Key topics in critical care PDF
Preview Key topics in critical care
The KEY TOPICS Series Advisors: T.M. Craft Department ofAnaesthesia and Intensive Care, Royal United Hospital, Bath, UK C.S. Garrard Intensive Therapy Unit, John Radcliffe Hospital, Oxford, UK P.M. Upton Department OfAnaesthetics, RoyalC ornwall Hospital, Treliske, Truro, UK Anaesthesia, Second Edition Obstetrics and Gynaecology, Second Edition Accident and Emergency Medicine Paediatrics, Second Edition Orthopaedic Surgery Otolaryngology Ophthalmology Psychiatry General Surgery Renal Medicine Trauma Chronic Pain Oral andM axillofacial Surgery Oncology Cardiovascular Medicine Neurology Neonatology Gastroenterology Thoracic Surgery Respiratory Medicine Orthopaedic Trauma Surgery Critical Care Forthcoming titles include: Accident and Emergency Medicine, Second Edition KEY TOPICS IN CRITICAL CARE TIM CRAFT MB BS, FRCA Consultant in Anaesthesiaa nd Intensive Care Medicine, Royal United Hospital, Bath,U K JERRY NOLAN MB BS, FRCA Consultant in Anaesthesia and Intensive Care Medicine Royal United Hospital, Bath,U K MIKE PARR MBB S, MRCP, FRCA, FANZCA Consultant in Intensive Care Medicine, Liverpool Hospital and Lecturer in Intensive Care, Anaesthesia aEndm ergency Medicine, University ofNew South Wales, Sydney, NSW, Australia BIOS 'SCIENTIFIC Q BIOS ScientificP ublishers Limited, 1999 First published1 999 All rights reservedN. o part of book may be reproduceodr transmitted, in any formo r by this any means,w ithout permission. A CIP catalogue record ftohri s book is availablef rom the British Library. ISBN 1 85996 286 6 BIOS Scientific Publishers Ltd 9 Newtec Place, Magdalen Road, OxfOorXd 4 IRE, UK Tel. +44 (0)1865 726286. Fax +44 (0)1865 246823 World Wide Web home page: http:/lwww.bios.co.ukl ZmportantNotefrom the Publisher The information contained withint his book was obtained by BIOS Scientific Publishers Ltd from sources believed by usto be reliable. However, while eveeryff ort has been matdoe ensure its accuracyn, o responsibility for loossr injury whatsoever occasionedt o any person acting or refraining from action as a resulto f information contained herein can be accepted by the authors or publishers. The readers hould remember that medicine is a constantlye volving sciencea nd while the authors and publishers have ensurethda t all dosages, applicationasn d practices are based on current indications, there may be specific practices which differ between communities. You should always followt he guidelines laid down tbhye manufacturers of specificp roducts and the relevant authorities in the country in which you are practising. Production Editor: Andrea Bosher. Typeset by Footnote Graphics, WarminsUteKr, . Printed by TJ International Ltd, Padstow,U K. Cover photograph kindly suppliedb y MikeS cott Photography CONTENTS Admission and discharge criteria 1 Acute respiratory distress syndrome 5 Adrenal disease 8 AIDS 11 Analgesia - basic 14 Analgesia - advanced 18 Anaphylaxis 20 Arterial bloodg ases - acid-base physiology 23 Arterial bloodg ases - analysis 26 Arterial cannulation 29 Asthma 31 Blood coagulation 34 Blood and blood products 39 Blood transfusion 43 Brain stem deathan d organ donation 48 Bums 51 Calcium, magnesium,a nd phosphate 56 Cancer therapy 61 Cardiac arrhythmias 64 Cardiac chest pain 69 Cardiac failure 73 Cardiac output - measurement of 77 Cardiac pacing 80 Cardiac valve disease 83 Central venous pressurem onitoring 87 Chest tube thoracostomy 89 Chronic obstructive pulmonary disease 91 Coma 96 Convulsions 100 Death certification 103 Diabetes mellitus 105 Drug overdose 109 Endocarditis 114 Epiglottis 118 Fibreoptic bronchoscopy 120 Fluid therapy 122 Guillain-Barre syndrome 126 Head injury 128 Hyperthermia 133 Hypothermia 136 Infection control 140 Infection in critical care 143 Liver dysfunction 147 Meningitis 151 CONTENTS v Meningococcal sepsis 154 Myasthenia gravis 156 Nutrition 159 Obstetric emergencies- major haemorrhage 162 Obstetric emergencies - medical 166 Pancreatitis 169 - Pneumonia community acquired 173 Pneumonia -hospital acquired 177 Potassium 180 Psychological aspects of critical care 183 Pulmonary aspiration 185 Pulmonary embolism 189 Renal failure - rescue therapy 192 Renal failure - acute 194 Renal replacement therapy 197 Respiratory support - non-invasive 200 Respiratory support - invasive 205 Respiratory support -w eaning from ventilation 210 - Resuscitation cardiopulmonary 213 Resuscitation - post-resuscitation care 216 Scoring systems 219 Sedation 223 Sickle cell disease 226 SIRS, sepsis, and multiple organ failure 228 Sodium 231 Spinal injury 235 Stress ulceration 240 Stroke 243 Subarachnoid haemorrhage 245 Thyroid emergencies 248 Tracheostomy 250 Transfer of the critically ill 253 Trauma - primary surveya nd resuscitation 257 Trauma - secondary survey 260 Trauma - anaesthesia and critical care 263 Index 265 vi CONTENTS CONTRIBUTORS Tim Cook MB BS BA FRCA Consultant in Anaesthesia, Royal United Hospital, BaUthK, Bronwen Evans MB BS FANZCA Visiting Fellow,D epartment of Anaesthesia, Royal United Hospital, BaUtKh, Stephen FletcherM B BS MRCP FRCA FFICANZCA Senior Registrar; Intensive CaUren it, Liverpool Hospital, Sydney, NSW, Australia Claire Fouque MB BS FRCA Resuscitation Registrar, Intensive CaUren it, Liverpool Hospital, Sydney, NSW, Australia Alex Goodwin MB BS FRCA Consultant in Anaesthesia and Intensive CareR, oyal United Hospital, BathU,K Manivannan Gopalkrishnan MB BS FFICANZCA SeniorR egistrar,I ntensiveC areU nit,R oyalP rinceA lfredH ospital,D arlington, NSW, Australia Kim Gupta MB ChB FRCA Senior Registrar in Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia Jonathon Hadfield MB BS FRCA Senior Registrar, Intensive CaUren it, Liverpool Hospital, Sydney, NSW, Australia Jeff Handel MB BS MRCP FRCA Consultant in Anaesthesiaa nd Intensive CareR, oyal United Hospital, BathU,K S. Kim Jacobsen MB ChB MSc MRCPM RCPath Consultant Medical Microbiologist, Royal United Hospital, Bath, UK and UBHT, Bristol, UK Myrene KilminsterM B BS FANZCA FFICANZCA Director, Intensive CarUen it, Lismore Base Hospital, NSW, Australia David Lockey MB BS Dip IMCR CS (Ed) FRCA Senior Registrari n Intensive CareR, oyal Perth Hospital, Perth, WA, Australia James Low MB BCh DCH Specialist Registrairn Anaesthesia, John Radcliffe Hospital, OxfordU, K Susan Murray PhD FRCPath Clinical Microbiologist, Royal United Hospital, BUaKth , CONTRIBUTORS vii Cathal Nolan MB BCh BA0 FFARCSI Senior Registrar, Intensive CaUren it, Liverpool Hospital, Sydney, NSW, Australia Andrew Padkin MB ChB BSc MRCP FRCA Specialist Registrairn Anaesthesia, Royal United Hospital, BaUtKh, Richard Protheroe MB BS MRCS MRCP FRCA Specialist Registrairn Anaesthesia, Royal United Hospital, BaUtKh, Martin Schuster-Bruce MB BS BSc MRCP FRCA Specialist Registrairn Anaesthesia, Royal United Hospital, BaUtKh, Tom Simpson MB BS BSc FRCA Specialist Registrairn Anaesthesia, Royal United Hospital, BaUtKh, Jas Soar BA MB BCh MA FRCA Specialist Registrairn Anaesthesia, Frenchay Hospital, BristUolK, Antony Stewart MB BS FANZCA Senior Registrar, Intensive CaUren it, Liverpool Hospital, Sydney, NSW, Australia Minh Tran MB BS BSc Registrar in Anaesthesia, Liverpool Hospital, SydneNyS, W, Australia Jenny Tuckey MB ChB DCH FRCA Consultant in Obstetric Anaesthesia, Royal United Hospital, BaUthK, Cynthia Uy MB BS Senior Registrari n Oncology, RoyalN orth Shore HospitalN, SW, Australia Angela White MB ChB Senior HouseO fficer in Surgery, Royal United Hospital, BaUtKh, viii CONTRIBUTORS ABBREVIATIONS ACE angiotensin converting enzyme ACT activated clotting time ACTH adrenocorticotrophic hormone ADH anti-diuretic hormone AF atrial fibrillation ALI acute lung injury ALS advanced life support APACHE acute physiology and chronich ealth evaluation APPT activated partial thromboplastin time ARDS acute respiratoryd istress syndrome ATN acute tubularn ecrosis BiPAP bilevel positive airway pressure BLS basic lifes upport CABG coronary arteryb ypass grafting CBF cerebral blood flow CHF congestive heart failure CMROZ cerebral metabolic rate of oxygen CNS central nervouss ystem COPD chronic obstructive pulmonaryd isease CPAP continuous positive airway pressure CPP cerebral perfusion pressure CPR cardiopulmonary resuscitation CSF cerebrospinal fluid CT computerized tomography CVP central venous pressure cvs cardiovascular system CXR chest X-ray DDAVP d”8-amino argininev asopressin or desmopressin DIC disseminated intravascular coagulation DPL diagnostic peritoneal lavage DVT deep venous thrombosis ECCOzR extracorporeal CO2 removal ECF extracellular fluid ESBL extended spectrumb eta-lactamase FBC full blood count FDPs fibrin degradationp roducts FFP fresh frozen plasma FOB fibreoptic bronchoscopy FRC functional residuacl apacity GALT gut associated lymphoid tissue GBS Guillain-Barr6 syndrome GCS Glasgow coma scale GFR glomerular filtration rate GI gastrointestinal ABBREVIATIONS ix
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