THE MASSACHUSETTS GENERAL HOSPITAL REVIEW OF CRITICAL CARE MEDICINE Section Editors Peter J Fagenholz, MD Instructor in Surgery, Harvard Medical School Assistant in Surgery, Department of Surgery Division of Trauma Emergency Surgery, and Critical Care Massachusetts General Hospital Boston, Massachusetts Jarone Lee, MD MPH Instructor in Surgery, Harvard Medical School Trauma, Emergency Surgery, Surgical Critical Care Massachusetts General Hospital Boston, Massachusetts Ala Nozari, MD, PhD Assistant Professor of Anaesthesia, Harvard Medical School Team Leader, Neurosurgical Anesthesia; Attending Physician, Neuroscience Intensive Care Unit, Massachusetts General Hospital Co-Director, Massachusetts General Hospital and Brigham and Women’s Hospital Training Program in Neurosurgical Anesthesia Assistant Anaesthetist, Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Ulrich Schmidt, MD, PhD, FCCM Associate Professor Department of Anesthesia Critical Care, Pain Medicine Massachusetts General Hospital Harvard Medical School Boston, Massachusetts THE MASSACHUSETTS GENERAL HOSPITAL REVIEW OF CRITICAL CARE MEDICINE Editors: Sheri M Berg, MD Instructor of Anaesthesia, Harvard Medical School Massachusetts General Hospital Boston, Massachusetts Edward A Bittner, MD, PhD Assistant Professor of Anaesthesia, Harvard Medical School Program Director, Critical Care Medicine Fellowship Associate Director, Surgical Intensive Care Unit Massachusetts General Hospital Boston, Massachusetts Product Manager: Nicole T Dernoski Production Editor: Alicia Jackson Manufacturing Manager: Beth Welsh Design Coordinator: Joan Wendt Compositor: Integra Software Services Pvt Ltd © 2014 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER BUSINESS Two Commerce Square 2001 Market St Philadelphia, PA 19103 USA LWW.com All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in China Library of Congress Cataloging-in-Publication Data Massachusetts General Hospital critical care board review / Sheri M Berg, MD, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, Edward A Bittner, MD, PhD, associate director for education, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, editors; Massachusetts General Hospital critical care board review, section editors, Jarone Lee, MD, MPH, Instructor in Surgery, Harvard Medical School, Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts [and three others] pages cm Includes bibliographical references and index ISBN 978-1-4511-7368-0 Critical care medicine—Handbooks, manuals, etc Medical emergencies—Handbooks, manuals, etc I Berg, Sheri M II Bittner, Edward A., 1967- III Lee, Jarone IV Title: Critical care board review RC86.8.M3935 2014 616.02'8—dc23 2013028741 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 2232320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 To our fellows: past, present, and future Contributors Young K Ahn, MD Assistant Clinical Professor Division of Critical Care Department of Anesthesia University of California Los Angeles Los Angeles, California Hasan B Alam, MD Norman Thompson Professor of Surgery Section Head, General Surgery University of Michigan Hospital Ann Arbor, Michigan Rebecca Aslakson, MD Assistant Professor The Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland Aranya Bagchi, MBBS Instructor in Anesthesia, Harvard Medical School Department of Anesthesia, Critical Care and Pain Medicine Boston, Massachusetts Lorenzo Berra, MD Assistant Professor of Anaesthesia, Harvard Medical School Assistant Anaesthetist, Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Edward A Bittner, MD, PhD Associate Director for Education Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Torrey Boland, MD Fellow, Neurocritical Care Massachusetts General Hospital and Brigham & Women’s Hospital Centennial, Colorado David Boldt, MD Assistant Professor Department of Anesthesiology University of California, Los Angeles Los Angeles, California Kathryn L Butler, MD Instructor in Surgery Division of Acute Care Surgery and Critical Care Beth Israel Deaconess Medical Center Boston, Massachusetts Mark Caridi-Scheible, MD Emory University School of Medicine Department of Emergency Medicine Atlanta, Georgia Christopher M Celano, MD Attending Psychiatrist Massachusetts General Hospital Boston, Massachusetts Jonathan E Charnin, MD Instructor, Harvard Medical School Anesthetist and Staff Intensivist Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts George Z Cheng, MD, PhD Department of Medicine Division of Pulmonary & Critical Care Massachusetts General Hospital Boston, Massachusetts Daniel Chipman Assistant Director Massachusetts General Hospital Respiratory Care Services Boston, Massachusetts Jason Chua, MD Assistant Professor Department of Anesthesiology University of California, Los Angeles Los Angeles, California Robert S Crawford, MD Assistant Professor Division of Vascular Surgery University of Maryland Medical Center Baltimore, Maryland Marc A de Moya, MD, FACS Assistant Professor of Surgery, Harvard Medical School, Surgical Critical Care Fellowship Director Medical Director, Blake 12 ICU Surgical Clerkship Director, Harvard Medical School Associate Program Director, Surgical Residency Department of Surgery Division of Trauma Emergency Surgery, and Critical Care Massachusetts General Hospital Boston, Massachusetts Ranjit Deshpande, MBBS Assistant Professor Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Anahat Dhillon, MD Assistant Professor University of California, Los Angeles Department of Anesthesiology Los Angeles, California José L Díaz-Gómez, MD Critical Care Anesthesiologist Mayo Clinic Anesthesia/Critical Care Services Jacksonville, Florida Anne M Drewry, MD Assistant Professor of Anesthesiology Washington University in St Louis Department of Anesthesiology St Louis, Missouri Shawn Fagan, MD Medical Director Division of Burns Massachusetts General Hospital Boston, Massachusetts Peter J Fagenholz, MD Instructor in Surgery, Harvard Medical School Department of Surgery Division of Trauma Emergency Surgery, and Critical Care Massachusetts General Hospital Boston, Massachusetts Corey R Fehnel, MD Fellow, Neurocritical Care Massachusetts General Hospital and Brigham & Women’s Hospital Boston, Massachusetts Karim Fikry, MD Resident Department of Anesthesia, Critical Care, and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Robert A Finkelstein, MD Clinical Fellow, Pediatric Emergency Medicine Boston Medical Center Division of Pediatric Emergency Medicine Graduate Assistant in Pediatrics Massachusetts General Hospital for Children Clinical Fellow, Pediatric Emergency Medicine Division of Pediatric Emergency Medicine Boston Medical Center Boston, Massachusetts Jonathan Friedstat, MD Resident, Plastic and Reconstructive Surgery University of North Carolina Chapel Hill, North Carolina Miguel M Gaeta, MD Instructor in Surgery, Harvard Medical School Trauma Medical Director, Elliot Hospital, Manchester, New Hampshire Assistant in Surgery, Massachusetts General Hospital Division of Trauma, Emergency Surgery, and Critical Care Massachusetts General Hospital Boston, Massachusetts Luis J Garcia, MD Assistant of Surgery The Johns Hopkins Hospital Baltimore, Maryland Edward George, MD, PhD Assistant Professor Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Brandy S Golenia, PharmD, BCPS Clinical Pharmacy Specialist-Drug Information Department of Pharmacy Services Cedars-Sinai Medical Center Los Angeles, California Jeremy W Goldfarb, MD Instructor in Anaesthesia, Harvard Medical School Director of Post Anesthesia Care Unit (PACU) Attending Anesthesiologist, Massachusetts Eye and Ear Infirmary Boston, Massachusetts Steven Greenberg, MD Director of Critical Care Services, Evanston Hospital Co-Director for Resident Education Department of Anesthesia NorthShore University HealthSystem Assistant Clinical Professor, Department of Anesthesiology Critical Care University of Chicago, Pritzker School of Medicine Chicago, Illinois Vadim Gudzenko, MD Assistant Clinical Professor Critical Care Division, Department of Anesthesiology David Geffen School of Medicine at University of California, Los Angeles Los Angeles, California Jessica Hines Administrative Coordinator Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts John O Hwabejire, MD, MPH Trauma Research Fellow Division of Trauma, Emergency Surgery, and Critical Care Massachusetts General Hospital Boston, Massachusetts Joseph A Hyder, MD, PhD Instructor in Anesthesia Department of Anesthesiology Harvard Medical School Boston, Massachusetts Daniel W Johnson, MD Critical Care Fellow University of Nebraska Medical Center Department of Anesthesiology Omaha, Nebraska Haytham M.A Kaafarani, MD, MPH Fellow in Trauma, Acute Care Surgery, and Critical Care Division of Trauma, Emergency Surgery, and Critical Care Massachusetts General Hospital PIP See Peak inspiratory pressure Piperacillin/Tazobactam, 209t Piperazine, 111 Pituitary hormone disorders, 153–154 Plain abdominal radiographs, 92 Plasma products, 262 coagulation factors, 263 cryoprecipitate, 263 fibrinogen concentrates, 263 fresh frozen plasma (FFP), 262 prothrombin complex concentrates (PCCs), 263 recombinant DNA-produced coagulation factors, 263 thrombin (Evithrom), 263 Plasmapheresis, 132 Plateau pressure (Pplat), 51 Platelets (PLTs), 262 surgery-related PLT transfusion management, 262 Pleural effusion, 291 PND See Paroxysmal nocturnal dyspnea Pneumonia, 74–76 See also Community-acquired pneumonia (CAT); Hospital-acquired pneumonia (HAP) definition, 74 differential diagnosis, 74 epidemiology, 74 in immunosuppressed patient, 75 management and treatment, 74–76 Pneumothorax, 83, 291 POI See Postoperative ileus Point-of-care ultrasound in ICU, 290–292 hypovolemia, 291 image quality, 290 lung ultrasonography, 291 pleural effusion, 291 ultrasound transducer, manipulating ways, 290 vascular access, 291–292 Pokilothermia, 175 Polyarteritis nodosa, 219 Polymyositis/dermatomyositis (PM-DM), 71 Polymyxins (polypeptides), 210t Pontine syndromes, 178t Portal decompression procedures, 127 Positive airway pressures (PAP), 82 Positive end expiratory pressure (PEEP), 46 Post capillary pulmonary hypertension, 62 Post intubation care, 338 Postcardiac arrest care, 34 cochrane metaanalysis, 34 systematic postcardiac arrest, 34 therapeutic hypothermia, 34 Posterior cerebral artery (PCA), 177, 178t Posterior cord syndrome, 173t Posterior inferior cerebellar artery, 178t Postoperative ileus (POI), 100 Postpartum hemorrhage, 238–239 primary, 239 secondary, 239 Postpyloric tubes, 316 Post-transfusion purpura (PTP), 264 Post-traumatic epilepsy, 278 Potassium balance, 243–243 PRBCs See Packed red blood cells Prednisone, 107 Pre-eclampsia/Eclampsia, 233–235 Preoperative evaluation for surgery, 340–342 cardiac patient evaluation for noncardiac surgery, 340–341 ACC/AHA guidelines, 340 antithrombotic medications, 341 Lee Revised Cardiac Risk Index, 341 pacemakers/ICDs, 341 primary prophylaxis, 341 secondary prophylaxis, 341 preoperative fasting guidelines, 342 preoperative history and physical, 340 pulmonary evaluation, 341–342 testing, 340 Preoperative fasting guidelines, 342 Preoxygenation, 110 Pressure-volume curves, 51 Primary ACS, 85 Primary AI, 151 Primary cardiovascular events, 33 Primary critical care-related effector organs, 147 Primary metabolic alkalosis, 120 Primary postpartum hemorrhage, 239 Primary prophylaxis, 341 Primary psychiatric disorders, 160 Primary pulmonary events, 33 Primary respiratory acidosis, 119–120 Primary respiratory alkalosis, 120 Prion disease, 190–191 Procainamide, 48 Procoagulant inducers (CRP), Prolonged or paralytic ileus, 100 Proning, 57 Propofol, 197t, 338 Proportional assist ventilation (PAV), 54t Propranolol, 114, 161 Propylthiouracil, 155 Prostacyclin analogues, 63 Prostaglandin analogues, 113 Prostatitis, 117 Protein metabolism, 250 Prothrombin complex concentrate (PCC), 143, 145, 199, 263 PS See Pulmonic stenosis Pseudo AS, 14 PTE See Pulmonary thromboendarterectomies PTP See Post-transfusion purpura PTT See Partial thromboplastin time Pulmonary alveolar proteinosis, 71 Pulmonary arterial hypertenion (PAH), 62 Pulmonary artery catheter (PAC), 45–46 Pulmonary artery occlusion pressure (PAOP), 45 Pulmonary balloon valvuloplasty (PBV), 17 Pulmonary capillary wedge pressure (PCWP), 62 Pulmonary complications, 138 Pulmonary contusion, 77, 278 common causes, 77 definition, 77 differential diagnosis, 78 epidemiology, 77 management and treatment, 78–79 fluid management, 79 oxygenation and ventilation, optimization, 78 pain control, 78 surgical management, 79 ventilatory support, 78 pathophysiology, 78 Pulmonary disorders, pharmacologic therapies for, 83–84 acetazolamide, 84 anticholinergics, 83 beta agonists, 83 epinephrine (nonpressor), 84 inhaled corticosteroids, 83 inhaled helium-oxygen mixture, 84 leukotriene inhibitors, 84 magnesium sulfate, 84 medroxyprogesterone, 84 oxygen therapy, 83 roflumilast, 84 systemic steroids, 83 theophylline, 84 Pulmonary edema, 31 cardiogenic, 31–33 neurogenic, 176 noncardiogenic, 31–33 Pulmonary embolism (PE), 60–62, 278 definition, 60 diagnostic testing, 60–61 chest X-ray(CXR) findings, 60 DVT studies, 60 echocardiographic findings, 60 laboratory findings, 60 ventilation perfusion scan (VQ scan), 60 management and treatment, 61–62 algorithm based on the PIOPED II study, 61 anticoagulation, 61 catheter-based embolectomy, 61 identifying right-heart strain, 61 initial stabilization, 61 IVC filter placement, 61 surgical embolectomy, 61 thrombolysis, 61 Pulmonary emergencies, 280–281 See also Airway and pulmonary emergencies Pulmonary evaluation for surgery, 341–342 obstructive sleep apnea (OSA), 341–342 respiratory failure index, 342t Pulmonary function tests, 68 Pulmonary hypertension (PH), 62–64 differential diagnosis, 63 management and treatment, 63 anticoagulation, 64 calcium-channel blockers, 64 non-Group I disease, 64 organ transplant, 64 prostacyclin analogues, 64 pathophysiology, 62–63 vasodilatory challenge, 63 Pulmonary irritants, 300 Pulmonary mechanics, 51–84 definitions, 51 formulas, 51 Pulmonary thromboendarterectomies (PTE), 61 Pulmonary vascular resistance (PVR), 29 Pulmonary venoocclusive disease (PVOD), 62 Pulmonic regurgitation, 18 Pulmonic stenosis (PS), 17, 28 mild and moderate PS, 17 severe PS, 17 Pulse contour analysis, 46 Pulseless VT, 287 Pure motor, 178t Pure sensory, 178t P-value, 322 PVOD See Pulmonary venoocclusive disease PVR See Pulmonary vascular resistance Pyelonephritis, 117 Pyloric stenosis, 282 Pyridostigmine (Mestinon), 199 Q Quetiapine, 160, 167 Quinupristin/Dalfopristin, 210t R RAA See Renin–angiotensin–aldosterone Radiation-induced lung disease, 71 bilateral lymphocytic alveolitis (BAL), 71 lymphangitic carcinomatosis, 71 Radiologic exposure, 298–301 See also Nuclear, radiologic, chemical, and biologic (NRCB) attacks Ranson’s criteria, 86 Rapid four-step cricothyroidotomy technique, 308 Rapid sequence intubation (RSI), 337 Rapidly acquired hypokalemia, 244 RBCs See Red blood cells RBF See Renal blood flow RBILD See Respiratory bronchiolitis-associated interstitial lung disease RDI See Respiratory disturbance index Reactive airway disease, 65–66 See also Asthma Receiver operating characteristic (ROC), 322 Recombinant DNA-produced coagulation factors, 263 Recombinant factor VIIa, 145 Recombinant human thrombomodulin, 145 Recombinant tissue factor pathway inhibitor, 145 Recurrent acute episodes, 137 Red blood cells (RBCs), 261 general information, 261 indications, 261 packed red blood cells (PRBCs), 261 special considerations, 261 Refeeding, 249 Refeeding metabolism, 256 Refeeding syndrome, 256–257 causes, 256 differential diagnosis, 257 management and treatment, 257 normal phosphate metabolism, 256 pathophysiology, 256–257 refeeding metabolism, 256 Refractory disease, 107 Relative AI, 152 Relative risk (risk ratio), 322 Renal blood flow (RBF), 115 Renal disorders, pharmacologic therapies for, 122–123 buffers, 122–123 diuretics, 122 Renal dysfunction, Renal replacement therapy (RRT), 120–121 dose, 121 epidemiology, 120 indications, 120–121 Renin, 251 Renin-angiotensin, 115 Renin–angiotensin–aldosterone (RAA) system, RERA See Respiratory effort related arousal Respiratory bronchiolitis-associated interstitial lung disease (RBILD), 69 Respiratory disturbance index (RDI), 81 Respiratory dysfunction, Respiratory effort related arousal (RERA), 81 Respiratory failure, 52t, 52–55 index, 342t type 1, 52 type 2, 52 Respiratory rate, 53 Respiratory sequelae, 220 Respiratory/hemodynamic support, 23 Restrictive airway diseases, 68–72 See also Interstitial lung diseases (ILDs) acute eosinophilic pneumonia, 70 causes, 69 connective tissue disorders, 71 drug-induced lung toxicity, 70 hypersensitivity pneumonitis (extrinsic allergic alveolitis), 70–71 idiopathic chronic eosinophilic pneumonia, 70 idiopathic interstitial pneumonias, 69 malignancy-related associations, 71–72 pulmonary alveolar proteinosis, 71 pulmonary function tests, 68 sarcoidosis, 70 Restrictive cardiomyopathy, 22–23 Resuscitation parameters, 295 Retained hemothorax, 278 Retropharyngeal abscess, 280 Revascularization, 11 Reye’s syndrome (hyperammonemia), 190 Rheumatoid arthritis, 71, 217 Rhythm analysis, 44 Rhythm disturbances, 12–13 common causes, 12 differential diagnosis, 12–13 bradycardias, 12 immediate goal, 12 narrow complex QRS, 12 occasional PVCs/PACs, 12 rhythm as perfusing, question of, 12 wide complex QRS, 12 Wolff-Parkinson-White (WPW) syndrome, 12 epidemiology, 12 management and treatment, 13 asymptomatic sinus bradycardia/ tachycardia, 13 heart block, 13 new-onset atrial fibrillation, 13 SVT, 13 symptomatic arrhythmias, 13 WPW with atrial fibrillation/SVT, 13 outcomes, 13 pathophysiology, 12 Rickettsiae, 207 Rifaximin, 128 Right ventricular (RV) decompensation, 62 Rigid bronchoscopy, 309t Rivoraxaban, 142 ROC See Receiver operating characteristic Rocuronium, 198t, 338 Roflumilast, 84 Roux-en-Y gastric bypass (RYGB), 99 RRT See Renal replacement therapy RSI See Rapid sequence intubation Rule of nines, 294f Rule of 10s, 152 Ruptured AAA, 39 Ruptured Aneurysm, 183 endovascular treatment of, 183 surgical treatment, 183 RV hypertrophy (RVH), 17 RVH See RV hypertrophy RYGB See Roux-en-Y gastric bypass S Saccular aneurysms, 182 Salvage therapies, 57 SAM See Systolic anterior motion SAPS See Simplified acute physiology score Sarcoidosis, 70 SBO See Small bowel obstruction SBT See Spontaneous breathing trial Schizoaffective disorder, 165 Scleroderma, 71, 225 Sclerosing cholangitis, 106 Scopolamine, 112 SCT See Stem cell transplant SCUF See Slow continuous ultrafiltration SE See Status epilepticus Secondary ACS, 85 Secondary AI, 152 Secondary hemostasis, 142 Secondary postpartum hemorrhage, 239 Secondary prophylaxis, 341 Secretagogues, 158 Seizures, 178, 184 Seldinger chest tube type, 312 Seldinger cricothyroidotomy technique, 308 Selective serotonin reuptake inhibitors (SSRIs), 166 Sensitizers, 158 Sentinel (warning) headaches, 181 Sepsis/multiple organ failure, 1, 125 liver dysfunction in, 125 Sepsis-related organ failure assessment (SOFA), 330 Septic shock, 1–3 causes, definitions, differential diagnosis, epidemiology, management and treatment, 2–3 corticosteroid administration, in first hours, in first hours, fluid resuscitation, glucose control, nutritional support, oxygenation and correct hypoxemia, source control, timely administration of antimicrobial therapy, outcomes, pathophysiology, 1–2 cardiac and circulatory dysfunction, cellular dysfunction, central nervous system dysfunction, endocrine dysfunction, endothelial dysfunction, hepatic dysfunction, immune response, infectious source, type, insulin deficiency, loss of hemostatic balance, procoagulant inducers (CRP), renal dysfunction, respiratory dysfunction, vasopressin deficiency, sepsis, severe sepsis, Sequelae, 148 Sequential compression, 111 Serine protease inhibitor Kazal type (SPINK1), 87 Serologic compatibility testing, 263–264 Serotonin (5-HT) receptor agonists, 112–113 Serotonin (5-HT) receptor antagonists, 112 Serotonin syndrome, 228, 230t Serotonin-norepinephrine reuptake inhibitors (SNRIs), 166 Severe AS, 14 Severe PS, 17 Severe sepsis, Severe shock, Severity scoring, 87–88 Shock in trauma, 271 Shock, 1–3 See also Anaphylactic shock; Cardiogenic shock; Hypovolemic shock; Septic shock “Shock liver”, 125 Short-bowel syndrome, 98 complications, 98 treatment and management, 98 SIADH See Syndrome of inappropriate diuretic hormone Sickle cell syndromes, 135–137 SID See Strong ion difference Silver nitrate, 295 Simple partial SE, 162 Simplified acute physiology score (SAPS), 330 Sinusoidal occlusion syndrome, 138 Sjögren syndrome, 71 SLE See Systemic lupus erythematosus SLED See Sustained low efficiency dialysis Sleep aides, 167 Sleep-related breathing disorders (SRBD), 81–83 clincial considerations, 82 differential diagnosis, 81–82 hyperventilation syndromes, 82 obstructive sleep apnea syndrome, 82 epidemiology, 81 management and treatment, 82 pathophysiology, 82 Sleroderma, 218 Slow continuous ultrafiltration (SCUF), 121 SMA See Superior mesenteric artery Small bowel ileus, 98t Small bowel obstruction (SBO), 101, 107 Small intestine bacterial overgrowth, 98–99 SNRIs See Serotonin-norepinephrine reuptake inhibitors Sodium balance, 241–243 SOFA See Sepsis-related organ failure assessment Somatostatin (SS), 114, 147 spinal cord injury (SCI), 172–177 aminophylline, 175 anterior cord syndrome, 173t autonomic hyperreflexia, 176 blood pressure regulation, 174–175 bradycardia, 174 Brown-Séquard syndrome, 173t central cord injury, 173t cerebrospinal fluid (CSF) drainage, 175 classification, 173 differential diagnosis, 173–174 Hangman’s fracture, 173 herniation of intervertebral disks, 173 Jefferson fracture, 173 ligamentous injuries, 173 vascular injuries, 173 epidemiology, 173 etiology, 173 guidelines for managing, 175 hypotension, 174 medical management, 174 methylxanthines, 175 neurogenic shock, 174–175 pathophysiology, 173 pokilothermia, 175 posterior cord syndrome, 173t spinal drainage, 175 subacute presentation, 174 surgical management, 175–176 Spirochetes, 207 Splenectomy, 137 Splenic sequestration crisis, 137 Spontaneous breathing trial (SBT), 54 if patient fails, 55 tolerance of, determination, 54 objective criteria, 54t subjective criteria, 54t SRBD See Sleep-related breathing disorders SSRIs See Selective serotonin reuptake inhibitors Standard cricothyroidotomy technique, 308 Status epilepticus (SE), 162–163 causes, 162 classification, 162 complex partial (nonconvulsive) SE, 162 differential diagnosis, 162–163 epidemiology, 162 generalized convulsive SE, 162 management and treatment, 163 first-line treatment, 163 second-line treatment, 163 third-line treatment, 163 myoclonic SE, 162 nonconvulsive SE, 162 pathophysiology, 162 simple partial SE, 162 Stem cell transplant (SCT), 138–139 See also Bone marrow transplant (BMT)/Stem cell transplant (SCT) Step-up approach, 89 Steroids, 57, 170 Stevens-Johnson syndrome, 224 Stewart Model, 119 Stimulant laxatives, 113 Stool tests, 97t Streptogramins, 210t Streptomycin, 208t Stress hormone response, 250–252 excessive stress hormone response, 251 inadequate stress hormone response, 251–252 metabolic response to stress, 250–251 carbohydrate metabolism, 250 electrolyte and water metabolism, 250 lipid metabolism, 250 protein metabolism, 250 Stress hyperglycemia, 148 Stroke, 40, 178 Strong ion difference (SID), 119 ‘Stunned’ myocardium, 26–27 Subarachnoid hemorrhage, 181–185 acute hydrocephalus, 184 catheter angiography, 182 causes, 181 CT angiography, 182 delayed cerebral ischemia, 183–185 diagnosis, 182–183 differential diagnosis, 182 epidemiology, 181–182 grading the severity of, 182 hemorrhage, 181 lumbar puncture (LP), 182 magnetic resonance imaging (MRI), 182 pathophysiology, 182 prevention of rebleeding, 183 seizures, 184 systemic complications, 184 cardiac, 184 fevers, 184 hyponatremia, 184 pulmonary, 184 Takotsubo cardiomyopathy, 184 traumatic brain injury (TBI), 181 treatment, 183–184 vasospasm, 183 Suboptimal caloric intake, 253 Suboptimal lipid/fatty acid intake, 253 Suboptimal micronutrient intake, 253 Substance-induced mood disorder, 165 Succinylcholine, 198t, 338 Sulfasalazine, 221 Sulfonylureas, 158 Superior mesenteric artery (SMA), 92 Surgery-related platelet (PLT) transfusion management, 262 Surgical embolectomy, 61, 93 Surgical emergencies, 282–283 biliary atresia, 283 congenital diaphragmatic hernia, 282 gastroschisis, 282 intussusception, 282–283 malrotation with volvulus, 282 meckel diverticulum, 282 necrotizing enterocolitis, 282 omphalocele, 282 pyloric stenosis, 282 tracheoesophageal fistula, 282 Surgical enteric access, feeding tube placement, 315 Surgical management, 175–176 Sustained low efficiency dialysis (SLED), 121 Sympathetic nervous system, 115 Sympathoadrenalchromaffin cell tumors, 152 Sympathomimetic intoxication, 37 Symptomatic bradycardia treatment, 287 Syndrome of inappropriate diuretic hormone (SIADH), 154, 184, 278 Systematic postcardiac arrest, 34 Systemic lupus erythematosus (SLE), 225 Systemic sclerosis, 71 Systemic steroids, 83 Systolic anterior motion (SAM), 17 Systolic dysfunction, 23–24 T Tachycardia treatment, 287 Takayasu’s disease, 219 Takotsubo cardiomyopathy, 184 Tamiflu, 211t Tamponade, 21 TAP See Trypsinogen activating peptide Taumatic brain injury (TBI), 169–172, 181 causes, 169 delayed neurologic deterioration after, 170 general care of, 170 management and treatment, 170 pathophysiology, 170 neurochemical mediators, 170 patients who “talk and deteriorate”, 170 primary injury, 170 secondary injury, 170 stratification of, 170 TBI See Taumatic brain injury T-cell, 213 TEB See Thoracic electrical bioimpedance Tegaserod, 112 Thalassemia, 136 THAM See Tris (hydroxymethyl)-aminomethane Theophylline, 84 Therapeutic hypothermia, 196–197 indication, 196 management and treatment, 196 pathophysiology, 196 Therapeutic hypothermia, 34, 232 Therapeutic weighted scores, 330 Thermoregulation, 226–270 See also Heat stroke; Malignant hyperthermia (MH); Neuroleptic malignant syndrome (NMS) Thiazide diuretics, 122 Thiazolidinediones, 158 Thionamides, 157 Thoracentesis, 313 complications, 313 contraindications, 313 postprocedure management, 313 transudates, 313 exudates, 313 procedure, 313 Thoracic electrical bioimpedance (TEB), 46 Thrombectomy, 93 Thrombin (Evithrom), 263 Thrombocytopenia, 132–133, 142–143, 217 causes, 132 differential diagnosis, 132 HIT, 132 HUS, 132 ITP, 132 TTP, 132 epidemiology, 132 management and treatment, 132–133 HIT, 133 HUS, 133 ITP, 133 TTP, 132 pathophysiology, 132 Thrombocytosis, 133–134 causes, 133 differential diagnosis, 133 epidemiology, 133 management and treatment, 133–134 myeloproliferative, 134 reactive/secondary, 133 pathophysiology, 133 Thrombolysis, 61 contraindications for, 61 absolute, 61 relative, 61 Thromboprophylaxis, 111 Thrombotic mesenteric arterial disease, 109 Thrombotic thrombocytopenic purpura (TTP), 132–133, 145 Thyroid disease treatments, 157 Thyroid disorders, 155–157 See also Hyperthyroidism; Thyroid storm pharmacologic therapies for, 157–158 insulins, 158 steroids, 157 Thyroid hormones, 251 Thyroid storm/hyperthyroid crisis, 155–156, 158 diagnosis, 155 precipitating factors for, 155t supportive therapy, 155, 156t symptoms, 155 thyroid-directed therapy, 156t thyroid hormone production, 155 Thyrotropin-releasing hormone (TRH), 147 Ticarcillin/Clavulanate, 209t Tidal volume, 53 Tigecycline, 210t Tight calorie control study (TICACOS), 254 Tissue hypoxemia, 33 TLC See Total lung capacity TLS See Tumor lysis syndrome Tobramycin, 208t Tolvaptan (Samsca), 122 Top of the basilar, 178t Torsemide (Demadex), 122 Total lung capacity (TLC), 65 Total parenteral nutrition (TPN), 88, 126, 248, 254–255 Toxic encephalopathy, 128t Toxic epidermal necrolysis, 224 Toxin B, 104 TPN See Total parenteral nutrition Tracheobronchitis, 76–77 See also Ventilator-associated tracheobronchitis causes, 76 definition, 76 differential diagnosis, 76 epidemiology, 76 management and treatment, 76 pathophysiology, 76 Tracheoesophageal fistula, 282 Tracheostomy, 305–307 complications, 305 decannulation, 306 equipment, 305–306 indications, 305 outcomes after, 306 procedure, 306 relative contraindications, 306 timing in endotracheally intubated patients, 306 weaning, 306 TRALI See Transfusion-related lung injury Transcranial Doppler ultrasonography, 196 Transfusion guidelines, 271–273 Transfusion-related lung injury (TRALI), 264 Transfusion therapy, 261–265 available blood products, 261 compatibility testing, 263–264 plasma products, 262 platelets (PLTs), 262 red blood cells (RBCs), 261 risks of transfusion, 264 immunologic complications, 264 Transient ischemic attack (TIA), 178 migraine, 178 seizure, 178 stroke, 178 Transmissible spongiform encephalopathies (TSE) See Prion disease Transplants, 266–270 heart, 267–268 kidney transplant, 269 liver, 268–269 lung, 266 pancreas transplantation, 269 Transthoracic echocardiogram (TTE), 22, 47 Transudates, 313 Transverse myelitis, 190 Trauma management, 271–279 basic management, 273–275 cardiogenic shock, 273 differential diagnosis of hypotension in, 273 epidemiology, 273 hypovolemic shock, 273 neurogenic shock, 273 obstructive shock, 273 blunt injuries, 274 diagnostic peritoneal lavage (DPL), 275 ED resuscitative thoracotomy, 275 focused assessment with sonography for trauma (FAST), 274 stable patients, 275 unstable patients, 275 fluid choices, 272 fluid resuscitation/transfusion guidelines, 271–273 hypotensive resuscitation (permissive hypotension), 271–272 management and treatment, 273–275 airway, 273 breathing, 274 cervical spine evaluation, 274 circulation, 274 hypotensive resuscitation, 274 penetrating injuries, 274 abdomen, 274 chest, 274 extremities, 274 neck, 274 thoracoabdomen, 274 shock and resuscitation monitoring, diagnosis of, 271 shock in trauma, 271 Traumatic hemorrhagic shock, Trazodone, 167 TRH See Thyrotropin-releasing hormone Triazoles, 211t Tricuspid regurgitation, 18 Tricuspid stenosis (TS), 15, 18 Tricyclic antidepressants, 166 Tris (hydroxymethyl)-aminomethane (THAM), 123 Tromethamine (THAM), 198t Tropisetron, 112 Trypsinogen activating peptide (TAP), 87 TS See Tricuspid stenosis TSE See Transmissible spongiform encephalopathies TTE See Transthoracic echocardiogram t-test, 322 TTP See Thrombotic thrombocytopenic purpura Two-by-two table, 322 Tube feed tolerance, 255 Tube thoracostomy (chest tube), 311–312 open/surgical type, 312 procedure, 312 antibiotic prophylaxis, 312 insertion site, 312 open/surgical method, 312 Seldinger method, 312 Seldinger type, 312 Tubuloglomerular feedback, 115 Tumor lysis syndrome (TLS), 139–141 clinical findings, 139 epidemiology, 140 laboratory findings, 139 management and treatment, 140–141 pathophysiology, 140 risk factors for development of, 140 Tumor necrosis factor (TNF)-alpha inhibitors, 222 U UCBT See Umbilical cord blood transplant UDDA See Uniform Determination of Death Act Ulcerative colitis (UC), 105 Umbilical cord blood transplant (UCBT), 138 Uncomplicated UTI, 117 Unconjugated hyperbilirubinemia, 125 Unfractionated heparin and LMWH, 145 Uniform Determination of Death Act (UDDA), 194 Unstable hemoglobins, 137 Upper GI bleeding, 94, 114 Urinary tract infections (UTI), 117–118 catheter-associated urinary tract infection (CAUTI), 117 complicated, 117 definitions, 117 epidemiology, 117 ICU-acquired, 117 management and treatment, 117–118 pathophysiology, 117 uncomplicated, 117 Urticaria, 225 Usual interstitial pneumonia, 69 Uterine atony, 239 Uvulopalatopharyngoplasty (UPPP), 82 V VALI See Ventilator-associated lung injury Valproate, 161 Valvular disorders, 14–19 Vancomycin, 104, 210t VAP See Ventilator-associated pneumonia Vaptans, 122, 198 Vascular access, 291–292 Vascular complication, 278 blunt cerebrovascular injury, 278 Vascular diseases of small bowel, 108–109 See also Arteriovenous malformation (AVM); Mesenteric venous thrombosis Vascular injuries, 173 Vascular malformations, 185–188 types, 185 See also Arteriovenous malformation; Cavernous malformations; Developmental venous anomaly; Dural arteriovenous fistulas Vasculitides, 218–221 GI sequelae, 220 giant cell arteritis, 218 Henoch–Schönlein purpura, 219–220 immune modulator drugs, 221–222 immunocompromised patient, 221 immunosuppressed patient, 220 Kawasaki disease, 218 neurologic sequelae, 220 polyarteritis nodosa, 219 respiratory sequelae, 220 Takayasu’s disease, 219 Wegener’s granulomatosis, 219 Vasodilators, 49–50 Vasopressin, 2–3, 49, 114, 157 Vasopressors, 48–49 Vasospasm, 183 Vasovagal reactions, Vecuronium dose, 198t Venlafaxine, 166 Ventilation perfusion scan (VQ scan), 60 Ventilator-associated lung injury (VALI), 58–59 causes, 58 differential diagnosis, 59 epidemiology, 58 management and treatment, 59 pathophysiology, 58–59 Ventilator-associated pneumonia (VAP), 74 Ventilator-associated tracheobronchitis, risk factors for, 76 Ventilator-induced lung injury (VILI), 58–59 causes, 58 differential diagnosis, 59 epidemiology, 58 management and treatment, 59 pathophysiology, 58–59 Ventilator management, in asthma patients, 66 Ventilator settings, 53 I:E ratio, 53 inspiratory time, 53 management, 53 proportional assist, 53 respiratory rate, 53 tidal volume, 53 treatment, 53 Ventricular septal defect (VSD), 28 Verapamil, 48 Vertebral artery, 178t Vesicants, 300 VILI See Ventilator-induced lung injury Viral infections, 168 Viral meningitis, 169 Volatile anesthetics, 66 Volutrauma, 58t Vomiting, 111–112 Von Willebrand’s factor (VWF), 132, 142 Voriconazole, 211t VSD See Ventricular septal defect VWF See Von Willebrand’s factor W Warfarin, 142 Water metabolism, 250 Weak acids, 119 Weaning, 52–55, 110, 306 Wegener’s granulomatosis, 219 Wolff-Parkinson-White (WPW) syndrome, 12 World Allergy Organization (WAO) guidelines, World Federation of Neurological Surgeons (WFNS), 182 Wound management, 295 Z Zinc, 128 Zonafasciculata (glucocorticoids), 148 Zonaglomerulosa, 148 Zonareticularis, 148 ... of Surgery University of Maryland Medical Center Baltimore, Maryland Kamal Medlej, MD Assistant Professor of Clinical Emergency Medicine Department of Emergency Medicine American University of. .. Critical Care Medicine Trauma/Acute Care Surgery Division of Surgery Baltimore, Maryland David Stahl, MD Clinical Fellow, Anesthesia Critical Care Department of Anesthesia, Critical Care and Pain Medicine... Clinical Professor, Department of Anesthesiology Critical Care University of Chicago, Pritzker School of Medicine Evanston, Illinois Kenneth Shelton, MD Clinical Fellow Department of Anesthesia, Critical