Critical Care Medicine Manual

ISBN-13: 9781461299349 / Angielski / Miękka / 2012 / 371 str.

M. H. Weil; P. L. Daluz

Opis

During the past twelve years, a course on critical care medicine has been sponsored by the Post Graduate Division of the University of Southern California School of Medicine in association with its Center for the Criti- cally Ill. The content of each of the symposia has paralleled the evolution of critical care medicine as a recognized service specialty. The annual program was planned as a teaching session for physicians and allied medical personnel who sought to advance their involvement in this rapidly advancing field. A panel of highly regarded authorities on sub- jects bearing on critical care medicine, faculty members of the USC School of Medicine, and staff members of our own Center for the Critically 111 at the Hollywood Presbyterian Medical Center serve as faculty of these symposia. Although the primary commitment of the organizers to maintain this as a teaching and demonstration session was not abandoned, the number of annual registrants progressively increased from fewer than 100 to more than 1200, gradually outstripping local hotel facilities in central Los Angeles. The symposium for the past two years has been held in the large and at- tractive Anaheim Convention Center adjacent to Disneyland.

Spis treści

I. Respiratory Crises.- Respiratory Monitoring.- Mechanics Monitoring.- Tidal Volume.- Pressure, Compliance, and Resistance Monitoring.- Monitoring Inspired and Expired Gases.- Blood-Gas Monitoring.- Blood and Gas Calculations.- Monitoring off the Ventilator.- Future Developments.- References.- Management of Acute Hypoxia and Hypercarbia in the Patient with Advanced Obstructive Airway Disease.- Morphologic Basis for Abnormal Distribution of Ventilation and Perfusion.- Oxygen and Carbon Dioxide Transfer in Chronic Airways Obstruction.- Respiratory Failure in Chronic Airways Obstruction.- Intubation and Artificial Ventilation in Chronic Airways Obstruction.- References.- Humidification, Nebulization, and Bronchodilator Agents.- Pulmonary Clearing Mechanisms.- Heated Humidification.- Nebulization.- Nebulization Equipment.- Clinical Selection.- Mucolytics and Detergents.- Drug Aerosols.- Adjunctive Physical Measures.- Summary.- References and Selected Readings.- Acute Respiratory Failure in the Critically Ill: “Shock Lung”.- Description and Historical Perspective.- Management of Pulmonary Edema in ARF.- Reference.- Selected Readings.- Mechanical Ventilators: Critical Assessment and Methods of Use.- Choosing a Ventilator.- Volume- or Pressure-cycled.- Electric or Pneumatic.- Assistor Controller or Controller.- Oxygen Concentration (FIo2).- Maximum Flow Rate and Pressure.- Advantages and Disadvantages of Specific Ventilators.- Gas Powered, Pressure-cycled Ventilators.- Electrically Operated Strict Controllers.- Gas-Powered, Volume-cycled.- Testing a Ventilator.- Guidelines in Purchasing Ventilators.- Summary.- References.- Weaning from Mechanical Ventilation.- General Principles of Weaning.- “Conventional” Weaning: Techniques and Principles.- Physiologic Effects of Weaning.- Intermittent Mandatory Ventilation.- Difficulties in Weaning.- Summary.- References.- Management of Flail Chest.- Emergency Measures.- Endotracheal Intubation.- Categorization of Chest Injuries.- Mechanical Factors versus Gas Exchange in Chest Injury.- Management.- Positive-end Expired Pressure (PEEP).- Crystalloid Overinfusion.- Tracheostomy.- Continuing Care.- Weaning from the Ventilator.- Summary.- Selected Readings.- Diagnosis and Treatment of Acute Pulmonary Thromboembolism and Fat Emboli.- Symptoms.- Pulmonary Embolism.- Pulmonary Infarction.- Physical Signs.- Pulmonary Embolism.- Pulmonary Infarction.- Laboratory Studies.- Treatment.- Fat Embolism Syndrome.- Summary.- References.- Selected Readings.- II. Shock and Trauma.- Treatment of Shock and Trauma States: Use of Cardiorespiratory Patterns to Define Therapeutic Goals, Predict Survival, and Titrate Therapy.- Pathophysiologic Mechanisms.- Physiologic Common Denominator in Various Types of Shock.- Therapy.- Therapeutic Goals.- Priorities of Therapy.- Summary.- References.- Prognostic Indices as a Basis for Assessing Severity of Shock.- Patient Material.- Methods.- Measurements.- Statistical Analysis.- Results.- Discussion.- Summary.- References.- Disseminated Intravascular Coagulation.- Summary.- References.- Principles of Fluid Challenge for Routine Treatment of Shock.- Rationale of Volume Repletion.- The Standard Fluid Challenge.- Summary.- References.- The Diagnosis and Treatment of Anaphylactic Shock.- Clinical Presentation.- Principles of Treatment.- Summary.- References.- Indications for Use of Corticosteroid Agents in Treatment of Shock.- Septic Shock.- Refractory Hypovolemic Shock.- Post-Traumatic Pulmonary Insufficiency.- Therapeutic Regime.- Summary.- References.- Hemodynamic Defects Underlying Shock with Indications for Treatment: An Appraisal of Vasopressors and Vasodilators.- Hemodynamic Mechanisms.- Pharmacotherapy.- Clinical Therapy.- Distributive Defects.- Summary.- References.- III. Neurologic Crises and Opportunistic Infections.- Brain Monitoring and Homeostasis in Comatose, Critically Ill Patients.- Pathophysiology and Monitoring.- Cerebrospinal Fluid.- Cerebral Edema and Intracranial Pressure.- Cerebral Blood Flow and Metabolism.- Cerebral Electrical Activity.- Patient Management.- Clinical Observations.- General Measures.- Special Brain-oriented Therapy.- Brain-death Certification.- Summary.- References and Selected Readings.- Neurologic Monitoring.- Monitoring Intracranial Pressure.- Monitoring Cerebral Metabolism.- Future Monitoring Trends.- Summary.- References.- Opportunistic Infections in Critical Care Units.- Selected Readings.- IV. Cardiovascular Crises.- The Relationship of Pulmonary Edema to Hydrostatic and Colloid Osmotic Pressures in Man.- Patients and Methods.- Effects of Therapy.- Summary.- References.- Indications for and Use of Flow-directed Catheters for Diagnosis and Treatment.- Assessment of Cardiac Performance in Critically Ill Patients.- Differential Diagnosis of Circulatory Syndromes.- Summary.- References.- Indications for the Treatment of Myocardial Infarcation with Corticosteroids.- Historical Perspective.- Possible Indications for the Use of Corticosteroids in Acute Myocardial Infarction.- High-degree Heart Block.- Adjunctive Therapy in Cardiac Surgery.- Dressler’s Syndrome.- Septic Shock Complicating Acute Myocardial Infarction.- True Cardiogenic Shock Secondary to Acute Myocardial Infarction.- Reduction of Infarct Size.- Summary.- References.- Avoiding Emergencies in the Pregnant Patient with Heart Disease.- Changes in Normal Pregnancy that May Simulate Heart Disease.- Circulatory Changes During Pregnancy.- Mitral Stenosis in Pregnancy.- Summary.- References.- Sudden Death and Acute Myocardial Infarction—What Are We Talking About?.- Potentially Fatal Ventricular Arrhythmias.- Parasystole.- Nonprotected Automatic Ventricular Rhythms.- Re-Entry Ventricular Rhythms.- Prevention and Treatment of Ventricular Arrhythmias.- Summary.- Techniques for Establishing Appropriate Dose Regimens of Digitalis.- Absorption and Bioavailability of Digitoxin and Digoxin.- Metabolism and Excretion.- Evaluation of Renal Function.- Kinetics of Cumulation.- Intuitive Cardiac Glycoside Therapy.- Advance Planning of Dosage Regimens.- Computer-Assisted Glycoside Therapy.- Digitoxin versus Digoxin.- Summary.- References.- Tissue Blood Flow and Oxygen Transport in Critically Ill Patients.- Hypoxia.- Oxygen Therapy and Cardiopulmonary Failure.- Cardiac Output.- Oxyhemoglobin Dissociation.- Summary.- References.- Influence of Pharmacologic Agents on Tissue Metabolism in Circulatory Shock.- Cyclic AMP Stimulators.- Epinephrine and Norepinephrine.- Glucagon.- Prostaglandin.- Glucocorticoids.- Protein Metabolism.- Fat Metabolism.- Membrane Function.- Summary.- References.- Cardiopulmonary Emergencies in the Newborn.- Cardiopulmonary Adjustments at Birth.- Circulatory Changes.- Pulmonary Adaptation.- Pathophysiology of Neonatal Respiratory Failure.- Differential Diagnosis of Neonatal Respiratory Distress.- Important Diagnostic Considerations.- Management of Neonatal Cardiopulmonary Emergencies.- Resuscitation Procedures.- Selected Readings.- Impedance Reduction in Therapy of Power Failure of the Heart.- Impedance Reduction.- Pharmacologic Agents.- Mitral Regurgitation.- Acute Myocardial Infarction.- Chronic Congestive Heart Failure.- Complications of Impedance-Reducing Agents.- Summary.- References.- V. Renal and Metabolic Crises.- Acute Life-threatening Fluid and Electrolyte Abnormalities.- Sodium.- Hyponatremia.- Hypernatremia.- Potassium.- Hypokalemia.- Hyperkalemia.- Divalent Cations.- Hypercalcemia.- Hypocalcemia.- Hypermagnesemia.- Hypomagnesemia.- Metabolic Causes of Arrhythmias in the Critically Ill Patient.- References.- Nutrition of the Critically Ill and Traumatized Patient: Parenteral Alimentation.- Gluconeogenesis During Stress.- Hyperalimentation.- Fat Emulsions.- Unfavorable Effects of Hyperalimentation.- Summary.- References.- Metabolic Crises in the Neonate: Thermoregulation and Hypoglycemia.- Thermoregulation.- Heat Losses.- Heat Production.- Consequences of Cold Stress.- Cold Injuries.- Hypoglycemia.- Summary.- References.- VI. Planning and Operations.- The “Stat” Laboratory.- Reference.- Bedside Automation for the Critically Ill Patient.- References.- Electrical Safety.- Electrical Hazards.- Possible Hazard.- Recommendations.- References.- The Ethics of Sustaining Life in the Infirm Aged and Critically Ill.- The Family.- The Dying Patient.- The Desire to Die with Dignity.- Summary.- Psychopharmacologic Management of Psychiatric Syndromes in the Critically Ill.- Patterns of Incidence.- Neurobiologic Integrative Principles.- Critical Care Psychiatric Syndromes.- Psychopharmacologic Treatment.- Summary.- References.