Table Of Content

ACCP Critical Care Medicine Board Review: 20th Edition iii Contents Solid Organ Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Joshua O. Benditt, MD, FCCP Infections in AIDS Patients and Other Immunocompromised Hosts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 George H. Karam, MD, FCCP Nervous System Infections and Catheter Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 George H. Karam, MD, FCCP Bradycardias: Diagnosis and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 James A. Roth, MD Upper and Lower GI Bleeding in the ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Gregory T. Everson, MD Tachycardias: Diagnosis and Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 James A. Roth, MD Heart Failure and Cardiac Pulmonary Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Steven M. Hollenberg, MD, FCCP Acute Coronary Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Steven M. Hollenberg, MD, FCCP Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 John P. Kress, MD, FCCP Mechanical Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Gregory A. Schmidt, MD, FCCP Hypertensive Emergencies and Urgencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 R. Phillip Dellinger, MD, FCCP Critical Illness in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Mary E. Strek, MD, FCCP Venous Thromboembolic Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 R. Phillip Dellinger, MD, FCCP Weaning From Ventilatory Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Scott K. Epstein, MD, FCCP Trauma and Thermal Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 David J. Dries, MD, MSE, FCCP Postoperative Critical Care Management and Selected Postoperative Crises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Jonathan S. Simmons, DO, MSc, FCCP Acute Respiratory Distress Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 John P. Kress, MD, FCCP Coma, Delirium, and Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Scott K. Epstein, MD, FCCP Abdominal Problems in the ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 David J. Dries, MD, MSE, FCCP iv Contents Hypothermia, Hyperthermia, and Rhabdomyolysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 Janice L. Zimmerman, MD, FCCP Ventilatory Crises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 Gregory A. Schmidt, MD, FCCP Poisonings and Overdoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 Janice L. Zimmerman, MD, FCCP Anemia and RBC Transfusion in the ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Karl W. Thomas, MD, FCCP Endocrine Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 James A. Kruse, MD Coagulopathies, Bleeding Disorders, and Blood Component Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 Karl W. Thomas, MD, FCCP Hemodynamic Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 Jesse B. Hall, MD, FCCP Nutritional Support in the Critically Ill Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 John W. Drover, MD Acid-Base Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Gregory A. Schmidt, MD, FCCP Issues in Postoperative Management: Postoperative Pain Management and Intensive Glycemic Control . . . . . . 425 Michael A. Gropper, MD, PhD, FCCP Seizures, Stroke, and Other Neurologic Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 Thomas P. Bleck, MD, FCCP Resuscitation: Cooling, Drugs, and Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467 Brian K. Gehlbach, MD Issues in Sedation, Paralytic Agents, and Airway Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 Michael A. Gropper, MD, PhD, FCCP Severe Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485 Michael S. Niederman, MD, FCCP Acute Kidney Injury in the Critically Ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507 Richard S. Muther, MD Antibiotic Therapy in Critical Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523 Michael S. Niederman, MD, FCCP Electrolyte Disorders: Derangements of Serum Sodium, Calcium, Magnesium, and Potassium . . . . . . . . . . . . . . 539 Richard S. Muther, MD The American Board of Internal Medicine (ABIM) is not affi liated with, nor does it endorse, preparatory examination review programs or other continuing medical education. The content of the ACCP Critical Care Medicine Board Review: 20th Edition is developed independently by the American College of Chest Physicians (ACCP), which has no knowledge of or access to ABIM examination material. The views expressed herein are those of the authors and do not necessarily refl ect the views of the ACCP. Use of trade names or names of commercial sources is for information only and does not imply endorsement by the ACCP. The authors and the publisher have exercised great care to ensure that drug dosages, formulas, and other information presented in this book are accurate and in accord with the professional standards in effect at the time of publication. However, readers are advised to always check the manufacturer’s product information sheet packaged with the respective products to be fully informed of changes in recommended dosages, contraindications, etc., before prescribing or administering any drug. ACCP Critical Care Medicine Board Review: 20th Edition Copyright © 2009 by the AMER I CAN COL LEGE OF CHEST PHYSICIANS. Copyright not claimed on material authored by the US Government. All rights reserved. No part of this book may be re pro duced in any manner with out per mis sion of the pub lish er. Published by the American College of Chest Phy si cians 3300 Dundee Road Northbrook, IL 60062-2348 Telephone: (847) 498-1400; Fax: (847) 498-5460 ACCP Web site: www.chestnet.org Printed in the United States of America First Printing ISBN 978-0-916609-76-4 ACCP Critical Care Medicine Board Review: 20th Edition v Authors Joshua O. Benditt, MD, FCCP Director of Respiratory Care Services Division of Pulmonary and Critical Care Medicine University of Washington School of Medicine Seattle, WA Thomas P. Bleck, MD, FCCP Chairman of Neurology, Evanston Northwestern Healthcare and Professor and Vice Chair for Academic Programs Department of Neurology Northwestern University Feinberg School of Medicine Evanston, IL R. Phillip Dellinger, MD, FCCP Professor of Medicine Robert Wood Johnson Medical School Director, Division of Critical Care Medicine Director, Medical/Surgical Intensive Care Unit Cooper University Hospital Camden, NJ David J. Dries, MD, MSE, FCCP Assistant Medical Director for Surgical Care HealthPartners Medical Group John F. Perry, Jr., Professor of Surgery University of Minnesota Regions Hospital St. Paul, MN John W. Drover, MD Associate Professor Chair and Medical/Director Critical Care Program Queen’s University Kingston General Hospital Kingston, ON Canada Scott K. Epstein, MD, FCCP Dean for Educational Affairs and Professor of Medicine Tufts University School of Medicine Pulmonary, Critical Care and Sleep Medicine Division Tufts Medical Center Boston, MA Gregory T. Everson, MD Professor of Medicine Director of Hepatology University of Colorado School of Medicine Denver, CO Brian K. Gehlbach, MD Assistant Professor of Medicine University of Chicago Section of Pulmonary and Critical Care Chicago, IL Michael A. Gropper, MD, PhD, FCCP Professor and Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine University of California, San Francisco San Francisco, CA Jesse B. Hall, MD, FCCP Professor of Medicine Anesthesia and Critical Care The University of Chicago The Pritzker School of Medicine Chicago, IL Steven M. Hollenberg, MD, FCCP Professor of Medicine Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey Director, Coronary Care Unit Cooper University Hospital Camden, NJ George H. Karam, MD, FCCP Paula Garvey Manship Professor of Medicine Louisiana State University School of Medicine New Orleans, LA Head, Department of Internal Medicine Earl Long Medical Center Baton Rouge, LA John P. Kress, MD, FCCP Assistant Professor of Medicine Section of Pulmonary and Critical Care University of Chicago Chicago, IL James Kruse, MD Chief, Critical Care Services Bassett Healthcare Cooperstown, NY Richard S. Muther, MD Medical Director Division of Nephrology Research Medical Center Kidney Associates of Kansas City PC Kansas City, MO Michael S. Niederman, MD, FCCP Chairman, Department of Medicine Professor of Medicine Winthrop University Hospital Vice Chairman, Department of Medicine SUNY at Stony Brook Mineola, NY James A. Roth, MD Director of Electrophysiology Associate Professor of Cardiovascular Medicine Medical College of Wisconsin Milwaukee, WI Gregory A. Schmidt, MD, FCCP Professor, Division of Pulmonary, Critical Care, and Occupational Medicine Department of Internal Medicine University of Iowa Iowa City, IA Jonathan S. Simmons, DO, MSc, FCCP Clinical Assistant Professor Co-Director, Critical Care Fellowship Program Chair, Disaster Preparedness and Emergency Management Departments of Anesthesia and Emergency Medicine Surgical Intensive Care Unit University of Iowa Hospitals and Clinics Iowa City, IA Mary E. Strek, MD, FCCP Associate Professor of Medicine Section of Pulmonary and Critical Care University of Chicago Chicago, IL Karl W. Thomas, MD, FCCP Assistant Professor Division of Pulmonary Diseases Critical Care, and Occupational Medicine University of Iowa Iowa City, IA Janice L. Zimmerman, MD, FCCP Head, Division of Critical Care Medicine and Director, Medical Intensive Care Unit Department of Medicine The Methodist Hospital Houston, TX The American College of Chest Physicians (ACCP) remains strongly committed to providing the best available evidence- based clinical information to participants of this educational activity and requires an open disclosure of any potential confl ict of interest identifi ed by our authors. It is not the intent of the ACCP to eliminate all situations of potential confl ict of interest, but rather to enable those who are working with the ACCP to recognize situations that may be subject to question by others. All disclosed confl icts of interest are reviewed by the educational activity course director/chair, the Continuing Education Committee, or the Confl ict of Interest Review Committee to ensure that such situations are properly evaluated and, if necessary, resolved. The ACCP educational standards pertaining to confl ict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all ACCP CME activities are ensured of independent, objective, scientifi cally balanced presentations of information. Disclosure of any or no relationships will be made available on-site during all educational activities. The following authors of the Critical Care Medicine Board Review: 20th Edition have disclosed to the ACCP that a relationship does exist with the respective company/organization as it relates to their presentation of material and should be communicated to the participants of this educational activity: Authors Relationship Thomas P. Bleck, MD, FCCP Grant monies (sources other than industry): NINDS, NIAD Grant monies (industry-related sources): ALSIUS, NovoNordisk, Actelion Consultant fee: USAMRICD Speakers bureau: PDL BioPharma Steven M. Hollenberg, MD, FCCP Speakers bureau: Novartis-Makers of Valsartan Michael S. Niederman, MD, FCCP Consultant fee, speaker bureau, advisory committee, etc: Pfi zer, Inc., Merck & Co., Inc., Schering-Plough, Ortho-McNeil, Nektar, Cerexa Grant monies (from sources other than industry): Nektar to study aerosolized amikacin in VAP therapy. Brahms to study procalcitonin James A. Roth, MD Advisory committee: Medtronic Regional Advisory Board Member Mary E. Strek, MD, FCCP Grant monies (industry-related sources): AstraZeneca LP, GlaxoSmithKline The following authors of the ACCP Critical Care Medicine Board Review: 20th Edition have disclosed to the ACCP that he or she may be discussing information about a product/procedure/technique that is considered research and is not yet approved for any purpose: Thomas P. Bleck, MD, FCCP Nicardipine for subarachnoid hemorrhage; several drugs for status epilepticus John W. Drover, MD Parenteral glutamine Michael S. Niederman, MD, FCCP Aerosolized amikacin The following authors of the Critical Care Medicine Board Review: 20th Edition have indicated to the ACCP that no potential confl ict of interest exists with any respective company/organization, and this should be communicated to the participants of this educational activity: DISCLOSURE OF AUTHORS’ CONFLICTS OF INTEREST Joshua O. Benditt, MD, FCCP R. Phillip Dellinger, MD, FCCP David J. Dries, MD, FCCP John W. Drover, MD Scott K. Epstein, MD, FCCP Gregory T. Everson, MD Brian K. Gehlbach, MD Michael A. Gropper, MD, PhD, FCCP Jesse B. Hall, MD, FCCP George H. Karam, MD, FCCP John P. Kress, MD, FCCP James A. Kruse, MD Richard S. Muther, MD Gregory A. Schmidt, MD, FCCP Jonathan S. Simmons, DO, FCCP Karl W. Thomas, MD, FCCP Janice L. Zimmerman, MD, FCCP vi ACCP Critical Care Medicine Board Review: 20th Edition vii Needs Assessment Rely on the ACCP Critical Care Medicine Board Review 2009 to review the type of information you should know for the Critical Care Subspecialty Board Examination of the American Board of Internal Medicine (ABIM). Designed as the best preparation for anyone taking the exam, this comprehensive, exam-focused review will cover current critical care literature and management strategies for critically ill patients. The ABIM Critical Care Subspecialty Board Examination tests knowledge and clinical judgment in crucial areas of critical care medicine. 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