The Handbook of Surgical Intensive Care: Practices of the Surgical Residents at Duke University Medical Center - 5th edition PDF
Preview The Handbook of Surgical Intensive Care: Practices of the Surgical Residents at Duke University Medical Center - 5th edition
VF/VT Asystole PEA ABC, CPR ABC, CPR ABC, CPR A Defibrillate up to 360 J Epinephrine 1 mg, Epinephrine 1 mg, repeat 3-5 min repeat 3-5 min Epinephrine 4 mg IV, may repeat 3-5 min Atropine 1 mg, Consider bicarbonate repeat 3-5 min 1 mEq/kg Defibrillate Consider Atropine 1 mg, transcutaneous repeat 3-5 min Lidocaine pacing 1-1. 5 mg/kg IV, repeat 3-5 min Causes to consider: to max 3 mg/kg Hypovolemia Cardiac tamponode Tension pneumothorax Defibrillate Hypoxia Acidosis Pulmonary embolism Brelylium 5 mg/kg IV, repeat in 5 min with 10 mg/kg Defibrillate Consider bicarbonate 1 mEq/kg Procainamide 30 mg/min to max 17 mg/kg Defibrillate The Handbook of Surgical Intensive Care This page intentionally left blank The Handbook of Surgical Intensive Care Practices of the Surgical Residents at Duke University Medical Center FIFTH EDITION EDITED BY Bryan M. Clary, M.D. Assistant Professor of Surgery, Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, North Carolina Carmelo A. Milano, M.D. Assistant Professor of Surgery, Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina with 34 illustrations Mosby An Affiliate ofElsevier Mosby An Affiliate ofElsevier Editor-. Judith Fletcher Senior Managing Editor: Kathryn H. Falk Project Manager: Carol Sullivan Weis Senior Production Editor: Rick Dudley Designer: Mark A. Oberkrom Cover Art: Duke University/Butch Usery FIFTH EDITION Copyright © 2000 by Mosby, Inc. Previous editions copyrighted 1984, 1989, 1992, 1995 Al rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. NOTICE Pharmacology is an ever-changing field. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the publisher nor the editor assumes any liability for any injury and/or damage to persons or property arising from this publication. Permissions may be sought directly from Elsevier's Health Sciences Rights Department in Philadelphia, USA: phone: (+1)215-238-7869, fax: (+1)215-238-2239, email: CONTRIBUTORS Unless noted, all contributors are from the Department of Surgery, Duke University Medical Center, Durham, North Carolina. Shahab A. Akhter, M.D. Andrew J. Lodge, M.D. Chief Resident, General Surgery Chief Resident, General Surgery Hartmuth Bruno Bittner, M.D. Carmelo A. Milano, M.D. Assistant Professor of Surgery, Assistant Professor of Surgery, Department of Surgery, Division of Cardiothoracic Surgery Division of Cardiovascular and Thoracic Surgery, Eugene W. Moretti, M.D. University of Minnesota, Associate, Department of Minneapolis, Minnesota Anesthesiology; Attending Physician, Surgical Intensive Lisa A. Clark, M.D. Care Unit Senior Assistant Resident, General Surgery Robert B. Noone, M.D. Chief Resident, General Surgery Bryan M. Clary, M.D. Assistant Professor of Surgery, R. Anthony Perez-Tamayo, M.D., Ph.D. Division of General Surgery Cardiothoracic Surgery Fellow, Department of Cardiovascular and Larkin J. Daniels, M.D. Thoracic Surgery, Senior Assistant Resident, General Loyola University Medical Center, Surgery Maywood, Illinois Joseph M. Forbess, M.D. Scott C. Silvestry, M.D. Instructor of Surgery, Resident, Cardiothoracic Surgery Harvard Medical School; Associate in Cardiovascular Surgery, Lynne A. Skaryak, M.D. Children's Hospital, Assistant Professor of Surgery, Boston, Massachusetts Division of Cardiothoracic Surgery, University of Massachusetts Medical Charles W. Hoopes, M.D. School, Cardiothoracic Surgery Fellow, Worcester, Massachusetts The University of Michigan Medical Center, James D. St. Louis, M.D. Ann Arbor, Michigan Resident, Cardiothoracic Surgery G. Chad Hughes, M.D. J.E. (Betsy) Tuttle-Newhall, M.D. Senior Assistant Resident, General Assistant Professor of Surgery, Surgery Divisions of Transplant Surgery and Critical Care Paul M. Kirshbom, M.D. Resident, Cardiothoracic Surgery Bryan C. Weidner, M.D. Surgical Intensive Care Unit Fellow Alan P. Kypson, M.D. Chief Resident, General Surgery John C. Wellons III, M.D. Senior Assistant Resident, Neurosurgery Jeffrey H. Lawson, M.D., Ph.D. Assistant Professor of Surgery, Kirsten Bass Wilkins, M.D. Assistant Professor of Pathology Senior Assistant Resident, General Surgery R. Eric Lilly, M.D. Resident, Cardiothoracic Surgery V This page intentionally left blank PREFACE The Duke Surgical ICU Handbook was first compiled in the mid-1980s by David C. Sabiston, Jr., M.D. and H. Kim Lyerly, M.D. for residents at the institution. Due to its popularity within the institution, it was expanded and published. Now as we submit the new fifth edition of this handbook, there are many changes relative to the original edi- tion. The goal of the handbook, however, remains the same: to provide ICU practitioners with a insightful and functional reference to assist them in the care of their critically ill patients. In addition to providing a reference to practitioners with experience, this manual is designed for residents and other trainees with limited ICU experience. ICU patients represent perhaps the most challenging of patients for new trainees. ICU patients frequently present complex problems with ventilator management, inotro- pic support, renal, and metabolic issues. While medical students often receive formal lectures regarding the pathophysiology related to these topics, residents may still find the actual clinical management of these patients difficult or even overwhelming. Fur- thermore, management decisions often need to be executed quickly or at odd hours, making reference to a formal textbook impractical. We have tried to limit the discussion of physiology and pathophysiology in order to focus on clinical management. We have shortened the text to provide a more user-friendly format. Four new chapters have been added, three of which address the important topics of nutrition, anesthesia, and the management of burns and wounds. A chapter focusing specifically on the techniques of common ICU procedures has also been added. Lastly, the chapter on medications has been greatly expanded and updated to include those medications that have been incor- porated into clinical practice since the release of the last edition. This book has been written predominantly by senior surgical residents at Duke Uni- versity Medical Center who have recently completed or are near completion of their sur- gical training. We feel this has helped to focus the content away from theoretical aspects toward practical ICU management issues that younger residents face on a daily basis. Furthermore, while ICU management is becoming a subspecialty itself, the authorship of this handbook reflects our program's continued emphasis that surgeons remain not only involved in the management of their ICU patients but leaders in the field. We thank Dr. David C. Sabiston, Jr. and Dr. Robert W. Anderson, our Chairmen, for their continued support and guidance on this project. The editors are indebted to our contributing authors for their dedication and perseverance in maintaining the quality of this manual. We also thank our wives and families whose constant support facilitated the completion of this project. Bryan M. Clary Carmelo A. Milano vii LIST OF ABBREVIATIONS AAA abdominal aortic aneurysm ABI ankle-brachial index ABG arterial blood gas ACE angiotensin-converting enzyme ACLS advanced cardiac life support ACT activated clotting time ACTH adrenocorticotropic hormone ADH antidiuretic hormone AHA American Heart Association AIOD aortoiliac occlusive disease APTT activated partial thromboplastin time ARF acute renal failure; acute respiratory failure ARDS adult respiratory distress syndrome ATN acute tubular necrosis AVo2 arteriovenous 02 content difference BLS basic life support BP blood pressure BSA body surface area BUN blood urea nitrogen CABG coronary artery bypass graft CAD coronary artery disease CAVHD continuous arteriovenous hemodialysis Cao2 arterial oxygen content CBC complete blood count CCR creatinine clearance CDH congenital diaphragmatic hernia CHF congestive heart failure Cl cardiac index CK creatine kinase CMV cytomegalovirus; controlled mechanical ventilation CNS central nervous system CO cardiac output COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure CPB cardiopulmonary bypass CPK creatine phosphokinase CSF cerebrospinal fluid CT computed tomography CVA cerebrovascular accident Cvo2 mixed venous oxygen content CVP central venous pressure CXR chest x-ray DIC disseminated intravascular coagulation Do2 oxygen delivery DVT deep vein thrombosis EBV Epstein-Barr virus ECG electrocardiogram ECMO extracorporeal membrane oxygenation EEG electroencephalogram EMD electromechanical dissociation ERCP endoscopic retrograde cholangiopancreatography ERV expiratory reserve volume FDP fibrin degradation product viii
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