387f risk factors for multidrug resistance, 383t Healthcare Epidemiology of America (SHEA), 403 Heart disease, 151 hemodynamic, 167–169 image of, 182f rate and rhythm, 169 atrial fibrillation, 169 Heat and moisture exchanger (HME), 537 Helicobacter pylori, 196 Heliox, 104 Hemodialysis, 212, 239, 416 EKG of patient with ESRD on chronic hemodialysis, 189f extracorporeal technique, 451 treatment of choice for malignant hypermagnesemia., 241 Hemodynamic management, 167–169 blood pressure, 168 cardiac contractility, 168 goal of, 167 low cardiac output, mechanical support for, 168–169 Hemodynamic monitoring, 117 arterial blood pressure, 117 invasive measurement, 118–119 noninvasive measurement palpation, 118 sphygmomanometry, 118 cardiac output, 120 invasive measurement, 121–122 noninvasive/minimally invasive measurement esophageal Doppler ultrasound (EDUS), 122 pulse pressure waveform analysis, 123 thoracic electrical bioimpedance (TEB), 122 transcutaneous Doppler ultrasound (TCDUS), 123 central venous pressure (CVP) invasive measurement, 120 noninvasive measurement jugular venous pulsation (JVP), 119 ultrasonography, 119–120 INDEX organ oxygenation experimental monitoring techniques, 124 lactate, 124 venous oxygen saturation monitoring clinical use of, 123–124 Hemodynamic resuscitation, 150t Hemodynamic variables vasopressors, effect of, 160t Hemofiltration, 212 Hemoglobin (Hb), 44, 199, 307, 377, 420t, 421 Hemolytic uremic syndrome (HUS), 311 Hemoperfusion, 451 Hemopericardium, 186 Hemoptysis, 109 Hemorrhagic/hypovolemic shock, 555 Hemorrhagic shock, 515 Henderson–Hasselbalch equation, 221, 228 Heparin-induced thrombocytopenia (HIT), 132, 253, 311 Hepatic encephalopathy grade, 212t Hepatitis B virus (HBV) infection, acute, 208 Herniation syndromes, 271f types of, 270 High fatal injury rates, 562f High-frequency oscillatory ventilation (HFOV), 95 Histamine (H2 ) receptor antagonists, 379 Histoplasmosis capsulatum, 184 H1N1 influenza epidemic, 72 Homan’s sign, 317 Hunter criteria, 429 Hydralazine, 143 pregnancy-induced hypertension, 145 Hydroxocobalamin, 423 γ-Hydroxybutyrate (GHB), 419 Hydroxyethyl starch (HES), 514 Hyperbaric oxygen therapy, 44 Hypercalcemia, 76t, 234, 240, 242 Hypercapnia, 222 Hyperchloremic metabolic acidosis, 227 Hypercoagulability, 315–316 Hyperglycemia, 176, 280, 333, 335, 379 pathophysiology of in ICU setting, 333–335 poor outcome, association of, 335 treatment and recommendations, 340 Hyperglycemic control, in ICU population key trials, 335 CVA patients, 337 MI and CVA patients, randomized trials, 338t–339t MI and post-CABG patients, 335, 337 randomized trials, review of prospective, 336t selected subgroup populations, 335 risks of, 337, 340 Hyperglycemic hyperosmolar nonketotic state (HHNKS), 327 Hyperkalemia, 236, 237–239 causes of, 237t serum potassium concentration and EKG findings, 238f Hyperlipidemia, 232, 232f Hypernatremia, etiologies of, 235f Hyperoxia, 44 Hyperphosphatemia, 242, 244 Hyperproteinemia, 232 Hypersplenism, 311 Hypertension, 139, 140 renal disease, 143 Hypertensive crises, 139–147 classification of, 140 emergencies, 140–141 epidemiology of, 139 hypertension, determination of, 139 medication options for, 141t pathophysiology of, 139–140 pharmacology of captopril, 147 clevidipine, 146 clonidine, 146–147 enalaprilat, 146 esmolol, 146 fenoldopam mesylate, 144 hydralazine, 145 labetalol, 145–146 nicardipine, 146 nitroglycerin, 144–145 phentolamine, 146 sodium nitroprusside, 144 presentations of aortic dissection, 144 cardiac ischemia, 143 congestive heart failure (CHF), 142–143 encephalopathy, 141 pregnancy, 143–144 renal failure, 143 stroke syndromes, 141–142 Hypertensive emergency, dosage of medication, 145t Hypertensive encephalopathy, 141 Hypertensive/hypervolemic therapy, 290 Hypertensive urgency, 140 Hyperthermia, 349 malignant, 428 pathophysiologic mechanisms for, 427 Hypertonic saline, 272, 301 Hypertonic sodium (HS) solutions, 515 Hyperventilation, 34, 38, 152, 215, 225, 272, 288, 300 risks cerebral vasoconstriction, 152 Hypervolemic hyponatremia, 233 Hypoglycemia, 176, 211 Hypoglycemic seizures, 344 Hypokalemia, 226, 234, 236–237 causes of, 236t treatment of, 237 Hypomagnesemia, 242 Hyponatremia, 231 etiologies of, 232f hyperosmolar, 231–232 hypoosmolar, 232–233 iso-osmolar, 232 treatment of, 233 Hypoperfusion, 294 Hypophosphatemia, 243 causes of, 243t Hypotension, 107 drugs and medications, 427t heart rate and ECG abnormalities, 425t Hypothalamic–pituitary–adrenal (HPA) axis, 340, 343, 344f, 345, 345t Hypothermia, 272 583 Hypothermia Network Registry, 545 Hypoventilation, 31, 34, 81, 103f, 522t drugs and medications, 421t Hypovolemia emesis and diaphoresis, 449 mean arterial pressure (MAP), 555 Hypovolemic hypernatremia, 234 Hypovolemic hyponatremia, 232 Hypovolemic shock, 497 treatment of, 163 Hypoxemia, 31, 57, 82, 83, 90t, 104, 295, 551, 554 Hypoxemic respiratory failure, 81 hypoventilation, 81 mechanical ventilation (MV), 81 ventilation–perfusion (V/Q) mismatch, 81 Hypoxia, 35, 59, 100, 112, 295, 316, 496, 531, 553 Hypoxic pulmonary vasoconstriction (HPV), 83 I IBW See Ideal body weight (IBW) ICH See Intracranial hemorrhage (ICH) ICP See Intracranial pressure (ICP) ICU beds, 3, 24 ICU for hyperglycemic control, 340 Ideal body weight (IBW), 519, 520f, 522 Idiopathic thrombocytopenia purpura (ITP), 311 IE See Infectious endocarditis (IE) IgG immune antibody, 402 Immunosuppressive medications, 359 Infectious causes, of fever, 353 See also Fever central nervous system (CNS) infection, 353 diarrhea, 353 immunocompromised patients, 354 intravascular devices, 353–354 pneumonia, 354 postoperative fever, 354 sinusitis, 354 urinary tract infection, 354 Infectious Disease Society (IDSA), 403 Infectious endocarditis (IE), 391 classifications of, 391 complication occurs in, 393–394 diagnostic criteria for, 396 disease prevention, 398t drug for, 395 etiology of, 392f ICU admissions, 395 microbiology of, 183t, 392–393 mortality in, 397 nosocomial endocarditis, 395–396 pathogenesis of bacterial valve colonization, 392f presentation of, 393 abdominal CT scan with IV contrast, 394f prosthetic valve endocarditis (PVE), 395 recommendations for prophylaxis, 397–398 Streptococcus pyogenes endocarditis, 393f surgical treatment for, 397 transthoracic echocardiography (TTE), 396, 396f treatment for, 396–397 Inferior vena cava (IVC), 456 Inflammations, 316 584 INDEX Inotropes, 159, 161, 172, 374, 377t, 559f Inspiratory positive airway pressure (IPAP), 55, 552 Insulin–euglycemia therapy, 425 Insulin-like growth factor-1, 280, 340 Insulin therapy, risks of, 177 Intensive care unit (ICU), 31, 71, 139, 333, 345, 359 vasopressors/inotropes, use of, 160 Intensive care units (ICU), 3, 345, 569 Interleukin (IL) 1, 351 Interleukin (IL)-1 receptor antagonist, 372 Internal jugular (IJ) approach, 211 Internal jugular vein, 119, 482f International Sepsis Definitions Conference (ISDC), 371 International subarachnoid aneurysm trial (ISAT), 289 Intraaortic balloon counterpulsation (IABP), 151 Intra-aortic balloon pump (IABP), 169 Intracerebral hematoma expansion, within bifrontal contusions, 298f Intracranial hemorrhage (ICH), 285 medical management of airway management, 286 blood pressure, 287 considerations for, 288 hematoma expansion, minimizing, 287 intracranial pressure, increased, 287–288 presentation and diagnosis, 285–286 subarachnoid hemorrhage, 288–291 aneurysmal SAH treatment, 289–290 medical management of, 290–291 Intracranial hypertension, acute, 269, 270 See also Intracranial pressure (ICP) cerebral autoregulation, 269–270 clinical signs of, 270 herniation syndromes, 270 indications for monitoring, 270 management of, 271 barbiturates, analgesia, & paralytics, 272–273 decompressive craniectomy, 273 hemodynamics, 272 hyperosmolar therapy, 272 hyperventilation, 272 position, 271–272 temperature, 272 radiographic signs, 270 radiographic signs of, 270 Intracranial pressure (ICP), 141, 210, 269, 531 definition of, 269 indications for monitoring, 270, 271f measurement of, 271 monitoring, indications, 270–271 position, 271–272 pressure–volume curve, 270f Intramuscularly (IM) injection, 164 Intravenous fluid (IVF), 112 Intravenous fluid bolus, 424 Intravenous fluid composition, distribution, 513t Intravenous immunoglobulin (IVIG), for treatment of CDI, 405 Intravenous (IV) insulin infusion, to reduce BG levels, 340 Intravenous magnesium, 153 Intravenous magnesium sulfate, 104 Intravenous (IV) thrombolytic therapy, 275 Intraventricular monitor, 214 Intubated asthmatic patient, initial ventilator settings for, 107 Intubating introducer, 14–15, 15f Intubating LMA (I-LMA), 18 Ionized hypocalcemia, causes of, 241t Ipecac, 414, 441, 450 Iron tablet overdose, 414f Iron toxicity, 200 Ischemic infarction, acute, 275–277 Ischemic stroke, acute, medical management, 277–280, 278f, 279f, 280f AHA/ASA guidelines, 278 Isoproterenol, 162 Isotonic sodium-based crystalloids, 513 composition of, 513t IVC diameter, subxiphoid IVC view, 470f IVDA population, risk of IE, 393 IV solutions, sodium concentrations, 234t J Jugular venous pressure, estimation of, 120f Jugular venous pulsation (JVP), 119, 120, 190 K Kaposi’s sarcoma, 185 Kassirer–Bleich equation, 221 Ketamine, 419, 432 Ketoacidosis, 222 β-hydroxybutyrate in, 226 Kidney injury, acute, 173 Kidneys, functions, 247 Killip classification, 134t King airway, 18f King’s College Hospital criteria, for ALF, 209t Korotkoff sounds, 118 L Labetalol, as blood pressure–lowering agent, 145–146 Laceration, 28 Lactate, conditions, 124t Lactated Ringer’s (LR), 514 Lactic acidosis, 222, 226, 228 Landstuhl Regional Medical Center (LRMC), 565 Laplace law states tension, 198 Laryngeal mask airway (LMA), 17–18, 17f, 21 Laryngoscopy, 450 Late airway complications, 28 Left bundle branch block (LBBB), 129 Left ventricular (LV), 121 Left ventricular assist device (LVAD), 498 Left ventricular outflow tract (LVOT), 459 Left ventricular outflow tract (LVOT) diameter (LVOT D), 459 Left ventricular (LV) stroke, 168 Leiomyomas, 197 Leukocytes, 316 Levetiracetam mechanism, 432 use of, 302 Lidocaine spray, 214 Life-threatening decompensation, Life-threatening episode, of acute adrenal insufficiency, 344 Lighted stylet, 14 Linton-Nachlas tube, 201 Lipid emulsion, 426 Lipid emulsion therapy, 425 Lipopolysaccharide (LPS) endotoxin, 351 Lithium, 234 Liver biopsy, 210 Liver failure, acute, 207, 208 encephalopathy, response head CT scan, 213–214 ICP interaction, principles of, 214 ICP monitoring, 214–215 intubate, 214 mechanical ventilation, 214 mental status, 212–213 osmotic therapy, hypothermia, 215–216 laboratory screen on, 209t MICU, admission checklist, 216f neurologic assessment of, 213 patient management, information sharing, 216–217 recognize, diagnose, exclude mimics, and provide early transplant triage, 207 epidemiology, etiology, and outcomes, 208 laboratory tests, 208–209 prognosticating from first contact, 209 suspect and diagnosis, 208 supportive therapy antibiotics, recommendations, 210 bleeding risk, management, 210 central line timing and safety issues, 211 electrolyte and fluid management, 211 emerging therapeutic options, 212 hemodynamic support, 210 renal replacement therapy, 211 therapeutic initiatives, 211–212 Locked-in syndrome (LIS), 264, 264f Long-term ICU patient, Lower extremity DVT, 315 Lower gastrointestinal bleeding (LGIB), 197 causes of, 198t Ludwig’s angina, Lung hyperinflation, 107 Lung hyperinflation, critical, 107 Lung-injured patient nutritional support for, 94 Lung injury, acute, 33, 81, 89 risk factors for, 92 Lung injury scoring, 90t Lung recoil pressure, 100 Lungs early vs delayed extubation, 171–172 pulmonary complications, 172 pleural effusions, 173 postoperative pulmonary dysfunction (PPD), 172–173 pulmonary edema, 173 pulmonary management following extubation, 172 recruitment begins and ends pressures, 95f LVOT outflow waveform, Doppler tracing, 469 LVOT spectral Doppler waveform, 470f INDEX M Machines, various settings for renal support, 256 Macrocirculatory signs, 151 Magnesium deficiency, 239–240 causes, 240 diagnosis, 240, 240t treatment, 240–241 Malicious exposures, 413 Malignant hyperthermia (MH), 350, 427 Mallory–Weiss (MW) syndrome, 197 Malnutrition, 439 classification, 520t Mannitol, 215 for treatment of intracranial hypertension, 272 May–Thurner syndrome, 320 MDR pathogens, 386 Mean airway pressure (Pma), 55 Mean arterial blood pressure (MAP), 498 Mean arterial pressures (MAPs), 117, 141, 159, 168, 210, 543 Mechanical ventilation (MV), 31, 81, 92 basic physiology, 32–33 peak inspiratory pressure, 32–33 plateau pressure, 32–33 respiratory rate, 32f ventilation/perfusion (V/Q) mismatch, 32 indications for, 31–32 initial settings, 36–37 modes of, 33–35, 34f A/C mode, 34f A/C vs SIMV mode, 35f CPAP/PSV mode, 36f SIMV mode, 35f oxygenation vs ventilation, 36 pediatric patients, 554t risks of, 33 specific scenarios, 37–38 target of, 35–36 troubleshooting, 38–39 Medication dosing for patients on CVV, 256 mental status See also Altered mental status (AMS) categories, 262t Glasgow Coma Scale (GCS), 262t Mesothelioma, 186 Metabolic acidosis, 226 Metabolic alkalosis, 222 characterization, 225t common causes, 226t Metabolic dysfunction, 294 Methemoglobinemia, 422 Methicillinresistant Staphylococcus aureus (MRSA), 365 Methylene blue dosing of, 422 Methylenedioxymethamphetamine (MDMA), 410 Midazolam, 153, 214, 264, 286, 431, 432 Milrinone, 162 in cardiac surgery, 168t Mineralocorticoids, 226, 343 Minimally conscious state (MCS), 264 Monocytes, 316 Morphine, 131 MR venography, to diagnosis DVT, 320 Multidrug-resistant (MDR) organisms, 363 Multiple brain abscesses, associated with bacterial endocarditis, 394f Multiple organ dysfunction syndrome (MODS), 499 Multistep approach to patient- and family, 570f Myasthenia gravis (MG), 84 myocardial infarction, acute, 162 Myoglobin, 130 N NAC dosing, for adult and pediatrics, 442t N-acetylcysteine, 174, 436 N-acetyl-p-benzoquinone imine (NAPQI), 436 Na–K-ATPase channels, 200 Nasal/oral airways, 550 Nasogastric tubes (NGT), 440 National Healthcare Safety Network (NHSN), 359 National Institute of Neurological Disorders and Stroke (NINDS), 275 National Nosocomial Infections Surveillance (NNIS), 359 National Registry of Cardiopulmonary Resuscitation (NRCPR), 542 National Spinal Cord Injury Statistical Center (NSCISC), 294 Nebulizer therapy, 106 Neck anatomy, 22f Neck, framework airway, 530f Needle cricothyroidotomy, 21, 22, 24, 26–27 complications in, 28 equipment for, 27t technique for, 27–28 Needle cricothyrotomy, 18 Needle–probe relationship, 480f Negative inspiratory forces (NIF), 84 Neurocognitive deficits, 176 Neurogenic shock, 164, 557 Neuroleptic malignant syndrome epidemiologically, 429 lab testing, 429 pharmacologic therapy for, 429 Neuroleptic malignant syndrome (NMS), 349 Neurologic complications incidence, 175–176 patients, at risk, 176 postoperative care, 176 Neurologic failure, 152 Neurologic injury, 175 Neurologic recovery, prognostication of, 152 Neuromuscular blockade, 21, 107 medications used for, 107 Neuromuscular diseases, 81, 84 Neuromuscular weakness, 108 Neuronal injury cascade of, 153 Neuroscience intensive care unit (NICU), 287 Neurotransmitters, 295 Nicardipine, 143 blood pressure, 146 Nielsen study, cooling method, 545f Nimodipine, oral, 290 585 NIPPV See Noninvasive positive pressure ventilation (NIPPV) Nitrogen balance study, 521 Nitroglycerin, 144 in cardiac surgery, 168t Nitroprusside in cardiac surgery, 168t hypertension-induced acute renal failure, 143 pressure-lowering agent, 144 NIV, See Noninvasive positive pressure ventilation (NIV) N-methyl-D-aspartic acid (NMDA), 212 Non-AG metabolic acidosis, 227 common causes, 227t Noncardiogenic pulmonary edema (NCPE), 173 Nonconvulsive status epilepticus AMS associated with, 263–264 Nonhemorrhagic volume loss anatomic sites of, 510t Noninfectious causes of fever drug fever, 352 head injury, 352–353 heatstroke, 353 neurologic causes of fever, 353 Noninvasive positive pressure ventilation (NIV), 55 acute cardiogenic pulmonary edema, 62–64 ARDS and acute lung injury (ALI), 65–66 asthma, 64–65 COPD and hypercarbic respiratory failure, 60–62 effectively treat hypoxia, 59 oxygenation and mean airway pressure, 60f immunocompromised patient, 64 initial settings and patient monitoring, 58–59 NIV monitoring, 58t patient selection, 57 patients with a DNI, 66–67 physiology of, 55 nomenclature, 55 pneumonia, 65 ventilation and work of breathing, 59, 59f Noninvasive positive pressure ventilation (NPPV), 86, 104, 551 Nonsteroidal anti-inflammatory drugs (NSAIDs), 172, 196, 200, 233t, 355 Non-ST-segment elevation myocardial infarction (NSTEMI), 127, 128 Norepinephrine, 160, 161, 164 in cardiac surgery, 168t Normal saline (NS), 511 Normocarbia, 152 Normoglycemia in Intensive Care Evaluation—Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial, 176 Nosocomial pneumonia (NP), 383 clinical diagnosis of, 385t management algorithm, 387f risk factors for multidrug resistance, 383t NPPV See Noninvasive positive pressure ventilation (NPPV) Nuclear scintigraphy, 202 586 INDEX Nutritional support, in critical care nutrition status, assessment of calorie/protein requirements, calculation of, 521–522 components, 519–520 laboratory values, 520–521 route of adjunctive therapy, 525 enteral nutrition (EN), 523–524 parenteral nutrition, 524–525 specific disease states, guidelines for, 525–526 Nutrition support, 519 O Obesity, 9, 73t, 317t, 520t, 521 Obstructive lung diseases (OLDs), 100 acute exacerbations of, 104 Ohm’s law, 56 Oliguria, 211 Opioid, 411 Oral potassium supplementation, 237 Organ oxygenation experimental monitoring techniques, 124 lactate, 124 venous oxygen saturation monitoring clinical use of, 123–124 Oropharyngeal airways (OA), 550 Orotracheal intubation maneuvers, 12–13 direct laryngoscopy (DL), 12–13 Orthogonal polarization spectroscopy (OPS), 124 Osmolality, medications, 524t Osmolar gap, 272 Osmotherapy, 300–301 Out-of-hospital cardiac arrests (OHCA), 542 Oxidative phosphorylation, 421 Oxygen delivery, 494f, 495f Oxygen diffusion, 82 Oxygen extraction fraction (OEF), 269 Oxygen saturation (SaO2), 110, 222 of arterial hemoglobin, 44 P Packed red blood cells (PRBCs), 199, 307 Packed red blood cell transfusion, 307 Palliative care, Pancreatitis, acute, 526 Paradoxically, 294 Paralyzing, 553 Parenteral nutrition (PN), 523 Parkland formula, 516t Partial pressure of oxygen, 44 Partial thromboplastin time (PTT), 132, 253 Passive leg raising (PLR), 121, 512 Pathogenesis of fever, 350f Pathogenic fungal organisms encountered in critical care, 367 Patient-controlled analgesia (PCA), 172 Patient management tool, 217f Patients with acute stroke (CVA), 337 with DVT vena caval filters for the, 323 and noninvasive ventilation interface, 57–58 with severe sepsis in CVVHF, 257 PDT See Percutaneous dilatational tracheostomy (PDT) Peak expiratory flow rate (PEFR), 102 measurement of, 102 Pediatric considerations airway initial airway management, 549–550 medications, 550–551 oxygen administration, 550 placement, 550 respiratory distress, recognition of, 549 ventilation, 551 breathing intubation, 552 invasive positive pressure ventilation, 552 mechanical ventilation, 554–555 noninvasive positive pressure ventilation (NIPPV), 551–552 rapid sequence intubation (RSI), 553–554 circulation categorizing and treating shock, 555–557 recognition, 558–559 septic shock, 557–558 further interventions goals of, 559–560 Pediatric patients, approximate normal vital signs, 550t Pediatric resuscitation, common medications, 550t Pediatric septic shock diagnosis of, 558 management of, 559f treatment, goal, 558 Pediatric transfer systems, 563 PEEP See Positive end-expiratory pressure (PEEP) Penetrating brain injury, 299 Percutaneous coronary intervention (PCI), 128 Percutaneous dilatational tracheostomy (PDT), 529 anatomy of, 530f anticoagulation considerations, 531–532 complication of, 536–537 Fantoni translaryngeal tracheostomy, 536 indications and timing, 532–533 patient selection for anatomy and anatomic issues, 529–531 procedural considerations, 533 techniques for Blue Rhino™, 535 ciaglia sequential dilators, 533–535 Griggs technique, 535 PercuTwist™, 535 tracheotomy tube care, 537–538 tracheotomy tube, management of, 537 traumatic brain injury (TBI), 531 ventilatory considerations, 532 Percutaneous tracheostomy, complications of, 536 Perfusion monitoring, 123–124 experimental monitoring techniques, 124 lactate, 124 venous oxygen saturation monitoring, 123 clinical use of, 123–124 Pericardial disease, 185 categories of, 182t Pericardial diseases, 182 anatomy and function, 181–182 pathophysiology of, 182–191 constriction, 189–191 infectious pericarditis, 183 autoreactive, 186 bacterial, 183–184 fungal, 184 HIV infection, 185 myocardial infarction, 185–186 neoplastic, 186 renal failure, 185 tuberculous, 185 traumatic tamponade, 186–189 Pericardial inflammation, stages, 182 Pericardial tamponade, 186 common risk factors for, 186t Pericardiocentesis, 485f paraxiphoid technique, 190 Peripheral vein longitudinal view of, 484f short-axis view of, 483 Persistent vegetative state (PVS), 261 Pharmacokinetics antimicrobials, not require dosage adjustments, 362t drug concentrations hepatic dysfunction, 361–362 renal dysfunction, 361 volume of distribution and drug concentrations, 361 Phased array probe, 478f Phased array transducer, 456f Phencyclidine, 41t, 352, 419, 427t Phentolamine, 145, 146, 426 myocardial ischemia, setting of, 146 Phenylephrine, 162 in cardiac surgery, 168t Phlegmasia cerulea dolens, 321, 321f Plateau pressure (Pplat), 107 Platelets, 75, 76, 128, 131, 199, 209t, 311, 316, 321, 392, 532 therapy, 131–132 Pleural effusions, 83, 172, 173, 485 hyperechoic line, 485f Pneumomediastinum (PM), 536 Pneumonia, 41, 172, 383 See also Health care-associated pneumonia (HCAP); Nosocomial pneumonia (NP) diagnosis of, 385–386 epidemiology of, 384 microbiology of, 384–385 pathophysiology of, 384 prevention for, 387–388 treatment for, 386–387 Pneumothorax (PTX), 24, 28, 60, 75, 107, 121t, 122, 152, 154, 486, 491, 536, 563 Point-of-care echocardiography, 455 apical four-chamber probe placement, 460f atrial collapse, right apical four-chamber view, 465f cardiac arrest, subxiphoid four-chamber view, 461f INDEX clinical indications, 456 clinical scenarios for in cardiac arrest, 460–462 to estimate central venous and RV filling pressures, 470–472 to estimate left ventricular systolic function, 465–466 qualitative estimation of, 466–467 quantitative estimation of, 467–470 to identify pericardial effusion and tamponade physiology, 462–465 pea/shock states, differentiation of, 474–475 right heart strain, acute evaluation of, 473–474 EF/EPSS parasternal long-axis view, 468f EF/M-mode parasternal short-axis view, 467f in emergency department, 455 heart, apical four-chamber view, 461f heart, papillary muscles of parasternal short-axis view, 460f heart, parasternal long-axis view of, 459f heart, subxiphoid four-chamber view, 457f imaging windows apical four-chamber view, 459–460 parasternal long-axis view, 458–459 parasternal short-axis view, 459 subxiphoid four-chamber views, 456–457 subxiphoid longitudinal IVC views, 457–458 liver/RV subxiphoid four-chamber view, 464f liver, subxiphoid IVC view, 463f LV/EF parasternal long-axis view, 466f, 467f, 469f parasternal short-axis view, 467f LV end-diastolic (LVDd) parasternal long-axis view, 469f mitral inflow Doppler, 465f MV/EF parasternal long-axis view, 468f parasternal long-axis probe placement, 458f parasternal short-axis probe placement, 459f pericardial effusion apical four-chamber view, 463f parasternal long-axis view, 463f subxiphoid IVC view, 465f pericardial fat pad, subxiphoid fourchamber view, 462f phased array transducer, 456, 456f practice, scope of, 455 qualitative echocardiography, 463 right ventricular dilation apical four-chamber view, 473f subxiphoid four-chamber probe placement, 457f subxiphoid four-chamber view, 474f subxiphoid IVC M-mode, 458f, 471f, 472f subxiphoid IVC probe placement, 457f subxiphoid IVC view, 458f, 471f technical considerations, 456 training, 460 Point-of-care ultrasound, 455 Point of maximum impulse (PMI), 459 Poisoned patient, critically ill airway/respiration, compromise affects, respiratory drive and ventilation, 421 cellular respiration, affecting, 421 carbon monoxide, 422 cyanide toxicity, 423 methemoglobinemia, 422 endotracheal intubation, 419–421 cardiovascular depression, 423–426 β-blocker cardiovascular depression, 424 caffeine/theophylline hypotension, 426 calcium channel blocker cardiovascular depression, 424–425 clonidine cardiovascular depression, 426 digoxin cardiovascular depression, 424 hyperinsulinemia/euglycemia therapy, 425 hypotension/bradycardia, 423 intravenous fluid bolus, atropine, and pressors, 424 lipid emulsion therapy, 425–426 tricyclic antidepressant hypotension, 424 cardiovascular stimulation, 426–427 hyperthermia, 427–430 malignant, 430 neuroleptic malignant syndrome, 429–430 serotonin syndrome, 428–429 toxin-induced seizure, 430–432 barbiturate, 432 management of, 430, 431 propofol, 432 third-line anticonvulsants, 432 valproic acid/midazolam, 432 Poison exposure, 409 See also Poisoning Poisoning common findings in, 410t, 411t decontamination of antidotes, 416 external and ocular, 414 gastrointestinal, 414–415 drug absorption, prevention, 414–416 dysrhythmias, 412 enhanced elimination of toxin, 415–416 history of, 409 laboratory and diagnostic assays abuse screening, drug of, 413 electrocardiograms, 411–412 imaging, 413–414 quantitative assays, 413 routinely indicated assays, 412–413 physical examination, 409–411 adrenergic (sympathomimetic), 410 anticholinergic, 411 cholinergic, 411 opioid, 411 sedative–hypnotic, 411 Polyethylene glycol–electrolyte solution (PEG–ES), 415 Polymicrobial infections, 365 587 Polyunsaturated fatty acids (PUFA), 94 Polyuria, 242 Positive end-expiratory pressure (PEEP), 55, 56, 89, 106, 152, 170, 214, 286, 532, 550 lung-protective ventilation, 95 patient breathing, 95 recruit alveoli, 171 Positive inspiratory pressure (PIP), 554 Post-arrest patients, care of pitfalls in, 154t Postarrest syndrome, Post–cardiac arrest care, Post-cardiac arrest disease, 150 Post-cardiac arrest management, 149–154 cerebral injury, 152–153 hemodynamic resuscitation, 150–151 myocardial dysfunction, 151 mechanical ventilatory support, 152 precipitating pathology coronary syndrome, acute, 151–152 dysrhythmia management, 152 resuscitation, 152–153 syndrome cardiovascular dysfunction, 149–150 therapeutic hypothermia, 153 miscellaneous, 154 seizures, 154 Post-cardiac arrest patient, 155 Post–cardiac arrest syndrome, 541 Posterior circulation syndromes, 277t Posterior cord syndrome, 297 Postintubation care, 554 Post-ischemic organ blood flow metabolic conditions of, 152 Postoperative atrial fibrillation, management of, 170f Postoperative bleeding management of, 171t Postoperative pulmonary care, 171 Postoperative pulmonary dysfunction (PPD), 172 Post-resuscitation cardiovascular status, 150 Post-resuscitation disease, 149, 150t Post-ROSC shock, 149 Postthrombotic syndrome, 324 Postthrombotic (phlebitic) syndrome (PTS), 320 Post-traumatic seizure (PTS), 299 Potassium disorders, 234t Practice environment, Prealbumin, nutrition status, marker of, 521 Preeclampsia, 106, 141t, 143 Pregnancy-associated hypertensive disorders classification of, 143 Prehypertension, 140 Preventilation abnormalities, 33 Primary respiratory acidosis, 222 Primary respiratory alkalosis, 222 Proinflammatory cytokines, 149 Propofol, 48, 106, 214, 286, 420t, 431, 432, 553 Prosthetic valve endocarditis (PVE), 395 Prothrombin complex concentrates (PCC), 210 Prothrombin time (PT), 309 Proton pump inhibitors (PPIs), 195 588 INDEX P-selectin, 316 Pseudomonas aeruginosa, 393 Pulmonary angiography, 110 Pulmonary artery catheter (PAC), 113, 167 Pulmonary artery catheter, hemodynamic variables, 122t Pulmonary artery catheters (PAC) use of, 93 Pulmonary artery occlusion pressure (PAOP), 89 Pulmonary capillary blood alveolar gas, equilibration of, 82 Pulmonary dysfunction, 532 Pulmonary edema, 82 Pulmonary embolism (PE), 109 amniotic fluid embolism, 113–114 clinical features, 109 diagnostic testing, 110 chest x-ray (CXR), 110 electrocardiogram (EKG), 110 oxygen saturation (SaO2 ), 110 and pregnancy, 111 pretest clinical probability, 111–112 risk stratification, 111–112 treatment of, 112–113 fat/bone marrow, 113 rule out criteria, 112t thromboembolic, 109, 114 deep venous thrombosis (DVT), 159 venous air emboli, 113 Well’s criteria, 111, 112t Pulmonary function tests, 102 Pulmonary tuberculosis, 185 Pulsatility index, transcranial Doppler assessment of, 214 Pulseless electrical activity (PEA), 108 cardiac arrests, 543 Pulse oximetry, 44, 104 Pulse pressure variation (PPV), 93 Pump failure, 83, 473, 497, 555 Pyridoxine, dosing, 431 Q QRS complex, 129, 238f Quinine, 415 Quinolones, 202, 361 R Rapid sequence intubation (RSI), 553 medications list of, 553t Rapid shallow breathing index, 42–43 Rapid shallow breathing index (RSBI), 171 RBC transfusion benefits of, 307 drawbacks of, 308 guidelines regarding, 309, 310t transfusion threshold, 308 Recombinant erythropoietin (EPO), 311 Recombinant human activated protein C (rhAPC) infusion, 254 Recombinant tissue plasminogen activator (rt-PA), 287 contraindications to, 281t treatment of acute ischemic stroke, 275 Refractory hypotension, 199 Renal failure (RF), 247 acute, 143, 161, 174, 176, 247, 397, 498, 525 anticoagulation, 253–254 requirement, situations, 254 argument, final, 250 basic RRT circuit—CVVHF, 251–252 chronic, 249 CVVHD, 252 CVVHF/CVVHD, combination of, 255–256 fever, evaluation of, 257 filter, 255 fluid, removing, 252 future directions, 257 in ICU patients, 247 ICU patients, incidence of, 247 labs, 255 machines, different, 256 medication dosing, 256 prefilter and postfilter, 252–253 renal support background for, 248–249 indications for, 248 renal support, termination, 256 RRT setup, 252 sepsis, 257 simplest circuit-SCUF, 250–251 substitution fluids, 254–255 vascular access, 251 Renal injury, 173–175 prognosis, 174–175 protection, 174 Renal insufficiency, 442 Renal replacement therapy (RRT), 174, 248, 361 categories of continuous renal replacement therapy (CRRT), 248 intermittent renal replacement therapy (IRRT), 248 continuous venovenous hemofiltration (CVVHF), 251–252 continuous venovenous renal replacement therapy (CVVRRT), 250 efficient setup, 252 fever, evaluation of, 257 fluid removing, 252 future directions, 257 renal support, 248–249 slow continuous ultrafiltration (SCUF), 250–251 Renal support background for, 248–249 follow mnemonic AEIOU RSI, 248 terminating, 256 Respiratory acidosis, causes of, 225t Respiratory alkalosis, causes of, 225t Respiratory cycle, 55 Respiratory depression, 432 Respiratory distress signs and symptoms, 550t Respiratory distress syndrome, acute, 555 Respiratory failure, 4, 81 Respiratory failure, acute, 81 arterial blood gas analysis in, 85, 85t common causes of, 82 definition of, 81 etiologies of, 81 hypercapnic respiratory failure alveolar ventilation, 83 cervical spinal cord injury, 83–84 ICU setting, 83 neuromuscular disorders, 84 hypoxemic respiratory failure diffusion, 82 hypoventilation, 81–82 shunt, 82 ventilation–perfusion, 82–83 intensive care unit (ICU), 81 mortality rates of, 81 patient approach, 84 acute management, 84 treatment options, 86 work of breathing, 85f Respiratory management, acute, 152t Respiratory pressure, 190 Respiratory quotients (RQ) traditional interpretation of, 522t Resuscitation CVP monitoring and, 119 by emergency physicians, hemodynamic, 150, 150t to minimize patient’s degree of shock, 93 post-arrest cerebral injury and, 152 Retrograde wire intubation, 16–17 Return of spontaneous circulation (ROSC), 149 RIFLE criteria, level of renal dysfunction, 248, 248f Rumack–Matthew nomogram, 436, 437f, 443 RV filling pressure, 473 S Salicylate metabolism, 448f, 451t Salicylate overdose, 447–451 clinical manifestations, 449 diagnostic testing, 449 history of, 448–449 management of, 449 alkalinization, 450 charcoal, 450 extracorporeal treatment, 450–451 gastric decontamination, 450 pharmacokinetics, 447 poisoning, pathophysiology of, 447–448 Salicylate overdose symptoms, 449t Salicylate poisoning, 449 Salicylate toxicity, 412 Salmonella, 393 SCCM/ASPEN guideline, 523 grading system, 522t Sedation medications used for, 107 Sedative–hypnotic, 411 Seldinger technique catheter, 25f kit, 24f for percutaneous cricothyroidotomy, 24 Sengstaken–Blakemore tube, 201 Sepsis, 4, 242 antibiotics and source control, 373–374 biomarkers of, 372 definition of, 371–372, 372t INDEX diagnostics in, 372, 372t early goal-directed therapy, 374–375, 375f activated protein c, 378 contraindications, 378t blood product administration, 376–377 corticosteroids and the septic patient, 377–378 fluid therapy, 375, 376t glycemic control, 379 inotropic therapy, 376 prophylactic unfractionated heparin, 379 prophylaxis, 379 vasopressor use, 376 exogenous vasopressors, 376, 377t ventilation with low tidal volume, 378–379 high-risk patients, identification, 373 pathogenesis of, 371 and quality initiative program, 379 sepsis resuscitation bundle by, 374t surviving sepsis campaign, 373 guidelines for management of, 375t Septic encephalopathy leading cause of AMS, 263 Sequential Organ Failure Assessment (SOFA) score, 210 Serotonin syndrome (SS), 427, 428t Serum alkalinization, 450 Serum bicarbonate concentration, 221–222 Serum cardiac biomarker analysis, 130 Serum creatine phosphokinase, 412 Serum cyanide levels, 423 Serum ethanol levels, 412 Serum osmolar gap measurement of, 412 Shikani endoscope, 15f Shock, 4, 493 cryptic shock, data, 500f differential diagnosis classification of, 497 cardiogenic shock, 497–498 distributive shock, 498 hypovolemic shock, 497 mixed shock, 498–499 obstructive shock, 498 differential diagnosis, mixed shock, 499 emergency department (ED) volume trends, 494f etiology, treatment, 163t hypotension and differential diagnosis of, 510t oxygen delivery, 494f, 495f pathophysiology, clinical implications of, 496 physical exam, presenting signs and symptoms, 497–498 structure and function, 494–496 treatment and disposition cryptic shock, 499–503 primary survey, 501–502 secondary survey, 502–503 disposition of, 503 types of, 556t Shock index (SI), 510 Shunting, 82 Simpson’s method apical four-chamber view, 469f Sinus bradycardia, 152 Sinus tachycardia, 509 Slow continuous ultrafiltrate (SCUF), 250, 251 Society of Critical Care Medicine (SCCM), 371 Sodium bicarbonate, 228 Sodium content of common IV solutions, 234t Sodium depletion, 232 Sodium disorders, 231 Sodium nitroprusside, 144 Sodium polystyrene sulfonate (SPS), 239 Sodium thiosulfate, 423 Somatostatin, 200 Sorbitol, 232 Soy-based lipids avoidance of, 525 Spectral Doppler gate apical five-chamber view, 470f Sphygmomanometry, 118 Spinal cord injury See Traumatic spinal cord injury (TSI) Spirometry, 102 Spontaneous breathing trial (SBT), 41–43 T-piece setup, close-up of, 43f S1Q3T3, EKG pattern of, 110 Square wave flush test, 118f Standard emergency department (ED), Staphylococcus aureus, 184, 351, 392 Starling’s cardiac function curve, 121 Starling’s law, 508t ST-elevation myocardial infarction (STEMI), 275 Sterile glove sterile probe cover, 479f Sterile probe sheath cord, 479f Steroid administration, 345 Streptococcus pneumoniae, 184, 392 Streptokinase, 133 Stress ulcers, 196 Stroke acute imaging in, 275, 277 management of, 275 thrombolysis in, 281–282 cyclic variation, 121 hemorrhagic, 142 interventional management of, 282 ischemic infarction, acute recognition of, 275–277 ischemic stroke, acute medical management of ABC’S, 277–280 glucose, 280 mortality, 142 Stroke volume (SV), 159, 555 Stroke volume variation (SVV), 93 ST-segment elevation myocardial infarction (STEMI), 127 Subarachnoid hemorrhage (SAH), 285 diagnosis of, 289 Subcutaneous emphysema (SE), 536 Subcutaneous (SQ) injection, 164 Substitution fluids, 254–255, 255t Subxiphoid pericardial ultrasound, 189f Superior vena cava (SVC), 496 Surgical cricothyroidotomy, 24 equipment for, 24t 589 Surgical decompression, 301 Surviving Sepsis Campaign, 309 Sympathetic nervous system, 426 stimulation, 426 Synchronized intermittent mandatory ventilation (SIMV), 554 Syndrome of inappropriate antidiuretic hormone (SIADH), 232, 291 Synergism, 365 Systemic inflammatory response syndrome (SIRS), 173, 242, 345, 371 Systemic oxygen delivery determinants of, 508f Systemic vascular resistance (SVR), 159, 498 Systolic blood pressure (SBP), 118, 543 T Tachycardia, 109 Temperature See also Fever effects on the host, 352 measurement, 351–352 TF-bearing microvesicles, 316 Thalamic hemorrhages, 285 Theophylline, 421 Therapeutic cooling, 153 guidelines, 153t physiologic changes, 154t Therapeutic hypothermia (TH), 4, 153, 541 adoption of, 544 2010 American Heart Association recommendations, 546f details of, 545–546 emergency department–specific concerns, 546 epidemiology of, 542 future directions, 546 history of, 542 implementation studies and databases, 544 pilot studies, 542–543 postarrest care, bundles of, 544–545 studies of, 543–544 trials, randomized, 543–544 Thienopyridine, 132 Thoracentesis potential complications, 485 Thoracic duct, 181 Thoracic electrical bioimpedance (TEB), 122 Thromboembolic pulmonary hypertension, chronic, 109 Thrombolysis, 151 in acute stroke, 281–282 Thrombolysis in myocardial infarction (TIMI) risk factors, 128t score, 128 thirty-day probability of, 128t Thrombolytics, 133 Thrombotic thrombocytopenic purpura (TTP), 311 Thrombus formation, 316 Thyroid cartilage, 22, 533 Tidal volume (Tv), 55, 56, 57 Tigecycline for treatment of CDI, 405 Tight glycemic control (TGC), 333 590 INDEX Tissue oxygenation, 503 Tissue plasminogen activators, 133 Total body water (TBW), 507 water distribution, 507 osmotic forces, 507 Total free water deficit, calculation, 235 Toxicologic syndrome, 409 Toxicology-related care, Toxic shock syndrome toxin (TSST), 351 Toxidromes common findings in, 411t Toxin enhancing elimination of, 415 lab values, 415t Toxin-induced illnesses, 428 Toxin-induced seizures management of, 430, 431 Toxins management of, 420t T-piece circuit, 43f Trachea, bronchoscopic evaluation of, 529 Tracheal intubation, failed, 17 Tracheostomy, 11 indication for, 533 overinflation of, 537 prolonged intubation, 532 trials, early vs late, 534t Transcutaneous Doppler ultrasound (TCDUS), 123 Transesophageal echocardiography (TEE), 396 Transfusion Requirements in Critical Care (TRICC) trial, 308 Transjugular intrahepatic portosystemic shunts (TIPS), 203, 212 Translaryngeal anesthesia, 17f Translaryngeal tracheostomy (TLT), 536 Transportation, hazards of, 562 Transporting critical care patients, 561 Transvenous pacemaker placement, 120 Trauma, patient, 309 systems, 563 Traumatic brain injury (TBI), 293–294, 309 classification of, 295–297 clinical severity of, 296 epidemiology, 293–294 etiologies of, 295 initial assessment of, 295–297 intensive care measures blood pressure and oxygenation, 299 brain oxygen monitoring, 301 cerebral perfusion pressure (CPP), 300 controlling intracranial pressure, 300–301 hypothermia, 301 intracranial pressure monitoring, 299–300 seizure prophylaxis, 302 steroids, 301–302 pathophysiologic mechanisms blood flow, 294 excitotoxicity, 295 inflammation, 294–295 metabolism, 294 radiographic evaluation cervical spine clearance, 297 head injury imaging, 297 spinal cord injury imaging, 297 spinal cord injury syndromes, 296–297 surgical indications, 297–299 depressed cranial fractures, 299 epidural hematoma, 298 parenchymal lesions, 298 penetrating brain injury, 299 posterior fossa mass lesions, 298 spinal decompression and stabilization, 299 subdural hematoma (SDH), 298 Traumatic parenchymal lesions, 298 Traumatic posterior fossa mass lesion, 298 Traumatic spinal cord injury (TSI), 293–294 classification of, 295–297 clinical severity of, 296 epidemiology, 293–294 etiologies of, 295 initial assessment of, 295–297 intensive care measures blood pressure and oxygenation, 299 brain oxygen monitoring, 301 cerebral perfusion pressure (CPP), 300 controlling intracranial pressure, 300–301 hypothermia, 301 intracranial pressure monitoring, 299–300 seizure prophylaxis, 302 steroids, 301–302 pathophysiologic mechanisms blood flow, 294 excitotoxicity, 295 inflammation, 294–295 metabolism, 294 radiographic evaluation cervical spine clearance, 297 head injury imaging, 297 spinal cord injury imaging, 297 spinal cord injury syndromes, 296–297 surgical indications, 297–299 depressed cranial fractures, 299 epidural hematoma, 298 parenchymal lesions, 298 penetrating brain injury, 299 posterior fossa mass lesions, 298 spinal decompression and stabilization, 299 subdural hematoma (SDH), 298 Trisodium citrate (TSC), 253 Trousseau’s signs, 241 Tumor necrosis factor (TNF), 351 U UGIB lesions embolization, 202 Ultrasound, 17 Ultrasound-guided critical care procedures, 477 arterial catheter placement, 484 central venous access, 479–483 femoral vein, 482–483 internal jugular vein, 481–482 subclavian vein, 482 chest tube placement, 487–488 dynamic vs static, 479 endotracheal intubation, 486–487 internal jugular vein (IJ) needle tip, 481f L3–L4 interspinous space static longitudinal view, 488f lumbar puncture, 488 needle-probe relationship, 481, 481f paracentesis, 486, 486f pericardiocentesis, 484–485 peripheral intravenous access, 483–484 probe selection, 477–478 setup, 478 short-axis schematic, 480f single- vs two- operator technique, 479 sterility, 478–479 tamponade, 484f thoracentesis, 485–486 trachea with endotracheal tube, 487f before intubation, 487f Ultrasound machine patient, relationship, 478f Unfractionated heparin (UFH), 112, 132 Unstable angina (UA), 127 Upper airway muscle dysfunction, 84 Upper extremity DVT, 320 Upper extremity (UE) thrombi, 320 Upper gastrointestinal angiodysplasia, 197 Upper gastrointestinal bleeding (UGIB), 195 Uremic pericarditis, 185 Urine anion gap (UAG), 227 V Valproic acid, 432 Vancomycin, 404 for infectious endocarditis, 397 for treatment of CDI, 404 Variceal bleeding endoscopic therapy of, 202 Vascular injury, 316 Vasculitis, 353 Vasculopathy, 286 Vasoactive agents inotropes, 159 vasopressors, 159 Vasoactive drugs, 159 Vasopressin, 161 in cardiac surgery, 168t in hemorrhagic shock, 201 Vasopressors, 159 physiologic actions of, 160t use, in the treatment of severe sepsis, 376, 377t Vasopressors/inotropes drugs adrenergic agonists function adrenergic receptors, 159 dopaminergic (DA) receptors, 159 clinical indications, 162 distributive shock, 163 anaphylaxis, 164 cardiogenic shock, 165 neurogenic shock, 164–165 septic shock, 163–164 INDEX hypotension, presumed etiology of, 162 hypovolemic shock, 163 nonadrenergic agonists cyclic adenosine monophosphate (cAMP), 159 vasopressin-specific receptor, 159 recptors α-adrenergic receptors, 159 β-adrenergic receptors, 159–160 dopaminergic receptors, 160 specific agents dobutamine, 161 dopamine, 160–161 epinephrine, 161 isoproterenol, 162 milrinone, 162 norepinephrine, 161 phenylephrine, 162 vasopressin, 161–162 use, in intensive care unit (ICU), 160 Vasopressor therapy, 558t Vasospasm, cerebral, 142 Venous air emboli, 113 Venous obstruction, chronic, 198 Venous oxygen saturation monitoring, 123 Venous stasis, 316 Venous thrombi, 315 Venous thromboembolism (VTE), 315 clinical presentation of, 317 Homan’s sign, 317 initial symptoms, 317 risk factors that promoting, 316–317, 317t Venous US, 318 diagnostic accuracy of, 318 Ventilation assist control (AC) mode of, 95 distribution of, 83 with low tidal volume, 378–379 Ventilation-perfusion (V/Q) mismatch, 81, 82 Ventilator-associated pneumonia (VAP), 383 Ventilator-induced lung injury (VILI), 31, 72, 92, 554 Ventilator management principles, 84 Ventilatory synchrony, 44 Ventricular arrhythmias, 169 Ventricular assist devices (VAD) use of, 169 Ventricular fibrillation (VF), 541 Ventricular filling schematic representation of, 187f Ventricular outflow tract, left spectral Doppler gate, apical five-chamber view, 470f Ventricular tachycardia (VT), 169 591 Ventricular tachycardia or fibrillation (VT/VF), 152 Video-assisted thoracoscopic surgery (VATS) use of, 184 Video laryngoscope, 13–14, 13f, 14f Vitamin K, 210 deficiency of, 200 Volumetric diffusive respirator (VDR-4), 565 von Willebrand factor (VWF), 200, 316 W Warfarin ingestion, 209 Weaning, 44 methods, 45–46 Wester-mark’s sign, 110 Wheezing, 100 Whole blood transfusions, 307 Whole bowel irrigation (WBI), 415 Willebrand factor, 198 Wilson’s disease, 208 Wintergreen, oil of, 447 Work of breathing (WOB), 83 Z Zollinger–Ellison tumors, 196 ... Trauma /Critical Care Virginia Commonwealth University Richmond, Virginia Transfusion in Critical Care Marie-Carmelle Elie-Turenne, MD Clinical Assistant Professor Emergency Medicine Critical Care Medicine. .. of Emergency Medicine University of Florida Gainesville, Florida Point-of -Care Echocardiography in the Emergency Department Alex Flaxman, MD, MSE Director, Emergency Medicine Critical Care Emergency. .. Department of Medicine, Section of Emergency Medicine Baylor College of Medicine Houston, Texas Transportation of the Critical Care Patient H Bryant Nguyen, MD, MS Director, Emergency Critical Care Associate