Handbook of Critical and Intensive Care Medicine

475 Pages·2016·8.733 MB·English

by  Joseph Varon (auth.)

Joseph Varon
Handbook of
Critical and Intensive
Care Medicine
Third Edition
123
Handbook of Critical
and Intensive
Care Medicine

Handbook of Critical
and Intensive
Care Medicine
Third Edition
Joseph Varon, MD, FACP, FCCP,
FCCM, FRSM
Professor of Acute and Continuing Care, The University
of Texas Health Science Center at Houston
Clinical Professor of Medicine, The University
of Texas Medical Branch at Galveston
Professor of Medicine and Surgery
UAT, UABC, USON, UPAEP, BUAP - Mexico
President Dorrington Medical Associates, PA
Houston, TX, USA
With 25 Illustrations
Joseph Varon MD, FACP, FCCP, FCCM, FRSM
Professor of Acute and Continuing Care
The University of Texas Health
Science Center at Houston
Clinical Professor of Medicine
The University of Texas Medical
Branch at Galveston
Professor of Medicine and Surgery
UAT, UABC, USON, UPAEP, BUAP - Mexico
President Dorrington Medical Associates, PA
Houston , TX , USA
ISBN 978-3-319-31603-1 ISBN 978-3-319-31605-5 (eBook)
DOI 10.1007/978-3-319-31605-5
Library of Congress Control Number: 2016941876
© Springer International Publishing Switzerland 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the
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The use of general descriptive names, registered names, trademarks, service marks,
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therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and
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implied, with respect to the material contained herein or for any errors or omissions
that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG Switzerland
T his book is again dedicated to my children
Adylle, Jacques, Daryelle, and Michelle for
their understanding as youngsters and adults,
about those countless days, nights, and
weekends, in which I was away from home
caring for those patients who needed me the
most at the time.
Joseph Varon, MD, FACP, FCCP, FCCM, FRSM

Prefa ce
Why write another book on the management of critically ill patients? When I wrote
the first edition of this book, over 20 years ago, I had realized the importance of a
small pocket book that would be useful for those caring for critically ill patients.
Over the past six decades we have seen an enormous growth in the number of inten-
sive care units (ICU) across the world. Indeed, it is estimated that a large proportion
of health-care expenses are devoted to patients in these specialized units. Medical
students, residents, fellows, attending physicians, critical care nurses, pharmacists,
respiratory therapists, and other health-care providers (irrespective of their ultimate
field of practice) will spend several months or years of their professional lives, tak-
ing care of critically ill or severely injured patients. These clinicians must have
special training, experience, and competence in managing complex problems in
their patients. Moreover, these clinicians must interpret data obtained by many kinds
of monitoring devices, and they must integrate this information with their knowl-
edge of the pathophysiology of disease. Even more important is the fact that anyone
working in an ICU or with a critically ill patient must approach patients with a
multidisciplinary team. The phrase t here is no I in TEAM comes to mind.
T his 3rd edition of this book was written for every practitioner engaged in
Critical Care Medicine across the world. I have attempted to present basic and
generally accepted clinical information, my own personal experience in the field,
facts and some important formulas, as well as laboratory values and tables which
we feel will be useful to the practitioner of Critical Care Medicine. The chapters
of this book follow an outline format and are divided by organ-system (i.e.,
neurologic disorders, cardiovascular disorders), as well as special topics (i.e.,
environmental disorders, trauma, toxicology). Every chapter has been updated
and many chapters are completely new.
It is important for the reader of this handbook to understand that Critical Care
Medicine is not a static field and changes occur every day. Therefore, this hand-
book is not meant to define the standard of care, but rather to be a general guide
to current clinical practice used in Critical Care Medicine. I wrote this book hop-
ing that it will benefit thousands of critically ill patients, but more importantly that
it will aid practicing clinicians to assume a multidisciplinary approach.
Joseph Varon ,
MD, FACP, FCCP, FCCM, FRSM

Contents
1 Approach to the Intensive Care Unit (ICU) .......................................... 1
Welcome to the ICU .................................................................................. 1
What Is an ICU? ................................................................................ 1
Historical Development of the ICU .................................................. 1
Economical Impact of the ICU ......................................................... 2
Organization of the ICU .................................................................... 2
Teamwork................................................................................................... 2
The Flow Sheet .......................................................................................... 3
The Critically Ill Patient ............................................................................ 3
System-Oriented Rounds ........................................................................... 4
Identification ...................................................................................... 5
Major Events Over the Last 24 h ...................................................... 6
System Review .................................................................................. 6
Do Not Resuscitate (DNR) and Ethical Issues .......................................... 9
2 The Basics of Critical Care ................................................................... 11
Cardiac Arrest and Resuscitation ............................................................ 11
The Alveolar Air Equation ...................................................................... 18
Oxygen Transport .................................................................................... 24
Mechanical Ventilation ............................................................................ 29
Hemodynamics ........................................................................................ 40
The Cardiopulmonary Interaction ............................................................ 46
Integrated Cardiopulmonary Management
Principles .................................................................................................. 48
3 Cardiovascular Disorders ..................................................................... 51
Ischemic Heart Disease ............................................................................ 51
Unstable Angina Pectoris ................................................................ 51
Myocardial Infarction ...................................................................... 54
Cardiac Pacemakers......................................................................... 62
Congestive Heart Failure ................................................................. 62
Cardiomyopathies ............................................................................ 64
Myocarditis ...................................................................................... 66
Pericarditis ....................................................................................... 66