Critical Care Medicine Manual

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.