Critical Care Obstetrics part 76 pps

739 Index Page numbers in italics represent fi gures, those in bold represent tables. supportive care 388–9 treatment 388 acute lung injury/respiratory distress syndrome 338–45 burns patients 511–12 clinical presentation and pathophysiology 338–40, 339, 339 defi nitions 338 epidemiology 338 etiology 340–2, 340 fetal monitoring 342–4 corticosteroids 344 fl uid management 343 inhaled nitric oxide 343–4 mechanical ventilation 342–3 prone positioning 343 prognosis 344–5 surfactant therapy 344 acute respiratory distress syndrome, septic shock 584 ADAMTS-13, thrombotic thrombocytopenic purpura 408–12, 409–11, 412 adenosine, fetal effects 629 adnexal masses 708–9 adnexal torsion 363 ADP 286 adrenal crisis 434 adrenal glands, pregnancy adaptations 46 agitation 689–94 management 690–2, 691 pregnant and postpartum patients 692 air embolism 157, 241 airway chest trauma 497 obstruction 97 pregnancy adaptations 41 resuscitation 97–9, 98 airway pressure release ventilation 133, 134 albumin 70, 71, 72–3 indications 72 side effects 72–3 albuterol 331 alcohol see ethanol alkalemia 54 alkalosis 54 metabolic 55, 64–5, 65 respiratory 55, 66, 66 Allen test 160–1 allergy, classifi cation 597 alteplase, ischemic stroke 246–7, 247 alveolar-arterial oxygen gradient 125 pulmonary embolism 291 American Nurses Association 16 amino acids 185 amiodarone, fetal effects 629–30 amniotic fl uid embolism 105, 241, 341–2, 466–72 clinical presentation 467–8, 468, 470–1, 470, 471 coagulopathy 468 hemodynamic alterations 467–8, 468 pulmonary manifestations 468, 468 diagnosis 471, 471 and DIC 401 experimental models 466–7, 467 history 466 pathophysiology 468–70, 469 treatment 471–2 amoxicillin, prophylaxis 641 amphetamine overdose 530–2 detection in urine 524 fetal considerations 531–2 lethal dose 531 management 532 maternal considerations 531, 531 metabolism 530–1 teratogenicity 531 toxicology 530 ampicillin, prophylaxis 641 amrinone, fetal effects 631 analgesia, ventilated patients 142–3, 144 anaphylactic shock 596–603 causative factors 596, 598–9 clinical presentation 597, 600 defi nitions 596 diagnosis 599, 600 differential diagnosis 602, 603 epidemiology 596 abdominal trauma blunt 493–5, 494, 495 penetrating 495–6 ACE inhibitors, pre-eclampsia 445 acetaminophen overdose 524, 527, 528–30 antidotes 526 fetal/neonatal considerations 529–30 half-life 528 lethal dosage 528 management 530 maternal considerations 528–9, 529 metabolism 528 teratogenicity 530 toxicology 528 acetylcholinesterase inhibitors 735 acid-base balance cardiopulmonary bypass 203 fetal 611–12 pregnancy adaptations 43, 54–5, 55 acid-base disorders 54–5, 55, 62–6 acidosis see acidosis alkalosis see alkalosis approach to 59–60, 60 graphic nomogram 59, 59 acid-base homeostasis 53–4 acidemia 54 acidosis 54 metabolic 55, 62–4, 63 respiratory 55, 65–6, 65 activated charcoal 525–6, 527 acute abdomen 358–63 adnexal torsion 363 appendicitis 359–61, 359, 360 bowel obstruction 362–3 cholecystitis 361–2 diagnostic imaging 359, 359 laparoscopy 358–9 acute fatty liver of pregnancy 380–1, 382, 385–9 clinical presentation 386–7, 386, 387, 388 diagnosis 387–8 and DIC 402–3 epidemiology 385 pathogenesis 385–6, 386 Index 740 management 599–603 acute 599–601 ongoing 601–2 pathophysiology 597 risk factors 596–7 exposure history 597 gender 596 history of atopy 597 type of exposure 597 timing/length of reaction 597, 599 anaphylactoid syndrome of pregnancy see amniotic fl uid embolism anaphylaxis, fetal distress 615 anemia 193 diabetic nephropathy 720 anesthesia 200–1 cardiac disease 639–53 mortality 560 anion gap 63–4 urinary 64 anthrax 731–2 antibiotics, prophylaxis 641 anticholinergics antidotes 526 asthma 331 overdose 522 anticholinesterases, antidotes 526 anticoagulant therapy 648, 648 cardiopulmonary bypass 203 fetal effects 633 prosthetic heart valves 274–5 thromboembolic disease 293–300 antepartum management 297–8, 298 heparin 293–4, 293 intrapartum management 298–9 low molecular weight heparin 294–5, 294 postpartum management 299 prophylaxis 299–300 selective factor Xa inhibitors 297 warfarin 296–7, 296, 297 antidepressant overdose 532–4 fetal considerations 533 management 533–4 maternal considerations 533 teratogenicity 533 toxicology 532–3, 532 antidiuretic hormone 73 antifactor Xa 259 antiphospholipid syndrome 301, 479–82 catastrophic 481–2, 482 clinical features 480 pathogenesis 479–80 postpartum 481–2 treatment 480–1, 481 antithrombin 401 antithrombin III 259, 286–7 defi ciency 301 in DIC 405 antithymocyte globulin 658 aortic coarctation 263–4, 644 anesthesia 644 aortic dissection 567, 644 aortic insuffi ciency 267, 270 aortic stenosis 266 acquired 267, 269–70, 647 anesthesia 643–4, 647 congenital 643 Apgar score 110 apnea primary 109–10, 110 secondary 109–10, 110 appendicitis 359–61, 359, 360 diagnostic imaging 360 mortality and morbidity 360 preparation for surgery 360–1 presentation 359–60 arginine vasopressin see antidiuretic hormone arrhythmias see cardiac arrhythmias arterial blood gases see blood gases arterial catheters, complications 156 arterial oxygen tension see PaO 2 arteriovenous malformations 245–6 asphyxia 112 factors associated with 113 Hon pattern 613 aspirin overdose 534–6 fetal considerations 535 half-life 534 lethal dose 534 management 535–6 maternal considerations 534–5, 535 metabolism 534 teratogenicity 535 toxicology 534 asthma 327–35 arterial blood gases 328 assisted ventilation 143–4 diagnosis 327–8, 328 effect on pregnancy 329–30, 330 effect of pregnancy on 329 hospitalization rates 329 management 330–4, 333, 334 delivery 333–4 emergency 335 medications 331–4 postpartum 334 pregnancy 330–4 prepregnancy 330 severity 328 atracurium 143, 144 atrial fi brillation, mitral stenosis 647–8 atrial natriuretic peptide 36 atrial septal defect 260, 260 atropine, fetal effects 630 autologous blood transfusion 172–3 acute normovolemic hemodilution 172–3 intraoperative blood salvage 173 preoperative donation 172 automated external defi brillator 99 autonomic hyperrefl exia 232–3 confusion with pre-eclampsia 232 paradoxical bradycardia 232 prevention 232 severe systolic hypertension 232 treatment 232–3 autonomy, respect for 666 axillary artery, cannulation 161 azathioprine 658 azotemia, prerenal 377, 377 bacteremia 573 bacterial endocarditis 276 bacteriuria, asymptomatic 720 Bacteroides fragilis 577 barbiturate overdose 533, 536–8 detection in urine 524 fetal considerations 537 management 537–8 maternal considerations 536–7, 536 symptoms 536 teratogenicity 537 toxicology 536, 536 Bartter’s syndrome 79 basilizimab 658 battery 666 bedside nursing 13 benifi cence 666 benzodiazepine overdose 538–9 antidotes 526 detection in urine 524 fetal considerations 538–9 management 539 maternal considerations 538, 538 teratogenicity 539 toxicology 538 β-agonists, asthma 331 β-blockers, fetal effects 632 bicarbonate 62 biliary disease 366 biological agents 731–5, 731 anthrax 731–2 plague 733–4 Q fever 734 ricin 734–5 smallpox 732–3 viral hemorrhagic fevers 734 bioterrorism 729–37 biological agents 731–5, 731 general preparations 730 radiation exposure 735–7, 736 toxins/chemicals 735 birth depression 108–9, 113 blindness, temporary 455 blood collection/storage 165–6 blood component transfusion 165–78 autologous blood 172–3 blood inventory and ordering 170–1 cryoprecipitated antihemophilic factor 168 directed donation 173 disease transmission through 177–8 duration 169 fi lters 169 fresh frozen plasma and thawed plasma 168 intravenous solutions used with 169 massive 172 obstetric hemorrhage 171–2, 171 patient/donor identifi cation 169 platelets 168 red blood cells 167 frozen 167–8 leukocyte reduced 167 sickle cell crisis 398 washed 167 red cell antigen-antibody reactions 169–70, 170 separation 166–7 Index 741 transfusion reactions see transfusion reactions warming of blood 169 whole blood 167 blood donation 165, 166 blood gas analysis 57–8 interpretation 58–9 mixed venous oxygenation 58 pulse oximetry 58 sample collection 57 blood gas analyzer 57–8 blood gases 53–66 asthma 328 bicarbonate 62 respiratory components 60–2 lung function assessment 61 oxygenation of peripheral tissues 61–2 PaCO 2 62 PaO 2 60–1, 61 blood loss, normal, physiologic changes 561 blood pH 58 blood pressure diastolic 34 fetus, apnea 110 pregnancy adaptations 32, 32, 33 systolic 34 blood products, allergy to 599 blood transfusion see blood component transfusion; exchange transfusion blood volume, pregnancy adaptations 30–2, 31, 31 bone marrow transplantation 661–2 sickle cell crisis 398 bowel edema, crystalloid-induced 71 bowel obstruction 362–3 clinical management 363 diagnosis 362 presentation 362 brachial artery, cannulation 161 bradycardia, fetal 606, 606 brain death 675–8 criteria and tests 677 historical background 675–6 maintenance in vegetative state 676 management guidelines 676–8, 677 outcomes 676 perimortem cesarean delivery 103–4, 621–2, 621, 676 states of 677 brain injury diffuse 500 focal 500–1 brain tumors 224 breast cancer 710–11 breathing, resuscitation 99 buffers 53 calcitonin, hypercalcemia 84 calcium, metabolic disturbances 81–5 hypercalcemia 83–5 hypocalcemia 82–3 calcium channel blockers fetal effects 630 pre-eclampsia 444, 444 cancer 704–12 adnexal masses 708–9 breast 710–11 cervix 705–8 Hodgkin’s lymphoma 712 melanoma 711–12 ovarian 709–10 surgical principles 705 capnometry 210–11 carbamazepine 223 overdose 524 carbohydrates 185 carbon monoxide poisoning 539–41 antidotes 526 fetal considerations 540 management 540–1 maternal considerations 539–40, 540 teratogenicity 540 toxicology 539 carbonic acid-bicarbonate system 53 carboxyhemoglobin 524 cardiac arrest 95 cardiopulmonary resuscitation see cardiopulmonary resuscitation pregnancy-specifi c conditions 95, 98 reversible causes 98 cardiac arrhythmias 566–7, 652 cardiac disease 256–77 acquired 267–70, 267 aortic insuffi ciency 267, 270 aortic stenosis 267, 269–70, 647 mitral insuffi ciency 267, 269 mitral stenosis 267, 268–9, 644–7, 645, 645–6 mitral valve prolapse 269 pulmonic and tricuspid lesions 267, 268 anesthesia 639–53 anticoagulation and prosthetic heart valves 274–5 bacterial endocarditis 276 cardiac transplantation see cardiac transplantation congenital 259–66, 640–4, 640 aortic stenosis 266, 643 atrial septal defect 260, 260 coarctation of aorta 263–4, 644 Ebstein’s anomaly 263 Eisenmenger’s syndrome 261–3, 262, 642–3 functional single ventricle and Fontan procedure 266 left to right shunts 641–2, 641, 642 patent ductus arteriosus 261 pulmonary hypertension and Eisenmenger’s syndrome 261–3, 262 pulmonary stenosis 266, 643 tetralogy of Fallot 264–5, 642 transposition of great vessels 265–6 ventricular septal defect 260–1 dysrhythmias 276–7 epidemiology 639 fetal considerations 266–7, 267 functional classifi cation 257 hypertrophic obstructive cardiomyopathy 272 ischemic 648–9 Marfan syndrome 210, 272–3 maternal risk 257 myocardial infarction 273–4, 274 patient counselling 256–8, 257 peripartum cardiomyopathy 270–2, 271 physiologic considerations 258–9, 258, 258, 259 cardiac index 34 cardiac output 18–24, 34, 38, 39, 258–9 coronary artery disease 18–24, 20–3, 20, 21 non-invasive monitoring 207–8 pregnancy adaptations 34–5, 34, 35, 259 pulmonary artery catheterization 218 cardiac surgery, timing of 197–8 cardiac tamponade 497–8 cardiac transplantation 276, 277, 652–3, 661 anesthesia 652–3 cardiac trauma 498 cardiogenic shock 564–5, 572 pathogenesis 564–5 cardiomyopathy Doppler ultrasound 209–10 hypertrophic obstructive 272 mortality 560 peripartum 270–2, 271, 565–6, 651–2, 651 cardioplegia 202 cardiopulmonary bypass 196–204, 653 acid-base status 203 anesthesia and surgery 200–1 anticoagulation 203 avoidance of 197 duration 203 fetal monitoring 200 hematologic considerations 203 maternal and fetal risks 196–7 myometrial activity during 199–200 postoperative course 203 technique cardioplegia 202 fl ow and perfusion pressure 202 hypothermia 201–2 priming pump 201 pulsatility 202 timing of cardiac surgery 197–8 and uteroplacental perfusion 198–9, 199, 200 cardiopulmonary resuscitation 93–105, 96, 97, 653 airway 97–9, 98 breathing 99 circulation 99–100 complications and aftercare 103 current recommendations 93–4, 94 drugs 100–1 modifi cations for pregnancy 101–3, 102 neurological impairment after 104 perimortem cesarean delivery 103–4 pregnancy effects 100, 101, 102 thrombolytic therapy 103 cardiovascular accident see stroke, pregnancy-related cardiovascular system pregnancy adaptations 30, 639–40, 640, 640 blood pressure 32, 32, 33 blood volume 30–2, 31, 31 cardiac output and stroke volume 34–5, 34, 35 central hemodynamic changes 39, 39 heart rate 32–4, 33 hemodynamic changes during labour 39–40, 39 hemodynamic changes postpartum 40–1, 40 postural effects 37–9, 37, 38 regional blood fl ow 36–7 systemic vascular resistance 35–6, 36 ventilator-associated complications 141 Index 742 cardioversion 647, 648 cathartics 526–7, 527 catheter-related infection 162 catheterization techniques 154–5, 156 Seldinger technique 154–5 catheters central venous 153, 154 occlusion 176–7 vascular access 152–4, 153, 154 central nervous system, crystalloid effects 71–2 central venous access 17–18 associated infections 17–18 central venous catheters 154 peripherally inserted 153 central venous pressure 34, 38, 39 cephalic vein, cannulation 159 cerebral autoregulation 499 cerebral blood fl ow 237 cerebral edema 454–5 cerebral perfusion pressure, Doppler ultrasound 212–13 cerebral vasculopathy, postpartum 240 cerebral venous thrombosis 224, 239–40 cervical cancer 705–8 carcinoma 706–8 intraepithelial neoplasia 706 cesarean delivery perimortem 103–4, 621–2, 621, 676 spinal injury 231 chemical burns 509 chest compressions 118–19 chest trauma 496–8 airway management 497 blunt cardiac injury 498 cardiac tamponade 497–8 classifi cation 496–7, 497 fl ail chest 498 hemothorax 497 open pneumothorax 497 tension pneumothorax 497 chest X-ray, pulmonary embolism 291 chlorhexidine gluconate 18 cholecystitis 361–2 diagnosis 361 management clinical 361–2 medical 362 surgical 362 presentation 361–2, 361 cholestasis of pregnancy 388 cholinergics, overdose 522 cholinesterase 524 choriocarcinoma 241 Chvostek’s sign 83 circulation resuscitation 99–100 spinal injury 229 cisatracurium 143, 144 Clostridium perfringens 573 coagulation, normal 440, 441 coagulation cascade, septic shock 585–6, 588 coagulation factors 259 pregnancy adaptations 45, 259 see also individual factors cocaine poisoning 541–3 detection in urine 524 fetal considerations 542 management 542–3 maternal considerations 541–2 teratogenicity 542 toxicology 541 colloid osmotic pressure 39, 350 colloid solutions 72–3 albumin 72–3 hetastarch 73 competency 666–8 computed tomography, spiral, pulmonary embolism 292 congenital anomalies, neonatal resuscitation 122 continuous positive airway pressure (CPAP) 128 mask 116 neonate 115–16, 117 coronary artery disease 18–24, 20–3, 20, 21 diabetes mellitus 724–5 corticosteroids acute lung injury/acute respiratory distress syndrome 344 asthma 331–2 complications 231 fetal effects 634 hypercalcemia 84 immunosuppression 658 pre-eclampsia/HELLP syndrome 239 septic shock 587–8 spinal injury 230–1 systemic lupus erythematosus 478 Couvelaire uterus 309 Creutzfeldt-Jakob disease, blood transmission 178 critical care nursing 16–29 cardiac output evaluation 18–24 central venous access 17–18 heparin fl ush 18 invasive haemodynamic monitoring 16–17 mechanical ventilation 24–9, 25, 26, 26, 28, 28 preparation for caring 29 standards of care 16, 17 technology 16 critical illness polyneuropathy 138 cromolyn sodium 331 cryoprecipitated antihemophilic factor 168 crystalloid solutions 70–2, 70 indications 87 isotonic crystalloids 70–1 side effects 71–2 Cullen’s sign 367 cyanide, antidotes 526 cyclosporine 658 cytomegalovirus, blood transmission 178 D-dimer 401 assay 290 daclizumab 658 dead space 125 deep venous thrombosis 288–90 clinical diagnosis 288, 288 ascending venography 289, 289 D-dimers and thrombin assay 290 impedance plethysmography 289 iodine 125 fi brinogen scanning 289–90 radionuclide venography 290 thermography 289 ultrasound 288–9 incidence 284 and route of delivery 285 delta gap 64 dependent moral status 666 depression 684–7 during pregnancy 684–5 perinatal risk factors 685–6 postpartum 685 treatment 686–7 dexamethasone, fetal effects 634 dexmedetomidine 143 dextrose 5% 71 diabetes insipidus cranial 77 transient of pregnancy 76 diabetes mellitus 717–25 coronary artery disease 724–5 diabetic ketoacidosis 425–7, 427, 721–4 clinical presentation 722 differential diagnosis 722–3 laboratory diagnosis 722, 722 management 723–4, 723 bicarbonate 723–4 fl uid and electrolytes 723 insulin 723 potassium 723 pathophysiology 721–2 precipitating factors 722 diabetic nephropathy 719–21 course in pregnancy 719–20 management 720–1, 721 prepregnancy evaluation 719 diabetic neuropathy 425 diabetic retinopathy 717–19 course in pregnancy 717 insulin effect 718 management 718–19 “pregnancy factor” 717–18 risk factors 718 dialysis 188–94, 721 antepartum management 193–4 fetal complications 192–3, 192 hemodialysis 189, 189, 190 indications 189 intensive 190–1 maternal complications 191–2, 192 modifi cation of prescription 191 overview 188–9 peritoneal 189–90, 190, 190 and pregnancy 190–3, 190 and uteroplacental perfusion 191 diaphragmatic hernia 121 diazepam 142, 226 diazoxide, pre-eclampsia 444 DIC see disseminated intravascular coagulopathy diet see nutrition digital subtraction pulmonary angiography 293 digoxin antidotes 526 fetal effects 631 overdose 524 diltiazem, fetal effects 630 Index 743 disseminated intravascular coagulopathy 400–5, 576 diagnosis clinical 403 laboratory 403–4, 403 etiology 401–3, 401 acute fatty liver of pregnancy 402–3 amniotic fl uid embolism 401 eclampsia 402 intrauterine death 402 intrauterine infections 402 placental abruption 402 factor VIIa 405 fetal distress 615–17, 616 management 404–5 activated protein C 404 antithrombin III 405 blood/blood products 404 fl uid therapy 404 heparin 404 normal coagulation 400, 401 pathophysiology 400–1 septic shock 585–6 distributive (vasodilatory) shock 572 diuretics, fetal effects 631–2 dobutamine, fetal effects 631 dopamine fetal effects 631 post-resuscitation 120 Doppler ultrasound and cardiomyopathy 209–10 critical care 208–9 physiology of pregnnacy 208 pre-eclampsia 209 transcranial 211–13, 211 bias and confounders 211–12 cerebral perfusion pressure 212–13 transesophageal 210 dorsalis pedis artery, cannulation 161 drug reactions 598 drug-depressed infants 119 dysrhythmias 276–7 Ebstein’s anomaly 263 ECG, pulmonary embolism 291 eclampsia 224, 237–9, 455–7, 456 and DIC 402 fetal distress 615 maternal-fetal complications 456 see also pre-eclampsia Eisenmenger’s syndrome 261–3, 262, 642–3 anesthesia 643 electrical burns 509 electrocardiogram see ECG electrolyte balance see fl uid/electrolyte balance electrolyte disorders 73–86 see also individual electrolytes embolism air 157, 241 amniotic fl uid 241 mortality 560 paradoxical 241 emesis, induction of 521, 523 enalapril, fetal effects 632 endocarditis, bacterial 276 endocrine emergencies 425–34 adrenal crisis 434 diabetic ketoacidosis 425–7, 427 hyperparathyroidism 432–3 hypoparathyroidism 433 pheochromocytoma 431–2, 432 thyroid dysfunction 428–31 hyperthyroidism 428–30, 429 hypothyroidism 430–1 thyroid storm 431 endocrine system pregnancy adaptations 45–6 endotracheal intubation 117–18, 118, 130 complications 131 endovascular occlusion therapy 245 envenomation 548–53 scorpion stings 553 snakebites 548–50, 549, 550 spider bites 551–3, 551, 552 epidemiology 1–10 epidural hemorrhage 494 epilepsy 222–7 etiology 222 gestational 224 new-onset in pregnancy 224–5, 224 prophylaxis 222–4 seizure classifi cation 223 status epilepticus 225–6, 226 subsequent management 226–7 treatment 225 epinephrine fetal effects 630 neonatal resuscitation 119 epistaxis 41 ergometrine, uterine atony 313 erythroblastosis 121–2 erythropoietin, sickle cell crisis 398 ethanol poisoning 524, 543–5 detection in urine 524 fetal considerations 544 management 544–5 maternal considerations 543–4 teratogenicity 544 toxicology 543 ethical issues 665–81 brain death 675–8 Jehovah’s Witnesses 678–80 letter of condolence 680–1 maternal-fetal confl ict see maternal-fetal confl ict medical-legal cases 667 ethical principles 665–9 competency 666–8 court cases 670–1 fetal rights 670–1 maternal autonomy 670 Roe vs Wade 670 fetal status 668–9 informed consent 665–6 ethosuximide 223 ethylene glycol poisoning 524 antidotes 526 exchange transfusion, sickle cell crisis 397–8 expiratory reserve volume 42 external jugular vein, cannulation 158 extracellular fl uid 69 volume control 73–4 extracorporeal membrane oxygenation 135–6 face tent 129 factor V 259 factor V Leiden 288 factor VII 259 factor VIIa, recombinant 405 factor VIII 259 factor IX 259 factor X 259 factor Xa inhibitors 297 factor XI 259 factor XII 259 factor XIII 259 Fallot’s tetralogy 264–5, 642 fat emulsions 185 feeding, post-resuscitation 120 femoral artery, cannulation 161 femoral vein, cannulation 159, 160 fentanyl 144 fetal effects 628 fetal brain injury 612–15 acute 612–13, 613 Hon pattern of asphyxia 613–14 persistent non-reactive heart rate pattern 614 reactive admission test 612 fetal distress 605–22 detection of 605–6 maternal and surgical conditions 615–22 anaphylaxis 615 burns patients 617–18, 617, 618 disseminated intravascular coagulopathy 615–17, 616 eclampsia 615 maternal brain death/persistent vegetative state 618–21, 619–21 fetal effects of drugs 626–34, 627 cardiovascular drugs 629–33 endocrinologic emergencies 633–4 maternal analgesia and sedation 626–9 see also individual drugs fetal heart rate 606–8 apnea 110 bradycardia 606, 606 brain damage 612–15 coronary artery disease 22, 23 maternal cardiopulmonary bypass 199 and maternal temperature 200 mechanical ventilation 26, 28 response to uterine contractions 609–11, 610 accelerations 609–10 late decelerations 611 variable decelerations 610 sinusoidal pattern 609 tachycardia 606–8, 607, 608 variability 608–9 fetal monitoring 614–15 fetoscopy 700–1 fetus acid-base balance 611–12 blood pressure, apnea 110 circulation 109 hazards of radiography 231–2, 231 Index 744 medical-legal status 668–9 monitoring, during cardiopulmonary bypass 200 response to hypoxia 109, 109 fi brinogen 259, 401 fi brosing alveolitis 340 fl ail chest 498 fl uid dynamics, pregnancy effects 69–70 fl uid resuscitation 70–3, 70 acute lung injury/acute respiratory distress syndrome 343 spinal injury 230 fl uid/electrolyte balance 69–86 ventilated patients 141–2 fl uids, post-resuscitation 120 fl umazenil, overdose 521 Fontan procedure 266 food allergies 598 formoterol 331 fosphenytoin 226 fractures, burns patients 512 functional residual capacity 42 furosemide, fetal effects 631 gabapentin 223 gallbladder, pregnancy adaptations 44 Gardnerella vaginalis 577 gastric contents, aspiration of 341 gastric lavage 523, 525 gastrointestinal haemorrhage 138 gastrointestinal system pregnancy adaptations 43–4 anatomy 43–4 hepatobiliary 44 physiology 44 septic shock 586–7 genitourinary system, pregnancy adaptations 43 gentamicin, prophylaxis 641 glomerular fi ltration rate 69 glomerulonephritis, acute 377–8, 378 glucose, post-resuscitation 120 graft-vs-host disease, transfusion-associated 177 Graves’ disease 428–9 Grey Turner’s sign 367 gunshot wounds 495–6 haemodynamic monitoring, invasive 16–17 haloperidol 142 fetal effects 628 head trauma 499–503 brain injury mechanism 499 cerebral autoregulation 499 classifi cation 500 delivery considerations 502–3 diffuse brain injury 500 focal brain injury 500–1 general principles 501–2, 502 primary management 499–500 skull fractures 501 heart rate 34, 38, 39 fetal see fetal heart rate pregnancy adaptations 32–4, 33 heavy metal poisoning 524 antidotes 526 Heimlich maneuver 97 HELLP syndrome 237–9, 380, 382, 417–19, 451–3, 452, 453 causes and pathogenesis 418 clinical features 417 differential diagnosis 419, 452 laboratory features 417–18 maternal outcomes 453 perinatal outcomes 453 treatment 238–9, 418–19 hematologic system pregnancy adaptations 44–5 coagulation factors 45 platelet count 45 red cell mass 44–5 white cell count 45, 45 hemodialysis 189, 189, 190, 190 hemodynamic changes central 39, 39 during labour 39–40, 39 postpartum 40–1, 40 hemolytic-uremic syndrome 381, 416–17 treatment 417 hemophilia 321 acquired 321 hemorrhage 171–2, 171, 308–22 bleeding disorders 319–22 causes 560, 561–2 clinical classifi cation 560 epidural 494 mortality 559, 560 placental abruption 308–9 postpartum see postpartum hemorrhage uterine rupture 309–11 see also hypovolemic shock hemostasis 285–7 pregnancy adaptations 287, 287 hemothorax 497 Henderson-Hasselbalch equation 53–4, 57, 62 heparin antidotes 526 antiphospholipid syndrome 481 fetal effects 633 low molecular weight see low molecular weight heparin side effects 295–6, 295 thromboembolic disease 293–4, 293 heparin fl ush 18 hepatitis, acute 388 hepatitis B, blood transmission 177 hetastarch 70, 73 indications 73 side effects 73 high humidity mask 129 high-frequency oscillatory ventilation 133–4 Hodgkin’s lymphoma 712 Homan’s sign 288 hospitalization length of hospital stay 2 perterm labor 13 pregnancy-related 2, 3 delivery 3, 4 non-delivery 3, 4 human T-lymphotropic virus, blood transmission 177–8 hydralazine fetal effects 632 pre-eclampsia 443–4, 444 hydrochlorothiazide, fetal effects 631–2 hydrocortisone, fetal effects 634 hydromorphone 144 hydrops 121–2 hydroxychloroquine, systemic lupus erythematosus 478 hyperalimentation 181–6 normal nutrition 181–2, 182 weight gain 182 hypercalcemia 83–5 clinical presentation 84 diagnosis 84 etiology 83, 83 treatment 84–5, 84 hypercapnia, permissive 137–8 hypercoagulability 258, 259 hyperemesis gravidarum, and hyponatremia 74–5 hyperkalemia 79–81 clinical presentation 80 diagnosis 80–1 etiology 80, 80 management 81, 81 hypermagnesemia 86 hypernatremia 76–8 clinical presentation 77 diagnosis 77 etiology 76–7, 76 management 77–8 hyperparathyroidism 432–3 hypertension pregnancy-induced 439 mortality 560 see also eclampsia; pre-eclampsia hypertensive cardiomyopathy 449–50 hyperthyroidism 428–30, 429 hypertriglyceridemia 366–7 hypertrophic obstructive cardiomyopathy 272 hypocalcemia 82–3 clinical presentation 83 etiology 82–3, 82 treatment 83, 83 hypokalemia 78–9 clinical presentation 79 diagnosis 79 etiology 78–9, 78 management 79 hypomagnesemia 85–6, 85 hyponatraemia 74–6 clinical presentation 75–6, 75 etiology 74–5, 74 hypoparathyroidism 433 hypotension, spinal injury 230 hypothermia, cardiopulmonary bypass 201–2 hypothyroidism 430–1 hypovolemic shock 229, 559–64, 572 management 562–4 hemostasis 564 oxygenation 562 pharmacologic agents 564 volume replacement 562–4 hypoxemia 60, 128 treatment see mechanical ventilation Index 745 hypoxia, fetal response to 109, 109 hypoxic ischemic encephalopathy 605 hysterectomy, postpartum hemorrhage 318–19 hysterotomy 699–700, 700 ibutilide, fetal effects 630 ICU see intensive care unit idiopathic thrombocytopenic purpura 319–20 immune system, pregnancy adaptations 46–7 immunosuppression 657–9, 658 immunotherapy anaphylaxis 598 asthma 332 septic shock 588 independent moral status 666 indium 111 platelet imaging 293 infection 573 catheter-related 162 central line-associated 17–18 mortality 560 intrauterine 402 inferior vena cava fi lter 300–1 informed consent 665–6 insect bites/stings 598 inspiratory capacity 42 insulin, fetal effects 634 intensive care unit 11–15 admission criteria 12 design of 14–15 patient population 11–12, 12 patient-centered care 12, 12 pregnancy-related admissions 6, 7 illnesses responsible for 6, 8 mortality causes 7–8, 9 rationale for 11 team members 12–14 nurses 13, 13 physicians 12–13 internal jugular vein, cannulation 157–8, 157, 158 International Normalized Ratio 168 interstitial nephritis 378, 378 intracerebral hemorrhage 241 intracranial hemorrhage 224 intracranial pressure, subarachnoid hemorrhage 244 intrauterine death, and DIC 402 intrauterine infection, and DIC 402 intravascular volume 258, 258 intubation, spinal injury 228–9 inverse ratio ventilation 132–3 iodine poisoning 527 ipratropium 331 iron poisoning 524, 527, 545–6 antidotes 526 fetal considerations 546 management 546 maternal considerations 545–6 teratogenicity 546 toxicology 545 ischemic heart disease 648–9 ischemic stroke 246–8, 247 prevention 248 symptoms 246 thrombolytic therapy 246 isoniazid, antidotes 526 isopropanol, overdose 524 isoproterenol, fetal effects 631 Jehovah’s Witnesses 678–80 guidelines for treatment 679–80 historical background 678 legal issues 678–9 justice 666 kallikrein 286 kidney, role in acid-base regulation 54 kininogen 286 labetalol 238 fetal effects 632 pre-eclampsia 444–5, 444 labor and delivery cesarean see cesarean delivery fetal heart rate 22, 23 fetal monitoring 614–15 hemodynamic changes 39–40, 39 preterm see preterm labor spinal cord injury 233 transplant patients 662 laparoscopy 358–9 latex allergy 599 left to right shunts 641–2, 641, 642 anesthetic management 641–2, 642 left ventricular outfl ow tract obstruction 644 left ventricular stroke work index 38, 39 letter of condolence 680–1 leukotriene modifi ers 332 Libman-Sacks endocarditis 210 lidocaine, fetal effects 630–1 lithium, overdose 524 liver function, pregnancy adaptations 44 liver rupture 453–4 liver transplantation 660–1 lorazepam 142, 144, 226 fetal effectsd 627 losartan, fetal effects 632 low molecular weight heparin, thromboembolic disease 294–5, 294 Lowenberg test 288 lung function, assessment 61 lung injury, ventilator-induced 137 lung transplantation 661 lung volumes, pregnancy adaptations 42, 42, 329 magnesium, metabolic disturbances 85–6 hypermagnesemia 86 hypomagnesemia 85–6 magnesium sulfate 238 antidotes 526 pre-eclampsia 442 malnutrition 186–7 mania 692–4 treatment 693–4 mannitol fetal effects 634 subarachnoid hemorrhage 244 Marfan syndrome 210, 272–3 marijuana, detection in urine 524 maternal mortality 1, 2–5, 4 pregnancy-related 5 thermal injuries 512 maternal-fetal confl ict 669–70 compromise views 673–4, 673 fetal rights 669–70, 672 management of 674–5 maternal autonomy 669, 672 special considerations 671–3 fetal rights 672 forcible restraint with good outcome 672–3 maternal autonomy 672 maternal-fetal unit, transport of substances between 182 maximal sterile barriers 17 mean arterial pressure 34, 38, 39 mechanical ventilation see ventilation meconium aspiration 120–1, 121 melanoma 711–12 Mendelson’s syndrome 577 mercury poisoning 527 metabolic acidosis 55, 62–4, 63 metabolic alkalosis 55, 64–5, 65 metaproteronol 331 methanol poisoning 524 methemoglobinemia 524 antidotes 526 methimazole, fetal effects 634 methylergonovine, uterine atony 313 methylxanthines, asthma 331 microalbuminuria 719–20 midazolam 142, 144 fetal effects 626–7 milrinone, fetal effects 631 minerals 186 misoprostol, uterine atony 314 mitral insuffi ciency 267, 269 mitral regurgitation 267 mitral stenosis 267, 268–9, 269, 566, 566, 644–7, 645, 645–6 anesthesia 646–7, 646 atrial fi brillation 647–8 mitral valve prolapse 269 mixed venous oxygenation 58, 128 monitoring fetal, cardiopulmonary bypass 200 non-invasive 207–13 capnometry 210–11 Doppler ultrasound 208–10, 211–13 oximetry 210, 210 montelukast 332 morbidity, ICU admissions 8 morphine 144 fetal effects 628 mortality causes 560 ICU admissions 7–8, 9 maternal see maternal mortality perinatal see perinatal mortality motor vehicle accidents 493 Moyamoya disease 241 muromononab-CD3 658 mycophenolate mofetil 658 myocardial infarction 273–4, 274, 565 myopathy 138 Index 746 naloxone, overdose 521 nasal cannula 129 negligence 666 neonatal lupus erythematosus 476–7 neonatal resuscitation 108–22 anticipation of 111–12 Apgar score 110 assisted ventilation 114–18 causes of birth depression 108–9 chest compressions 118–19 complications 120–2 diaphragmatic hernia 121 erythroblastosis/hydrops 121–2 meconium aspiration 120–1, 121 pneumothorax 121 congenital anomalies 122 drug-depressed infants 119 equipment 112 initial steps and evaluation 112–14 airway clearance 113–14 free-fl ow oxygen 114 tactile stimulation 114 thermal management 112–13, 114 medications 119 overview 110–11, 111 personnel 112 post-resuscitation care 120 primary and secondary apnea 109–10, 110 ventilation 111 nerve agents 735 neurogenic shock 229 neutralizing agents 526 nicotine poisoning 527 nifedipine 82 pre-eclampsia 444 nimodipine, subarachnoid hemorrhage 243–4 nitric oxide 136 inhaled 343–4 nitroglycerin fetal effects 632 pre-eclampsia 444, 445 nitroprusside, fetal effects 632–3 non-malefi cence 666 non-steroidal anti-infl ammatory drugs see NSAIDs NSAIDs, systemic lupus erythematosus 478–9 nurses, ICU 13, 13 nutrition 181–2, 182 hyperalimentation 181–6 renal failure 193 septic shock 586–7 ventilated patients 140–1 nutritional assessment 183 nutritional support 183–4, 184, 186 amino acids 185 carbohydrates 185 fat emulsions 185 fl uids and electrolytes 185 total parenteral nutrition 184 obstetric critical care unit see intensive care unit obstetric hemorrhage see hemorrhage oliguria diagnosis 71 pre-eclampsia 450–1 opiates antidotes 526 overdose 522 organ transplantation see transplant patients organophosphate/carbamate poisoning 546–8 fetal considerations 547 management 547–8 maternal considerations 547 teratogenicity 547 toxicology 546–7 orotracheal intubation 228–9 orthopedic trauma 503 osmolarity, control of 73–4 ovarian cancer 709–10 overdose and poisoning 514–48 antidotes 526 decontamination procedures 520–7 gastrointestinal 521, 523, 525–7 skin 520–1 defi nitions 514 evaluation 515–27, 516, 517, 519–20 altered mental status 517, 521 initial 515, 517 secondary 517–19 toxic identifi cation 519–20, 524 incidence by substance 527 management 524 activated charcoal 525–6, 527 cathartics 526–7, 527 dialysis 525 emesis 521, 523 gastric lavage 523, 525 hemoperfusion 525 neutralizing agents 526 whole-bowel irrigation 527 medications 514, 515 physical signs 523 suicide attempts 528 toxic exposures 514 during pregnancy 514–15, 515 toxicologic considerations in pregnancy 515 see also specifi c agents oximetry 210, 210 oxygen free-fl ow 114 toxicity 137 oxygen consumption 55–6, 56, 56, 125–7, 126, 126 and oxygen delivery 56–7, 127 in pregnancy 57, 127 oxygen delivery 55–6, 56, 56, 125–7, 126, 126 impaired 126 and oxygen consumption 56–7, 127 in pregnancy 57, 127 oxygen delivery systems 129 oxygen extraction ratio 56 oxygen therapy, sickle cell crisis 398 oxygenation 127–8, 127 impaired 128 mixed venous 128 pulse oximetry 127–8 oxyhemoglobin dissociation curve 56, 126 fetal 61 maternal 61 oxytocin and hyponatremia 74 uterine atony 313 PaCO 2 62 pamidronate, hypercalcemia 84 pancreas, endocrine, pregnancy adaptations 46 pancreas transplantation 660 pancreatitis, acute 365–72 clinical manifestations 367 complications 368, 368 diagnosis 368–70 differential 369–70, 369 laboratory evaluation 368–9 radiologic evaluation 369, 369 epidemiology 365–6 etiology 366–7, 366 biliary disease 366 drugs 367 hypertriglyceridemia 366–7 management 371–2 pathology and pathophysiology 367 in pre-eclampsia 454 prognostic indicators 370, 370 pancuronium 143 fetal effects 628–9 PaO 2 60–1, 61, 125 paralysis, ventilated patients 142–3, 144 parvovirus B19, blood transmission 178 patent ductus arteriosus 261 paternalism 666 patient-centered care 12, 12 PCO 2 54, 57–8 percutaneous balloon mitral commissurotomy 197 perinatal mortality 5–6, 5 peripartum cardiomyopathy 270–2, 271, 565–6 peripheral edema, crystalloid-induced 71 peripheral vascular resistance 34, 38, 39 peritoneal dialysis 189–90, 190, 190 perterm labor, hospitalization 13 phenobarbital, overdose 524 phenytoin 223, 226 overdose 524 pheochromocytoma 431–2, 432 phosphates, hypercalcemia 84 physicians, ICU 12–13 physiologic adaptations to pregnancy 30–47 cardiovascular system 30 endocrine system 45–6 gastrointestinal system 43–4 hematologic system 44–5 immune system 46–7 respiratory system 41–3 physostigmine, overdose 527 pica 79 pituitary gland, pregnancy adaptations 45 placenta, substances crossing 182 placental abruption 308–9 and DIC 402 plague 733–4 plasma fresh frozen 168 thawed 168 plasminogen activator inhibitor 401 platelets, transfusion 168 Index 747 platelet count normal values 401 pregnancy adaptations 45 pneumonia, ventilator-associated 139–40 pneumothorax neonatal 121 open 497 tension 497 PO 2 57–8 poisoning see bioterrorism; overdose and poisoning polyneuropathy 138 positive end-expiratory pressure (PEEP) 115, 134–5, 135 positive-pressure ventilation neonate 116–17, 117 non-invasive 128–9, 129 postpartum hemorrhage 311–12, 311 etiology 311–12 secondary 321–2 surgical management 314–19, 316, 317 arterial embolization 318 bilateral uterine artery ligation 316–17, 316 hysterectomy 318–19 uterine brace suture 315, 316 uterine devascularization 315–16 uterine tamponade 315 uterine inversion 312 postpartum period agitation 692 depression 685 hemodynamic changes 40–1, 40 psychosis 692–4 renal failure 381, 382 suicidality 689 postpartum psychosis 694 postural changes in pregnancy 37–9, 37, 38 potassium, metabolic disturbances 78–81 hyperkalemia 79–81 hypokalemia 78–9 povidone iodine 18 pre-eclampsia 237–9, 438–58 abnormal cerebral hemodynamics 238 acute renal failure 380 analgesia-anesthesia 445–6 antihypertensive therapy 443–5, 444 ACE inhibitors 445 calcium channel blockers 444 diazoxide 444 hydralazine 443, 444 labetalol 444–5, 444 nitroglycerin 445 sodium nitroprusside 445 cardiopulmonary complications 341, 447–50 hypertensive cardiomyopathy 449–50 malignant ventricular arrhythmias 450 pulmonary edema 448–9 confusion with autonomic hyperrefl exia 232 defective cerebral autoregulation 238 diagnosis 440, 440 differential diagnosis 388 Doppler ultrasound 209 etiology 438–40, 439 HELLP syndrome see HELLP syndrome hemodynamic monitoring 446–7, 446, 447 liver rupture 453–4 management 440–1, 440 fl uid therapy 441 seizure prophylaxis 441–3, 442 neurologic complications 454–5 cerebral edema 454–5 temporary blindness 455 pancreatitis 454 renal complications 450–1 oliguria 450–1 uteroplacental-fetal complications 457 prednisolone, systemic lupus erythematosus 479 pregnancy loss, burns patients 512 pregnancy-related mortality ratio (PRMR) 4 pressure support ventilation 132 pressure-regulated volume control ventilation 132 preterm labor, burns patients 512 procainamide, fetal effects 631 propofol 142, 144 fetal effects 627–8 propylthiouracil, fetal effects 634 prostacyclin 286 prostaglandins septic shock 588 uterine atony 313–14 prosthetic heart valves 274–5 protein C 287, 401 activated 404 defi ciency 301 protein S 287, 401 defi ciency 301 protein Z 401 prothrombin 259, 401 pseudohyperkalemia 79–80 pseudohyponatremia 75 pseudoseizures 224 psychiatric conditions, acute 684–94 agitation and psychosis 689–94 depression 684–7 suicidality 687–9 psychosis 689–94 management 690–2, 691 pregnant and postpartum patients 692, 693–4 postpartum 694 pulmonary arteriography, pulmonary embolism 292, 293 pulmonary artery catheterization 16, 215–19 cardiac output determination 218 catheter placement 216–18, 216, 217 catheter insertion 216–17, 216 sheath insertion 216 waveforms 217–18, 217 complications 218 non-invasive techniques 218–19 pulmonary embolism 292 pulmonary artery pressure 34 pulmonary capillary wedge pressure (PCWP) 27, 34, 38, 39 pulmonary edema 348–56, 349 clinical setting 349 crystalloid-induced 71 diagnosis 352, 354, 354, 355 literature reviews 353 lung mechanics and gas exchange 352 pathophysiology 349–52, 350 hydrostatic pulmonary edema 383–5 lymphatic insuffi ciency 351 permeability edema 350–1, 351 unknown causes 351–2 pre-eclampsia 448–9 prevention 356 tocolytic-induced 341 treatment 354, 356, 356 pulmonary embolism 290–3 clinical diagnosis 290–1, 290 diagnosis 291–3, 291 alveolar-arterial oxygen gradient 291 chest X-ray 291 digital subtraction pulmonary angiography 293 ECG 291 indium 111 platelet imaging 293 laboratory studies 291, 291 pulmonary arteriography 292, 293 pulmonary artery catheterization 292 spiral CT 292 ventilation-perfusion lung scan 291–2, 292 incidence 284 mortality 284 risk factors 285 and route of delivery 285 pulmonary hypertension 261–3, 262, 649–51, 649 pathophysiology 649, 649 perioperative management 650–1 pharmacologic therapies 649–50 pulmonary stenosis 266, 267, 643 anesthesia 643–4 pulmonary toxins 735 pulmonary vascular resistance 109 pulmonic insuffi ciency 267 pulse oximetry 58, 127–8 pulse pressure 34 purpura, post-transfusion 177 Purtscher’s angiopathic retinopathy 368 pyelonephritis 379–80, 382, 720 Q fever 734 quinine, overdose 527 radial artery, cannulation 159–61 radiation exposure 735–7, 736 radiocontrast media, allergy to 599 radiofrequency ablation 701–2 radiology fetal exposure 231–2, 231 spinal injury 231 rapamycin 658 red cells antigen-antibody reactions 169–70, 170 transfusion 167 frozen 167–8 leukocyte reduced 167 washed 167 red cell mass 69 pregnancy adaptations 44–5 red cell volume, pregnancy adaptations 31 regional anesthesia, spinal cord injury 233 regional blood fl ow, pregnancy adaptations 36–7 renal cortical necrosis, bilateral 382, 382 Index 748 renal failure acute 194, 376–83, 382 acute fatty liver of pregnancy 380–1 acute glomerulonephritis 377–8, 378 bilateral renal cortical necrosis 382 burns patients 511 etiology 376–7, 377 HELLP syndrome 380 interstitial nephritis 378, 378 intrinsic renal disease 377–9, 378 management 382 pre-eclampsia 380 prerenal azotemia 377, 377 prognosis 382–3 pyelonephritis 379–80 thrombotic thrombocytopenic purpura/ hemolytic uremic syndrome 381 tubular necrosis 378–9 urinary obstruction 379, 379 dietary guidelines 193 end-stage, incidence in pregnancy 188, 189 postpartum 381 signs and symptoms 189 ventilation-induced 139 see also dialysis renal function pregnancy effects 69–70 septic shock 586 renal physiology, pregnancy adaptations 43 renal tract, pregnancy adaptations 43 renal transplantation 659–60, 659, 721 renin–angiotensin-aldosterone system 73 reserve volume 42 reservoir mask 129 respiratory acidosis 55, 65–6, 65 respiratory alkalosis 55, 66, 66 respiratory failure 124–5, 125 alveolar-arterial oxygen tension gradient 125 arterial oxygen tension 125 dead space 125 defi nition of 130 shunts 124–5 ventilation/perfusion mismatch 124–5 respiratory system pregnancy adaptations 41–3, 298, 299, 299 mechanics of respiration 41–2 physiologic changes 42–3, 42, 42 upper airways 41 resuscitation cardiopulmonary see cardiopulmonary resuscitation neonatal see neonatal resuscitation resuscitation devices 116, 117 rhinitis of pregnancy 41 ricin 734–5 Ringer’s lactate 70, 71 salicylates, overdose 524 saline 70, 71 salmeterol 331 schizophrenia 692–4 treatment 693–4 scorpion stings 553 sedation, ventilated patients 142–3, 144 sedatives, overdose 522 seizures see epilepsy Seldinger technique 154–5 self-injurious behavior 688 sepsis 573 burns patients 511–12 severe 572, 573 septic shock 571–88, 572 clinical presentation 576–7 defi nition 573 diagnosis 579–80, 580 disseminated intravascular coagulopathy 585–6 gastrointestinal tract and nutrition 586–7 outcome 586 pathophysiology 572–6, 574 predisposing factors 577–8, 578 pregnancy-related factors 578–9, 578 renal function 586 systemic infl ammatory response syndrome 571–2 treatment 580–6 antimicrobial therapy 584–5 coagulation cascade 585–6, 588 corticosteroids 587–8 immunotherapy 588 oxygenation 583–4 prostaglandins 588 resuscitation 581 surgery 585 vasoactive drug therapy 582–3 volume expansion 581–2 serotonin 286 Sheehan’s syndrome 75 shock anaphylactic 596–603 cardiogenic 564–5, 572 distributive (vasodilatory) 572 hypovolemic 229, 559–67, 572 septic 571–88 treatment, crystalloids 71 shunts fetal 701–2 intrapulmonary 124–5 sickle cell crisis 391–8 diagnosis 392 epidemiology 391 management 394–6, 395, 396 chest syndrome 395–7 fetal assessment 395 hepatic crisis 397 pain management 397, 398 uncomplicated acute pain crisis 394–5 molecular basis 391–2, 392 pathophysiology 392–3 secondary organ system effects 393–4 cardiovascular 393 renal 394 respiratory 393–4 therapeutic options 398–9 bone marrow transplant 399 erythropoietin 399 exchange transfusion 398–9 hydroxyurea 399 oxygen therapy 398 simple transfusion 399 silver sulfadiazine 511 single ventricle 266 sinus thrombosis 239–40 sirolimus 658 skin, decontamination 520–1 skull fractures 501 smallpox 732–3 snakebites 548–50, 549, 550 sodium, metabolic disturbances 74–8 hypernatraemia 76–8 hyponatraemia 74–6 sodium nitroprusside, pre-eclampsia 444, 445 spider bites 551–3, 551, 552 spinal cord injury 228–33 fetal considerations 231–2 cesarean delivery 231 hazards of diagnostic radiography 231–2, 231 long-term concerns 232–3 autonomic hyperrefl exia 232–3 labor and delivery 233 maternal considerations 228–31, 229 circulatory system 229 corticosteroids 230–1 fetal status 230 hemodynamic status 230 hypotension and fl uid resuscitation 230 neurogenic vs hypovolemic shock 229 orotracheal intubation 228–9 pregnancy physiology 229 radiologic imaging 231 spinal immobilization 228 ultrasound 230 spinal immobilization 228 spinal trauma 503–4 stab wounds 496 Staphylococcus aureus 573 status epilepticus 225–6, 226 stenosis, catheter-related 176–7 stillbirth, burns patients 512 Streptococcus pyogenes 573 stroke, pregnancy-related 235–48 air embolism 157, 241 amniotic fl uid embolism 241 cardioembolism 241 causation and time of occurrence 235, 236 cerebral blood fl ow 237 cerebral venous and sinus thrombosis 239–40 choriocarcinoma 241 diagnosis 236–7 gestational hypertension 237–9 intracerebral hemorrhage 241 ischemic 246–8, 247 Moyamoya disease 241 paradoxical embolism 241 physiology and pathophysiology 235–6 postpartum cerebral vasculopathy 240 pre-eclampsia-eclampsia-HELLP syndrome 237–9 risk factors 236 subarachnoid hemorrhage 241–4 aneurysm 245 arteriovenous malformations 245–6 types of 236, 237 stroke volume 34 pregnancy adaptations 34–5, 34, 35 . background 675–6 maintenance in vegetative state 676 management guidelines 676 8, 677 outcomes 676 perimortem cesarean delivery 103–4, 621–2, 621, 676 states of 677 brain injury diffuse 500 focal . 274–5 thromboembolic disease 293–300 antepartum management 297–8, 298 heparin 293–4, 293 intrapartum management 298–9 low molecular weight heparin 294–5, 294 postpartum management 299 prophylaxis . 80–1 etiology 80, 80 management 81, 81 hypermagnesemia 86 hypernatremia 76 8 clinical presentation 77 diagnosis 77 etiology 76 7, 76 management 77–8 hyperparathyroidism 432–3 hypertension pregnancy-induced