The Intensive Care Unit Manual

Table of Contents
Sect. I Basic Pathophysiologic Principles and their Application
in the Intensive Care Unit
1 Approach to Acute Respiratory Failure 1
2 Mechanical Ventilation 13
3 Weaning and Extubation 31
4 Sedation and Paralysis During Mechanical Ventilation 45
Treating Distress and Agitation 45
Use of Neuromuscular Blocking Agents 55
5 Assessment and Monitoring of Hemodynamic Function 59
6 Cardiogenic Shock and Other Pump Failure States 69
7 Hemorrhagic Shock and Other Low Preload States 85
8 Septic Shock and Other Low Afterload States 93
9 Vascular Access Issues and Procedures 103
Sect. II Care of Generic Intensive Care Unit Patients
10 Approach of Supportive Care and Noninvasive Bedside
Monitoring 117
11 Nosocomial Infections 129
12 Pharmacokinetics and Drug Interactions 143
13 Nutritional Therapy 153
14 Rational Use of Antibiotics 165
15 Rational Use of Blood Products 181
Sect. III Care of Special Intensive Care Unit Patients
16 Renal Replacement Therapy 193
17 Care of the Patient Infected with the Human Immunodeficiency
Virus 205
18 Care of the Cancer Patient with Neutropenia or
Thrombocytopenia 217
19 Care of the Patient with End-Stage Liver Disease 225
20 Care of the Patient with End-Stage Renal Disease 233
21 Care of the Maternal-Fetal Unit 243
22 End-of-Life Care 255
23 The Challenge of Wean Patient 267
24 Swallowing and Communication Disorders 279
25 Rehabilitation Interventions 293
Sect IV Problems Arising in the Intensive Care Unit Setting:
Evaluation and Management
26 Acute Arterial Desaturation 303
27 Acute Hypercapnic Episodes 315
28 Airways and Emergency Airway Management 323
29 Allergies to Antibiotics 333
30 Arrhythmias (Bradycardias) 341
31 Arrhythmias (Tachycardias) 355
32 Barotrauma and Chest Tubes 379
33 Change in Mental Status or New-Onset Seizures 389
34 Chest Pain and Myocardial Ischemia 399
35 Diarrhea Developing in the Intensive Care Patient 415
36 Electrolyte Disorders 425
37 Falling Urine Output and Rising Creatinine Levels 441
38 Fever, Hypothermia, or a Rising White Blood Cell Count 451
39 Hypertensive Episodes 463
40 Hypotensive Episodes or Falling Hemoglobin 471
41 Ileus 481
42 Increased Intracranial Pressure 487
43 Skin Rashes and Pressure Ulcers 499
44 Sleep Disturbances in the Intensive Care Unit 511
45 Thrombocytopenia 521
46 Transfusion Reactions 531
47 Limb Swelling 541
48 Ventilator Alarm Situations 553
Sect. V Presenting Problems for Intensive Care Unit Admission
49 Acute Coronary Syndromes: Acute Myocardial Infarction and
Unstable Angina 563
50 Thoracic Aortic Aneurysms and Dissections 581
51 Cardiogenic Pulmonary Edema 591
52 Hypertensive Crisis 603
53 Pericardial Tamponade 615
54 Hypothermia and Hyperthermia 627
55 Smoke and Carbon Monoxide Inhalation 637
56 Burns 645
57 Drug Overdoses and Toxic Ingestions 655
58 Acute Pancreatitis 667
59 Acute Liver Failure 675
60 Lower Gastrointestinal Bleeding and Colitis 683
61 Upper Gastrointestinal Bleeding 693
62 Hemolytic Anemia 705
63 Idiopathic and Thrombotic Thrombocytopenias 715
64 Acute Central Nervous System Infections 723
65 Community Acquired Pneumonia 735
66 Necrotizing Fasciitis and Related Soft Tissue Infections 745
67 Acute Neuromuscular Weakness 755
68 Brian Death and Management of Potential Organ Donors 767
69 Prognosis After Cardiopulmonary Arrest 775
70 Status Epilepticus 783
71 Stroke 795
72 Obstetric and Postobstetric Complications 805
73 Acute Respiratory Distress Syndrome 817
74 Acute Respiratory Failure Due to Asthma and Chronic
Obstructive Pulmonary Disease 835
75 Massive Hemoptysis and Diffuse Pulmonary Hemorrhage 847
76 Major Pulmonary Embolism 857
77 Obesity Hypoventilation Syndrome 869
78 Acute Renal Failure and Rhabdomyolysis 877
79 Diabetic Ketoacidosis, Nonketotic Hypertonic Hyperglycemia,
and Alcoholic Ketoacidosis 891