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(BQ) Part 1 book Fundamental critical care support - FCCS has contents: Airway management, cardiopulmonary cerebral resuscitation, diagnosis and management of acute respiratory failure, mechanical ventilation, neurologic support,.... and other contents.
Fundamental Critical Care Support Fifth Edition Copyright © 2012 Society of Critical Care Medicine, exclusive of any U.S Government material All rights reserved No part of this book may be reproduced in any manner or media, including but not limited to print or electronic format, without prior written permission of the copyright holder The views expressed herein are those of the authors and not necessarily reflect the views of the Society of Critical Care Medicine Use of trade names or names of commercial sources is for information only and does not imply endorsement by the Society of Critical Care Medicine This publication is intended to provide accurate information regarding the subject matter addressed herein However, it is published with the understanding that the Society of Critical Care Medicine is not engaged in the rendering of medical, legal, financial, accounting, or other professional service and THE SOCIETY OF CRITICAL CARE MEDICINE HEREBY DISCLAIMS ANY AND ALL LIABILITY TO ALL THIRD PARTIES ARISING OUT OF OR RELATED TO THE CONTENT OF THIS PUBLICATION The information in this publication is subject to change at any time without notice and should not be relied upon as a substitute for professional advice from an experienced, competent practitioner in the relevant field NEITHER THE SOCIETY OF CRITICAL CARE MEDICINE, NOR THE AUTHORS OF THE PUBLICATION, MAKE ANY GUARANTEES OR WARRANTIES CONCERNING THE INFORMATION CONTAINED HEREIN AND NO PERSON OR ENTITY IS ENTITLED TO RELY ON ANY STATEMENTS OR INFORMATION CONTAINED HEREIN If expert assistance is required, please seek the services of an experienced, competent professional in the relevant field Accurate indications, adverse reactions, and dosage schedules for drugs may be provided in this text, but it is possible that they may change Readers must review current package indications and usage guidelines provided by the manufacturers of the agents mentioned Managing Editor: Katie Brobst Printed in the United States of America First Printing, May 2012 Society of Critical Care Medicine Headquarters 500 Midway Drive Mount Prospect, IL 60056 USA Phone +1 (847) 827-6869 Fax +1 (847) 827-6886 www.sccm.org ePub International Standard Book Number: 978-0-936145-99-0 QED stands for Quality, Excellence and Design The QED seal of approval shown here verifies that this eBook has passed a rigorous quality assurance process and will render well in most eBook reading platforms For more information, please visit the QED Seal Web page Fundamental Critical Care Support Fifth Edition Editor David J Dries, MD, FCCM Regions Hospital Saint Paul, Minnesota, USA No disclosures FCCS Fifth Edition Planning Committee Marie R Baldisseri, MD, FCCM University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, USA No disclosures Thomas P Bleck, MD, FCCM Rush Medical College Chicago, Illinois, USA No disclosures Gregory H Botz, MD, FCCM University of Texas MD Anderson Cancer Center Houston, Texas, USA No disclosures Edgar Jimenez, MD, FCCM Orlando Regional Medical Center Orlando, Florida, USA No disclosures Keith Killu, MD Henry Ford Hospital Detroit, Michigan, USA No disclosures Rodrigo Mejía, MD, FCCM University of Texas MD Anderson Cancer Center Children’s Cancer Hospital Houston, Texas, USA No disclosures Rahul Nanchal, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures Don C Postema, PhD Regions Hospital Gillette Children’s Specialty Healthcare Bethel University Saint Paul, Minnesota, USA No disclosures Mary J Reed, MD, FCCM Geisinger Medical Center Danville, Pennsylvania, USA No disclosures Sophia C Rodgers, ACNP, FCCM University of New Mexico School of Medicine Albuquerque, New Mexico, USA No disclosures John B Sampson, MD Johns Hopkins Hospital Baltimore, Maryland, USA No disclosures Babak Sarani, MD George Washington University Washington, DC, USA No disclosures Janice L Zimmerman, MD, FCCM Methodist Hospital Houston, Texas, USA No disclosures Contributors Kent Blad, DNP, ACNP-BC, FNP-c, FAANP, FCCM Brigham Young University Provo, Utah No disclosures Steven M Hollenberg, MD, FCCM Cooper University Hospital Camden, New Jersey, USA No disclosures Sabrina D Jarvis, DNP, ACNP-BC, FNP-BC, FAANP College of Nursing Brigham Young University Provo, Utah No disclosures Zahid P Khan, MBBS, FCCM City Hospital NHS Trust Birmingham, UK No disclosures Gagan Kumar, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures Patti L Kunkel, CNP Henry Ford Hospital Detroit, Michigan, USA No disclosures Joshua M Levine, MD University of Pennsylvania Philadelphia, Pennsylvania, USA No disclosures Jayshil Patel, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures F Elizabeth M Poalillo, CCRN, MSN, RN, ARNP Pulmonary Practice of Orlando Orlando, Florida, USA No disclosures Bruce M Potenza, MD University of California San Diego San Diego, California, USA No disclosures Nitin Puri, MD Inova Fairfax Hospital Falls Church, Virginia, USA No disclosures Amit Taneja, MD Medical College of Wisconsin Milwaukee, Wisconsin, USA No disclosures Contents Preface Chapter Recognition and Assessment of the Seriously Ill Patient Chapter Airway Management Chapter Cardiopulmonary/Cerebral Resuscitation Chapter Diagnosis and Management of Acute Respiratory Failure Chapter Mechanical Ventilation Chapter Monitoring Oxygen Balance and Acid-Base Status Chapter Diagnosis and Management of Shock Chapter Neurologic Support Chapter Basic Trauma and Burn Support Chapter 10 Acute Coronary Syndromes Chapter 11 Life-Threatening Infections: Diagnosis and Antimicrobial Therapy Selection Chapter 12 Management of Life-Threatening Electrolyte and Metabolic Disturbances Chapter 13 Special Considerations Chapter 14 Critical Care in Pregnancy Chapter 15 Ethics in Critical Care Medicine Chapter 16 Critical Care in Infants and Children: The Basics Appendix Rapid Response System Appendix Endotracheal Intubation Appendix Airway Adjuncts Appendix Advanced Life Support Algorithms Appendix Defibrillation/Cardioversion Appendix Intraosseous Needle Insertion Appendix Temporary Transcutaneous Cardiac Pacing Appendix Thoracostomy Appendix Brain Death and Organ Donation Appendix 10 Infection Control Measures Appendix 11 Unfractionated Heparin Anticoagulation Appendix 12 Thromboprophylaxis for Venous Thromboembolism PREFACE This is the fifth edition textbook publication of the Fundamental Critical Care Support (FCCS) program of the Society of Critical Care Medicine Reflecting the continued growth of the FCCS program since its inception in 1994, this edition will be available in multiple languages, at hundreds of sites, in over 30 countries, and with a growing volume of online resources As with previous editions, the success of the program is built on the efforts of individuals who have volunteered their time and talents to present the important concepts and principles of fundamental critical care Our volunteers’ energy and compassion has been guided by key members of the SCCM staff: Gervaise Nicklas, MS, RN, Program Development Manager for FCCS; and Ms Katie Brobst, Managing Editor, Books, both of whom diplomatically kept the contributors on task We have expanded the disciplines represented among chapter contributors Major input to this fifth edition came from the FCCS, Fifth Edition Planning Committee In addition, the total list of contributors reflects input from approximately half of the international FCCS Program Committee As in the fourth edition, we have increased the emphasis on case-based education, with scenarios presented throughout the chapters and considerations highlighted in text boxes Online skill station materials, which accompany the text, also feature an interactive and case-based format Our goal is to present our students with problems that mirror clinical reality rather than emphasize the artificial confines of lecture topics The FCCS program continues to be a cornerstone of the Society of Critical Care Medicine’s education mission It is a concrete manifestation of our goal to provide the Right Care, Right Now™ David J Dries, MSE, MD Editor 2010-2012 Chair, FCCS Program Committee confirmed by detecting elevated serum levels of CK-MB or cardiac-specific troponins The delay in elevation of these markers, however, prevents their use to determine reperfusion therapy Cardiacspecific troponins are the optimum cardiac markers for the evaluation of patients with STEMI who have coexistent skeletal muscle injury B General Management Once STEMI is suspected or diagnosed, the immediate concerns are to ensure the patient’s stability and to intervene to limit infarct size by restoring blood flow to the infarct artery as soon as possible (Figure 10-5) Treatment of STEMI in the patient with other critical illness requires careful individualization Absolute and relative contraindications to therapies must be considered and relative risk assessed Choices may be limited by the availability of specialized procedures, the need to transport the patient to another facility, significant comorbidities, bleeding risk, or the unavailability of the oral route for administering medication Figure 10-5 Treatment Algorithm for Myocardial Infarction With ST Elevation Abbreviations: ECG, electrocardiogram; GP, glycoprotein; PCI, percutaneous coronary intervention Early Therapy Early therapy in STEMI is similar to the management of UA and NSTEMI Immediate 12-lead ECG, cardiac markers, and related laboratory tests should be completed Immediate therapy includes the administration of supplemental oxygen in the presence of dyspnea, hypoxemia, heart failure, or shock; the control of pain; and consideration of reperfusion therapy Aspirin should be administered immediately The addition of clopidogrel, prasugrel, or ticagrelor as part of dual antiplatelet therapy decreases the rates of mortality and major vascular events An anticoagulant agent should also be administered Because of its multiple salutary effects on myocardial oxygen demand and supply, nitroglycerin is indicated for the first 48 hours for treatment of persistent ischemia, hypertension, or heart failure, unless systolic blood pressure is 180/110 mm Hg) History of chronic severe hypertension Ischemic stroke >3 months ago or intracerebral pathology Current use of anticoagulants Traumatic or prolonged (>10 min) CPR or major surgery within past weeks Previous use of streptokinase/anistreplase: allergy or prior exposure (>5 days ago) Active peptic ulcer disease Recent internal bleeding (within past 2-4 weeks) Bleeding diathesis (hepatic dysfunction, use of anticoagulants) Noncompressible arterial or central venous puncture Abbreviations: ECG, electrocardiogram; CPR, cardiopulmonary resuscitation Table 10-10: Thrombolytic Agents Used in ST-Segment Elevation Myocardial Infarction Table 10-11: Killip-Kimball Hemodynamic Subsets Continuing Therapy Patients who undergo PCI with angioplasty, with or without stent placement, should be treated with aspirin, an adenosine diphosphate inhibitor (clopidogrel, prasugrel, or ticagrelor), and an anticoagulant agent Administration of clopidogrel or an alternative agent should be discussed with the cardiologist because the optimum duration may vary with the type of stent used (bare metal vs drug-eluting) Anticoagulation with heparin is continued Although fondaparinux reduces the bleeding risk in STEMI patients undergoing PCI, the risk of catheter thrombi is increased when fondaparinux is used alone An increased risk of stent thrombosis occurs with use of bivalirudin after PCI After thrombolysis with a plasminogen activator, heparin should be used to maintain vessel patency for at least 48 hours Enoxaparin is preferred over unfractionated heparin following thrombolysis Infusion rates of unfractionated heparin should be adjusted to keep the partial thromboplastin time at 1.5 to times the control value Heparin anticoagulation after use of streptokinase is not necessary; fondaparinux can be considered in these situations Patients with large anterior infarctions who not receive thrombolysis or PCI and patients who have intramural thrombus detected or suspected on echocardiography should receive heparin Aspirin (162-325 mg/day) should be continued Clopidogrel is the antiplatelet agent of choice in patients treated with thrombolytics who undergo delayed invasive reperfusion interventions Intravenous nitroglycerin, if tolerated, is recommended for 48 hours post-MI in patients with hypertension, recurrent ischemia, or heart failure In the absence of recurrent ischemia, heart failure, or arrhythmias, bed rest should not be continued beyond 12 to 24 hours Long-term use of oral β-blockers is helpful in all patients who are at risk for recurrent cardiovascular events and who have no contraindications to their use (Table 10-6) Oral β-blockers in STEMI can be initiated after the patient has stabilized Longer-acting calcium channel blockers may be a useful secondary therapy for recurrent myocardial ischemia but are not appropriate for first-line treatment Immediate-release nifedipine is contraindicated in treatment of an acute MI Diltiazem and verapamil are contraindicated in patients with STEMI and left ventricular dysfunction and heart failure Use of ACE inhibitors decreases the risk of mortality in all patients with STEMI The greatest benefit is seen in patients with left ventricular dysfunction (ejection fraction 100 mm Hg (pulmonary artery occlusion pressure >15 mm Hg, if available) and cardiac index