2017 evidence based critical care a case study approach

Robert C Hyzy Editor Evidence-Based Critical Care A Case Study Approach 123 Evidence-Based Critical Care Robert C Hyzy Editor Evidence-Based Critical Care A Case Study Approach Editor Robert C Hyzy Division of Pulmonary and Critical Care University of Michigan Ann Arbor MI USA ISBN 978-3-319-43339-4    ISBN 978-3-319-43341-7 (eBook) DOI 10.1007/978-3-319-43341-7 Library of Congress Control Number: 2017931641 © Springer International Publishing Switzerland 2017 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to the memory of Eugene C. Hyzy, MD Preface Along with Springer International, I am pleased to offer you our new textbook entitled Hyzy’s Evidence-Based Critical Care Medicine: A Case Study Approach In medicine, “teachable moments” usually occur in clinical context, where the engagement in a real case exemplifies principles of diagnosis or therapy We have created our new textbook with the teaching moment in mind: each chapter begins with a real case gleaned from the authors’ clinical experience In order to replicate the teaching dyad, each case poses a question which offers the reader to process and reflect on the components of the case before offering and answer While medical practice attempts to be evidence-based, common approaches to diagnosis and management incorporate not only evidence but heuristics and biases which await either validation or repudiation Hence, we have divided the discussion section of each chapter into two segments: the “Principles of Management” section and the “Evidence Contour” section In the “Principles of Management” section, the common approach to the care of patients having a given condition is presented Here you will find the nuts and bolts of what you need to know about the condition and the usual approach to diagnosis and treatment Evidence-based approaches are emphasized, where appropriate However, medical knowledge is ever evolving The approach to many aspects of the diagnosis and treatment of a condition remains the subject of controversy In the “Evidence Contour” section, each author discusses the aspects of diagnosis and management which are the subject of ongoing debate in the medical literature In the way, the reader will appreciate not only what appears to be known but also what is becoming known about a given topic We believe the approach we have taken with this textbook successfully bridges the gulf between the traditional encyclopedic sit-on-your-shelf textbook and the single-hit online reference, each of which lacks the contextual elements of effective learning This is a new way to present knowledge in a medical textbook and should help critical care practitioners, fellows, residents, allied health professionals, and students expand their critical care knowledge in an efficient and effective manner This approach should also benefit those preparing for board examinations I would like to thank the many friends, colleagues, and former fellows whose labors went to create this book In particular, I would like to thank my section editors, Drs Robert Neumar, David Morrow, Ben Olenchock, Romer Geocadin, John Kellum, Jonathan Fine, Robyn Scatena, Lena Napolitano, vii Preface viii and Marie Baldisseri Without their thoughtful and insightful efforts, this book would not have been possible I would also like to thank my editors at Springer, Connie Walsh and Grant Weston for their vision and for seeing this work through to fruition Ann Arbor, MI, USA Robert C. Hyzy, MD Contents Part I ER- ICU Shock and Resuscitation Robert W Neumar 1 Cardiac Arrest Management������������������������������������������������������������  3 Ronny M Otero 2 Post-cardiac Arrest Management ��������������������������������������������������  13 Ronny M Otero and Robert W Neumar 3 Undifferentiated Shock��������������������������������������������������������������������  25 Sage P Whitmore 4 Hypovolemic Shock and Massive Transfusion������������������������������  39 Joshua M Glazer and Kyle J Gunnerson 5 Acute Respiratory Failure: NIV Implementation and Intubation����������������������������������������������������������������������������������  49 Torben K Becker and John M Litell 6 Diagnosis and Management of Tricyclic Antidepressant Ingestion����������������������������������������������������������������  57 Patrick George Minges and Robert W Shaffer 7 Management of Calcium Channel Blocker Poisoning������������������  65 David M Black and Robert W Shaffer 8 Diagnosis and Management of Ethylene Glycol Ingestion����������  73 Christine Martinek Brent and Robert W Shaffer 9 Accidental Hypothermia ����������������������������������������������������������������  83 Carrie Harvey and Ivan Nathaniel Co Part II  Cardiac Disease David A Morrow and Benjamin A Olenchock 10 Management of Cardiogenic Shock ����������������������������������������������  95 Michael G Silverman and Benjamin A Olenchock 11 Management of Acute Heart Failure��������������������������������������������  103 Gregory T Means and Jason N Katz ix x 12 Management of Acute Coronary Syndrome��������������������������������  111 Arman Qamar and Benjamin M Scirica 13 Complications of Myocardial Infarction�������������������������������������  121 Brandon M Jones and Venu Menon 14 Management of  Cardiac Tamponade ������������������������������������������  129 David D Berg, Gregory W Barsness, and Benjamin A Olenchock 15 Hypertensive Crises ����������������������������������������������������������������������  135 Mark Schmidhofer 16 Atrial Fibrillation and Other Supraventricular Tachycardias����������������������������������������������������������������������������������  145 Daniel Sedehi 17 Ventricular Arrhythmias ��������������������������������������������������������������  153 Sohaib Tariq and Howard A Cooper 18 Management of  Acute Aortic Syndromes������������������������������������  163 Carol H Choe and Rohan R Arya 19 Management of  Endocarditis��������������������������������������������������������  171 Janek Manoj Senaratne and Sean van Diepen Part III  Respiratory Disease Robert C Hyzy 20 Community Acquired Pneumonia������������������������������������������������  181 Richard G Wunderink and Mark W Landmeier 21 Management of Acute Respiratory Distress Syndrome��������������  189 Robert C Hyzy 22 Acute Exacerbation of COPD: Non-­invasive Positive Pressure Ventilation��������������������������������������������������������  199 Kristy A Bauman 23 Management of Status Asthmaticus ��������������������������������������������  205 Jacob Scott and Ryan Hadley 24 Immunocompromised Pneumonia�����������������������������������������������  215 Robert P Dickson 25 Venous Thromboembolism in the Intensive Care Unit��������������  221 Scott J Denstaedt and Thomas H Sisson 26 Massive Hemoptysis����������������������������������������������������������������������  233 Andrew M Namen, Norman E Adair, and David L Bowton 27 Sedation and  Delirium������������������������������������������������������������������  241 Timothy D Girard 28 Prolonged Mechanical Ventilation������������������������������������������������  251 Thomas Bice and Shannon S Carson Contents Contents xi 29 Ventilator-Associated Pneumonia and Other Complications��������������������������������������������������������������������������������  257 Jennifer P Stevens and Michael D Howell 30 Respiratory Failure in a Patient with Idiopathic Pulmonary Fibrosis������������������������������������������������������������������������  265 Ryan Hadley 31 Weaning from  Mechanical Ventilation����������������������������������������  273 Ayodeji Adegunsoye and John P Kress 32 The Post-intensive Care Syndrome����������������������������������������������  281 Jason H Maley and Mark E Mikkelsen 33 Management of Decompensated Right Ventricular Failure in the Intensive Care Unit������������������������������������������������  287 Rana Lee Adawi Awdish and Michael P Mendez 34 Diffuse Alveolar Hemorrhage ������������������������������������������������������  295 Joshua Smith and Mark Daren Williams Part IV  Neurologic Disease Romergryko G Geocadin 35 Acute Stroke Emergency Management���������������������������������������  303 Pravin George and Lucia Rivera Lara 36 Bacterial Meningitis in the ICU����������������������������������������������������  315 Jennifer S Hughes and Indhu M Subramanian 37 Management of Intracerebral Hemorrhage��������������������������������  325 Shamir Haji and Neeraj Naval 38 Status Epilepticus��������������������������������������������������������������������������  333 Jharna N Shah and Christa O'Hana V San Luis 39 Neuroleptic Malignant Syndrome������������������������������������������������  343 Kathryn Rosenblatt 40 Traumatic Brain Injury����������������������������������������������������������������  355 Yogesh Moradiya and Romergryko G Geocadin 41 Management of Anoxic Brain Injury ������������������������������������������  363 Maximilian Mulder and Romergryko G Geocadin Part V  Renal Disease John A Kellum 42 Traditional and Novel Tools for Diagnosis of Acute Kidney Injury ��������������������������������������������������������������������������������  375 Fadi A Tohme and John A Kellum 43 Management of Acute Kidney Injury������������������������������������������  383 Fadi A Tohme and John A Kellum Index Feedings enteral, 548, 575–576 in pancreatitis, 548 trophic, 576 Fenestrated tracheostomy tube, 253, 255 Fenoldopam, hypertensive crises, 139, 141 Fever See also Leptospirosis Blackwater, 495 NMS, 345, 347, 350 Fibrinolysis, 111, 114, 116 Fibrosis cystic, 746 IPF (see Idiopathic pulmonary fibrosis (IPF)) Fidaxomicin, 571 Flexible bronchoscopy, 237 Fluid management ARDS, 193 rhabdomyolysis, 396, 398 Focused assessment with sonography in trauma (FAST), 355, 665, 666 Foley urinary catheter, 751 Folic acid, methanol ingestion, 80 Fomepizole, 77 aldehyde dehydrogenase blockade, 78 Fondaparinux, 116 Free T3 (triiodothyronine), 426, 427 Free T4 (thyroxine), 426, 427 Fresh frozen plasma (FFP), 531, 606, 609–611, 617, 622 Frisen Scale, 136, 137 Futility, ICU, 777–778 G Gallstone pancreatitis, 545, 547 Gastric decontamination, 77 Gastric residuals, 576–577 Gastrointestinal bleed (GIB) anticoagulant, reversal, 531–532 blood transfusion, 529 case study, 527 clinical factors, 528 coagulopathy, reversal, 531 diagnosis, 527–528 nasogastric lavage, 529–530 proton pump inhibitor therapy, 529, 530 risk stratification, 528–529 salvage therapy, 530–531 thrombocytopenia, 531 warfarin, reversal, 531 Gastrointestinal decontamination, 66–67 Geneva Score, pulmonary embolism, 223–224 German Registry for Acute Aortic Dissection Type A (GERAADA) study, 170 GIB See Gastrointestinal bleed (GIB) Glasgow-Blatchford Score (GBS), 528 Glasgow Coma Scale/Score (GCS), 39, 83 ICH, 330 TBI, 355–358 791 Glasgow Motor Score (GMS), 19 Glomerulonephritis, 298, 299 Glucagon, calcium channel blocker poisonings, 67 Glucocorticoids, 428 Glycoprotein IIb/IIIa inhibitors, ACS, 116 Graft versus host disease (GVHD), 631, 633–634 Gram negative bacilli (GNB) meningitis, 323 Granulocyte colony-stimulating factor (G-CSF), 476 Granulomatosis with polyangiitis (GPA), 298 H Hamman’s syndrome, 746 Hantavirus, 521 HAS-BLED score, 147, 148 HCT See Hematopoietic stem cell transplantation (HCT) Healthcare-associated pneumonia (HCAP), 182 Heart failure See also Acute heart failure (AHF) acute stroke management, 308–309 medical therapy for, 733–734 Heart failure with preserved ejection fraction (HFpEF), 104 Heart failure with reduced ejection fraction (HFrEF), 104, 729 Heart rate control, in septic shock, 466–467 Heliox, status asthmaticus, 211 HELLP syndrome, 750–752 antenatal steroids and delivery, 752 dexamethasone therapy in, 754 magnesium sulfate therapy, 753 Helmet ventilation, ARDS, 194 Hematochezia, 561, 562, 564 Hematologic values, 394 Hematopoietic stem cell transplantation (HCT) case study, 631–632 etiology, 632 GVHD, 633–634 infectious complications, 635 primer on, 632–633 prognosis, 638 pulmonary complications, 634–637 recovery from, 634–635 respiratory failure, 634, 637–638 Hemicraniectomy, 310 Hemodialysis, ethylene glycol ingestion, 78 Hemodynamics, 288, 290–292 directed resuscitation, Hemoglobinuria, 518 Hemolysis, 504 Hemolytic anemia, microangiopathic, 608 Hemolytic uremic syndrome, 606, 607 Hemophagocytic lymphohistiocytosis (HLH) biomarker testing, 628–629 case study, 625–627 diagnosis, 627, 628 presentation, 627 prognosis, 628 treatment, 627–628 792 Hemoptysis, 295, 296, 298, 299 approach to managing life threatening, 236–237 assessment, 237 case study, 233 causes of, 236 clinical algorithm to, 235 computed tomography, 234 CT angiography, 236 diseases associated with, 236 dual lumen vs unilateral airway intubation, 237–238 epidemiology, 234 plain radiographs, 236 recurrent bleeding, 238–239 rigid vs flexible bronchoscopy, 237 sources of hemorrhage, 234–236 systemic treatments for, 238 Hemorrhage, 238 active vs non-active, 237 acute coagulopathy, 620–622 intracerebral (see Intracerebral hemorrhage (ICH)) intraretinal, 648 sources of, 234–236 stable vs unstable, 237 variceal (see Variceal hemorrhage) Hemorrhagic shock antifibrinolytics, 42–43 coagulopathy and, 41–42 crystalloid administration, 42 damage control surgery, 41 expedite anatomic control of bleeding, 41 hemostatic resuscitation, 46 invasive non-surgical hemorrhage control, 45–46 ionized calcium repletion, 44–45 massive transfusion protocol, 44 permissive hypotension, 41 point-of-care monitor, 45 transfusion therapy, 43 vasopressors, 46 Hemorrhoids, 563 Hemostasis, 535, 536 interventions, 536–537 Hemostatic resuscitation, 41, 46 Hemothorax, 658, 660–661 Heparin See Unfractionated heparin (UFH) Hepatic encephalopathy, 556 Hepatic injury angioembolization of, 668 blunt, 668, 669 Hepatic steatosis, asymptomatic, 591 Hepatic support system, 559 Hepatitis, 590–593 Hepatorenal syndrome (HRS), 384–385 clinical diagnosis of, 585 management, 599–600 Hernia, 681, 682, 685 Herpesviruses (HSV), 635 HHS See Hyperosmolar hyperglycemic syndrome (HHS) HIDA scan, 723 Index High-flow nasal cannula (HFNC), 50, 53–54, 268 High frequency oscillatory ventilation (HFOV), 195 HLH See Hemophagocytic lymphohistiocytosis (HLH) HRS See Hepatorenal syndrome (HRS) Human leukocyte-associated antigens (HLA), 632–633 HVS See Hyperviscosity syndrome (HVS) Hydralazine, hypertensive crises, 138, 140 Hydrocortisone, 435, 437 Hyperbaric oxygen (HBO) therapy, 716 Hypercalcemia, 427 Hypercapnia, permissive, 208–209 Hyperferritinemia, 627 Hyperglycemia, 88, 443 Hyperglycemic crisis, 443 Hyperinflation, status asthmaticus, 209–210 Hyperkalemia, 398, 642, 643 Hyperleukocytosis, 649 Hyperosmolar hyperglycemic syndrome (HHS) anticoagulation, 445 case study, 441–442 diagnosis, 442–443 vs DKA, 443 electrolytes correction magnesium, 444 phosphate, 444 potassium, 444 sodium, 444 fluid therapy, 443 insulin therapy, 443–444 type of IV fluid, 444–445 Hyperosmolar therapy, ICH, 330–331 Hyperosmotic agents, 330 Hyperphosphatemia, 387, 398, 616, 642, 644, 645 Hypertension, 332, 750, 751 Hypertensive crises case study, 135–136 diagnosis, 136–137 physical examination, 135 secondary causes, 141, 142 treatment, 137 beta blockers, 142 blood pressure control, 142 drugs and clinical scenarios, 139–141 pharmacotherapy, 137–141 Hyperthermia, neuroleptic malignant syndrome, 347, 350 Hypertonic saline, 402, 407, 414 ICH, 330, 331 Hypertriglyceridemia, 547 Hyperviscosity syndrome (HVS) case study, 647–648 clinical symptoms, 649, 650 diagnosis, 649–650 lack of procedural standardization, 652 management, 650–651 pathophysiology, 648–649 plasma viscosity measurement, 652 Hypocalcaemia, 398, 643–644 Hypoglycemia, 444, 505 Hypoinsulinemia, 66 Index Hypokalemia, 444 Hypomagnesaemia, 444 Hyponatremia, 520 acute vs chronic, 407 adrenal deficiency, 407 and association with mortality, 407–408 avoidance of overcorrection, 403–405 bolus therapy, 403 case study, 401–402, 413–414 causes of, 415 correction rate monitoring, 415 despite suppressed ADH, 406 diagnosis, 402–403 drugs associated with, 405 evaluation, 414 hypotonic, 402 hypovolemic, 415 with increased extracellular volume/sodium, 406 lasting correction, 405 novel treatments, 416 with reduced ECV/sodium, 405–406 risk stratification, 414 serum sodium correction, 414–415 treatment algorithm, 403 Hypotension ethylene glycol ingestion, 77 tricyclic antidepressant toxicity due to, 60–61 Hypothermia, 342, 536 adjunctive testing, 85–86 anoxic brain injury, 365–366 bacterial meningitis, 323 case study, 83–84 classification and staging, 85 clinical findings, 86 core afterdrop, 90 diagnosis, 85 disposition, 88 endovascular rewarming, 89 extracorporeal support, 89 ICH, 332 patient monitoring, 85 pediatric patients, 88 post-cardiac arrest management, 18 rewarming, 86–87 active and passive, 86 in cardiac arrest, 89 extracorporeal, 86–87 TBI, 359 transcutaneous pacing, 89 withholding CPR, 88–89 without pulse, 87–88 Hypothermic targeted temperature management (HTTM), 14, 17–18, 20–21 Hypothyroidism, 447, 449 Hypotonic fluids, 404 Hypotonic hyponatremia, 402 Hypoventilation, status asthmaticus, 208–209 Hypovolemia, 27, 414 hyponatremia, 415 793 Hypovolemic shock albumin role in, 43 IV access, 40 normal saline vs balanced solutions, 43 physiologic reserve, 40–41 pressors, 43 resuscitation, 41 volume responsiveness monitor, 41 Hypoxemia, 499, 738 Hypoxic-ischemic encephalopathy, 365, 369 I IABP See Intra-aortic balloon pump (IABP) Ideal body weight (IBW), calculation, 192 Idiopathic pneumonia syndrome (IPS), 636 Idiopathic pulmonary fibrosis (IPF) anticoagulation, 268 anti-fibrotic medications, 269–270 case study, 265–266 corticosteroids, 267 CT scan, 267 cyclophosphamide, 268–269 cyclosporin A, 269 diagnosis, 267 exacerbation during surgical procedures, 267–268 extracorporeal life support, 269 high flow nasal cannula, 268 incidence and prognosis, 266 noninvasive ventilation, 268 palliative care, 267 pulmonary transplantation, 269 restrictive operative fluid balance, 269 supportive care, 267 ventilator settings, 268 IE See Infective endocarditis (IE) ILCOR See International Liaison Committee on Resuscitation (ILCOR) ILD See Interstitial lung disease (ILD) Ileus, hyperinfection associated with paralytic, 483 Immune dysregulation, 629 Immunocompromised pneumonia antimicrobial therapy, 217 case study, 215 chest X-ray, 216 CT scan, 216, 217 diagnosis, 216–218 empiric treatment, 217 etiology, 216 noninvasive ventilation, 219 presentation, 215–216 serologic tests, 217 serum tests for, 218–219 supportive care, 218 utility of invasive testing, 218 Immunonutrition, 576 Immunosuppressive agents, 610, 611 Impella, 98 Impella DeviceTM, 22 794 Implantable cardioverter defibrillator (ICD), 734 Infectious Diseases Society of America (IDSA), 259–260, 262, 321 Infective endocarditis (IE) antimicrobial therapy, 174 cardiac device related, 176 case study, 171–172 diagnosis, 173–174 epidemiology, 172–173 follow-up evaluation, 174 indications for surgery, 174 Modified Duke criteria, 173 neuroimaging in, 175 non-emergent surgery, timing of, 175 septic cerebral embolic stroke, 175 valve repair vs replacement, 175–176 Inferior vena cava (IVC), 460, 461 filter placement, 229–230 Inflammation and Host Response to Injury Project, 667 Inflammatory bowel disease, 563 Inhaled nitric oxide (iNO), 292 Inhibitors, TNF alpha, 762 Inotropes cardiogenic shock, 97 therapy, 729 Inotropes agents, 291 acute heart failure, 106–107 Insulin-like growth factor binding protein-1, 739 Insulin therapy calcium channel blocker poisonings, 68 diabetic ketoacidosis, 421, 422 HHS, 443–444 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2), 332 Intensive Care Delirium Screening Checklist (ICDSC), 242 Intensive care unit (ICU) admission, indications for, 200 code status and ICU patient, 775–776 with COPD exacerbations, 200 decision making, 774 life support, 776–777 decompensated RV failure in, 287–292 end of life care, 775 futility, 777–778 hemoptysis, 234, 238 life-sustaining treatment decisions, 777 problems with DNR, 776 prognostication, 774–775 venous thromboembolism in case study, 221–222 clinical presentation, 223–224 diagnosis, 226 epidemiology, 222–223 evidence contour, 228–230 pulmonary embolism severity, 224–226 risk factors, 222 treatment, 226–228 Index International Liaison Committee on Resuscitation (ILCOR), 367, 368 Interstitial lung disease (ILD), 267 Interventional Radiology (IR), 238 Intra-abdominal hypertension (IAH), 688–689 Intraabdominal infections, 677, 679 anti-infective therapy, 676–677 case study, 673 diagnosis, 673–674 empiric antimicrobial therapy for health care, 678 laparoscopic peritoneal lavage, 677 procalcitonin, 679 resuscitation, 674–676 source control, 676 treatment of extra-biliary complicated, 677 Intra-abdominal pressure (IAP), 687 Intra-aortic balloon pump (IABP), 98, 104 myocardial infarction, 127 Intracerebral hemorrhage (ICH) acute management, 328–330 calculation, 329 case study, 327 clinical presentation, 328 complications, 330 CT, 328, 329 diagnosis, 328 hyperosmolar therapy, 330–331 hypertension management, 332 hypothermia, 332 natural history, 330 score, 330–331 seizure prophylaxis, 331 spot sign, 328, 329 Intra-compartmental pressure, 688 Intracranial arterial stenosis (ICAS), 311–312 Intracranial hypertension, in ALF, 557 Intracranial pressure (ICP), 46, 329–332, 403 indication of, 358 management, 323 traumatic brain injury, 358, 359, 367 Intramural hematomas (IMH), 164, 167 Intraparenchymal hematoma, 358 Intraretinal hemorrhage, 648 Intravenous fluids, AKI, 384–385, 387–389 Intravenous immunoglobulins (IVIG), 762 Intravenous lipid emulsions, 69–70 Intravenous vasodilators, 105 Invasive mechanical ventilation (IMV) indications for, 201, 202 status asthmaticus, 208–209 Iodinated radiocontrast agents, 429–430 Ionized calcium repletion, hemorrhagic shock, 44–45 IPF See Idiopathic pulmonary fibrosis (IPF) IPS See Idiopathic pneumonia syndrome (IPS) Ischemia See also Acute arterial ischemia acute limb, 707 bowel, 682 post-cardiac arrest syndrome, 16 Ischemic colitis, 563 Index Ischemic-hypoxic encephalopathy See Anoxic brain injury Isopropyl alcohol, 80 Itraconazole, 475 IVIG See Intravenous immunoglobulins (IVIG) J Jarisch-Herxheimer reaction, 522 Jaundice, 518 Jugular bulb oximetry, 359 Jugular venous distention (JVD), 124 K Kernig’s signs, 318 Ketogenic diet, 336, 342 Kidney Disease Improving Global Outcomes (KDIGO), 385, 387, 389 Kidney injury, acute See Acute kidney injury (AKI) L Labetalol, 753 hypertensive crises, 137, 140 Laboratory risk indicator for necrotizing fasciitis (LRINEC), 715 Lactated Ringer’s, 388–389 Lactic acidosis from beta agonist, 211 bicarbonate infusion in, 466 Laparotomy, 689 Large bowel obstruction (LBO), 684–685 LC See Lung contusion (LC) L-Carnitine, 430 Left ventricular assist devices (LVADs), 100 Left ventricular failure (LVF), 25, 122, 123, 125, 266 Left ventricular function, 731, 734 Left ventricular thrombus, 729, 731, 732 Leptospirosis, 514, 517 antibiotic administration, 521–522 case study, 517–518 clinical presentation, 520 corticosteroids role, 522–523 diagnostic tools culture, 522 molecular tests, 522 reference standard, 522 serology, 522 differential diagnosis, 521 drug resistance, 522 epidemiology, 518–519 laboratory presentation, 520–521 microbiology, 519–520 prevention, 523 risk factors, 519 Leucopenia, 513 Leukapheresis, in AML, 652 Leukocyte larceny, 651 795 Leukostasis, 649 LGIB See Lower gastrointestinal bleeding (LGIB) Lidocaine arrhythmias, 62 ventricular arrhythmias, 158–159 Life-threatening asthma, 207, 211 Limb ischemia, acute, 707 Linezolid, 181, 184–186 Lipase, 546 Lipid, in tube feeds, 577–578 LIPS See Lung injury prediction score (LIPS) Listeria monocytogenes, 318, 319, 584, 585 Liver failure, acute See Acute liver failure (ALF) Liver injury scale, 668 Liver transplantation, 559 Long-term acute care hospital (LTAC), 252, 254 Loop diuretics, 385 Lower extremity trauma, 708, 710 vascular, endovascular treatment approach, 710–711 Lower gastrointestinal bleeding (LGIB), 528–530 appropriate patient disposition, 564 blood transfusion goals, 566 case study, 561–562 definition, 562 diagnostic imaging modalities, 567 differential diagnosis, 563 initial evaluation, 562–563 initial resuscitation and management, 563–564 management, 565 massive transfusions, 566–567 mesenteric angiography, 565–566 nasogastric tube lavage, 564 predicting severity and outcomes of, 566 provocation testing, 567 surgery, 566 urgent colonoscopy, 564–565 Low molecular weight heparin (LMWH), 116, 222–223, 227, 622–623, 670 LTAC See Long-term acute care hospital (LTAC) Lumbar puncture (LP), 317–319 Lung contusion (LC), 659–660 Lung injury prediction score (LIPS), 190, 191 Lung Open Ventilation Study (LOVS), 192 Lung protective ventilation (LPV), ARDS, 189–192 Lymphopenia, 513 M Maculopapular rash, 514 Magnesium status asthmaticus, 211 for ventricular arrhythmias, 62 Magnesium sulfate therapy, 750–753 Magnetic resonance imaging (MRI) acute aortic syndromes, 166 anoxic brain injury, 364, 369 pituitary and hypothalamus, 438 status epilepticus, 337 796 MAHA See Microangiopathic hemolytic anemia (MAHA) Malaria anemia and coagulopathy, 504–505 antigen rapid detection test, 506 bacterial infection, 506 blood products, 505 case study, 495 cerebral, 504 clinical management principles, 497–499 definition, 496 diagnosis, 496–497 diagnostic modalities, 506 exchange transfusion, 507 fever, 505–506 hypoglycemia, 505 management, principles, 495–496 molecular methods, 507 monitoring parasite density, 499 neurologic involvement, 504 nutrition, 505 quantitative buffy coat, 506 respiratory system, 499 retina in patient with, 499 seizure management, 504 serology, 506 treatment, 500–503 volume management, 505 Malignant hyperthermia (MH), 347, 350, 351 Mannitol, 330, 356 Massive hemoptysis See Hemoptysis Massive transfusion protocol, hemorrhagic shock, 44 MAT See Microscopic agglutination test (MAT) MATCH trial, AIS, 312 MDCT See Multidetector Computed Tomography (MDCT) Mechanical chest compressions, 7–9 Mechanical circulatory support, 731, 734 acute heart failure, 106 cardiogenic shock, 99–101 percutaneous, 97–98 temporary surgical, 98–99 ventricular arrhythmias ECMO, 159–160 IABP, 159 Mechanical intubation, IPF, 268 Mechanical ventilation ARDS, 274 prolonged (see Prolonged mechanical ventilation (PMV)) TBI, 356–357 weaning from, 273–279 Medical paternalism, 774 Medication-induced movement disorder, 348–349 MELD score, 592 Meningococcemia, 322–323 Mental health, 282, 489 Mesenteric angiography, 562, 565–566 Metabolic acidosis, 420, 466, 536 Methanol, ethylene glycol ingestion, 79–80 Index Methicillin-resistant Staphylococcus aureus (MRSA), 184–185 community-acquired, 186 drugs to suppress toxin with, 186 Methicillin-sensitive Staphylococcus aureus, 258 Methimazole, 428 Methylene blue, calcium channel blocker poisonings, 70 Michigan alcohol withdrawal severity (MAWS) scoring system, 596 Microangiopathic hemolytic anemia (MAHA), 605, 606, 608, 619 Microdialysis, cerebral, 359 Micronutrient goals, 577 Microscopic agglutination test (MAT), 517, 522 Microscopic polyangiitis (MPA), 296, 298 Microvascular thrombosis, 607 Mitral valve repair, 175 Modification of Diet in Renal Disease (MDRD) formula, 378 Modified Rankin score, 33, 308 Montreal Cognitive Assessment (MoCA), 282 Morphine, ACS, 114 MPA See Microscopic polyangiitis (MPA) MRI with diffusion-weighted imaging (MRI-DWI), 304–305 Mud fever See Leptospirosis Multidetector Computed Tomography (MDCT), 237, 238 Multidrug resistant (MDR) community acquired pneumonia, 185 pathogens, 257, 258, 260 risk factors, 258 VAP, 258 Multivessel revascularization, cardiogenic shock, 99 Muscle biopsy, 396 Muscle damage, 398 Muscle injury, 395, 398 Muscular rigidity, NMS, 350–351 Mycoplasma pneumonia, 760 Myelinolysis, 415 Myocardial dysfunction, in post-cardiac arrest syndrome, 15–16 Myocardial infarction case study, 121–122 diagnosis, 123–125 epidemiology, 123 intra-aortic balloon pump, 127 Killip Class definition, 122, 123 LV failure, 125 mechanical complications, 125–126 VSR, 126 Myocarditis, viral, 730 Myoglobin, 395 Myxedema coma (myxedema) case study, 447–448 corticosteroid replacement, 449 diagnosis, 448–449 supportive care, 449–450 symptoms and signs, 449 thyroid hormone replacement, 450 thyroxine replacement, 449 Index N Nanukayami fever See Leptospirosis National Acute Brain Injury Study: Hypothermia II, 332 National Health Safety Network, 261 National Institutes of Health Stroke Scale (NIHSS) score, 303–307 NCSE See Non-convulsive status epilepticus (NCSE) Necrosis, 682 pancreatic, 677, 679 Necrotizing fasciitis, 715 Necrotizing soft tissue infection (NSTI) antibiotic therapy and resuscitation, 715 case study, 713–714 debridement, 714, 715 diagnosis and outcome, 715–716 early amputation, 716 hyperbaric oxygen therapy, 716 immunomodulatory therapy, 716 rapid diagnosis, 714–715 surgical source control, 715 Negative pressure therapy (NPT), 690 Negative pressure ventilation (NIV) altered mental status, 53 ARDS, 52–53 asthma exacerbation, 52 full face mask, 50 hi-flow nasal cannula, 50 indications and contraindications, 51 pneumonia patients, 52 predictors of failure, 51–52 Neisseria meningitidis, 318–319, 322, 324 Nephrostomy, 453, 456 Nesiritide, acute heart failure, 107–108 Neurocritical Care Society (NCS), 335 Neurointensive care, 336 Neuroleptic malignant syndrome (NMS) altered mental status, 350 autonomic dysfunction, 351 benzodiazepines, 351 bromocriptine, 345, 352 case study, 345–346 dantrolene, 345, 351–352 diagnosis, 346–347 differential diagnosis for, 348–349 ECT, 345, 352 hyperthermia, 350 medication history and temporal clues, 347 muscular rigidity, 350–351 Neurologic outcome, 366–369, 506 Neuromuscular blockade, ARDS, 194–195 Neuromuscular diseases, 746 Neuromuscular paralysis, TBI, 357 Neuroprognostication, 368, 369 post-cardiac arrest syndrome, 18–19 Neuroprotective agents, TBI, 360 Nicardipine, hypertensive crises, 138, 139 NICE-SUGAR trial, 463 Nifedipine, 753 NIPPV See Noninvasive positive pressure ventilation (NIPPV) 797 Nitrates, ACS, 114 Nitroglycerin acute heart failure, 105 hypertensive crises, 138, 139 NMS See Neuroleptic malignant syndrome (NMS) Non-cardiogenic acute pulmonary edema, 744 Non-convulsive status epilepticus (NCSE), 335–337, 340, 341, 366, 367, 369 Non-dihydropyridines, 65 Non-Hodgkin’s lymphoma, 642 Noninvasive mechanical ventilation, 202 Noninvasive positive pressure ventilation (NIPPV), 199, 201–202, 268 after extubation, 202 DNI orders, 202 immunocompromised pneumonia, 218, 219 status asthmaticus, 211–212 Non-neutrocytic bacterascites, 586 Nonoperative management (NOM), 667–668 Nonselective beta blockers (NSBB), 585 Non-steroidal anti-inflammatory drugs (NSAIDs), 114, 350, 760 Non-ST segment elevation ACS (NSTE-ACS), 115, 117–118 Non-ST segment elevation MI (NSTEMI), 112, 114, 116 Norepinephrine, 461, 555 decompensated RV failure, 291 Normal saline, 413 Normoglycemia, 505 Normothermia, 366, 368 Novel oral anticoagulants (NOAC), 309 NSBB See Nonselective beta blockers (NSBB) NSTEMI See Non-ST segment elevation MI (NSTEMI) NSTI See Necrotizing soft tissue infection (NSTI) NT-pro brain natriuretic peptide (NT-proBNP), 732 Nuchal rigidity, 317, 318, 324 Nutrition in AKI, 389 in critically Ill patient, 575–578 O Obesity, 578 Obstructive shock, 28 Obstructive sleep apnea, in pregnancy, 745 OD See Osmotic demyelination (OD) ODS See Osmotic demyelination syndrome (ODS) OHSS See Ovarian hyperstimulation syndrome (OHSS) Oliguria, refractory, 753 OMEGA trial, 578 Ommaya reservoir, 323 Open lung ventilation, 192 Opiate, 439 Organizing pneumonia (OP), 637 Osmotic demyelination (OD), 401, 404, 407 Osmotic demyelination syndrome (ODS), 415 outcomes, 416 prevention, 416 Osmotic diuresis, 331, 420, 442 Out-of-hospital cardiac arrests (OHCA), 798 Ovarian hyperstimulation syndrome (OHSS), 744 Overwhelming post-splenectomy infection (OPSI), 668 Oxygenation, ARDS, 191 Oxygen therapy, ACS, 114 P Palliative care, IPF, 267 Pancreatic necrosis, 677, 679 Pancreatic pseudocyst, 546 Pancreatitis acute (see Acute pancreatitis) alcoholic, 545, 547 feeding in, 548 gallstone, 545, 547 Panton-Valentine leukocidin (PVL), 186 Papillary muscle rupture, 121, 123–125 Paralytic ileus, hyperinfection associated with, 483 Parapneumonic effusions, 185 Paraproteinemias, 649–651 Parasitemia, 499 Parenteral nutrition (PN), 576, 577 CALORIES Trial, 577 Partial thromboplastin time (PTT), 620, 622 PASP See Pulmonary artery systolic pressure (PASP) Passy-Muir® speaking valve, 253, 254 Pathogen-directed therapy, community acquired pneumonia, 183–185 PCC See Prothrombin complex concentrate (PCC) PDS See Pericardial decompression syndrome (PDS) PE See Pulmonary embolism (PE) PEEP See Positive end-expiratory pressure (PEEP) PEITHO trial, pulmonary embolism, 221, 228 Penetrating aortic ulcers (PAU), 164, 165, 167 Percutaneous cholecystostomy, 724 Percutaneous coronary intervention (PCI), 14, 15, 118, 119 Percutaneous dilational tracheostomy, 252, 253 Percutaneous transhepatic cholangiographic (PTC) drainage, 722 Perforated diverticulitis, 674 Pericardial decompression syndrome (PDS), 133 Pericardial effusion, 129–133 Pericardiocentesis, 133 Peripartum cardiomyopathy (PPCM), 744 anticoagulation, 734 anti-inflammatory mediators, 735 case study, 729–731 chronic medical therapy, 734 delivery, 734–735 diagnosis, 732 immunotherapy, 735 implantable cardioverter defibrillator, 734 maternal risk factors and adverse events in, 731 mechanical support, 734 pharmacologic therapy in, 733 postpartum supportive care, 735 symptoms, 730–731 Peripheral intravenous (PIV) catheters, 564 Index Permissive hypercapnia, 208–209 Personal protective equipment (PPE), 485–490 PESI See Pulmonary Embolism Severity Index (PESI) Petechiae, 510, 605 Phenobarbital, 768 Phentolamine, hypertensive crises, 140, 141 Phosphate binders, in TLS, 644 Phosphodiesterase (PDE5) inhibitors, 292 Physical impairment, PICS, 282–284 PICS-F See Post-Intensive Care Syndrome-Family (PICS-F) Placental abruption, 750 Plain radiographs, hemoptysis, 236 Plasmapheresis, 299, 651 extracorporeal, 430 Plasmodium falciparum, 495–498 Plateau airway pressure, 189, 192, 194 Platelet transfusion, 617 Plethysmography variation index (PVI), 29 PMV See Prolonged mechanical ventilation (PMV) PN See Parenteral nutrition (PN) Pneumonia bacterial, 745 case study, 215 chest X-ray, 216 community acquired (see Community acquired pneumonia (CAP)) CT scan, 216, 217, 287 diagnosis, 216–217 empiric treatment, 217 etiology, 216 immunocompromised, 215–219 immunosuppressed, 216, 217, 219 mycoplasma, 760 negative pressure ventilation, 52 noninvasive ventilation, 219 presentation, 215–216 serum tests for, 218–219 supportive care, 218 utility of invasive testing, 218 viral, 745 Pneumonia Severity Index (PSI), 182 Pneumonitis, 635 Pneumothorax, 658, 660 in pregnancy, 746 Point-of-care ultrasound, RV failure, 287, 289 POINT trial, AIS, 312 Polyenes, 475 Polymerase chain reaction (PCR), Pneumocystis, 215 Posaconazole, 475 Positive end-expiratory pressure (PEEP) ARDS, 189, 191–194 IPF, 268 RV dysfunction, 290, 292 Post-cardiac arrest syndrome (PCAS) brain injury, 15 case study, 13–14 emergency coronary angiography, 19–20 glucose control, 18 Index hemodynamic optimization, 16–17 hypothermic TTM, 17–18, 20–21 myocardial dysfunction, 15–16 neuroprognostication, 18–19 organ donation, 19 patient selection, 19–21 persistent precipitating pathology, 16 with refractory cardiogenic shock, 21–22 seizures, 18 STEMI and ACS, 17 systemic ischemia/reperfusion response, 16 ventilation and oxygenation, 17 Post exposure prophylaxis, 324 Post-intensive care syndrome (PICS), 254, 638 ABCDEF bundle, 283–284 case study, 281 cognitive rehabilitation, 284–285 diagnosis, 281–282 ICU follow up clinic, 284 physical impairment, 282–284 prevention, 282 rehabilitation, 282 Post-Intensive Care Syndrome-Family (PICS-F), 284 Post-pyloric feed, 577 Post-traumatic seizures, 358–359 Post-traumatic stress disorder (PTSD), 774 PPE See Personal protective equipment (PPE) PPI See Proton pump inhibitor (PPI) Preeclampsia, 744 antenatal steroids and delivery, 752 anti-hypertensive therapy, 752–753 diagnosis, 751–752 invasive monitoring, 753–754 magnesium sulfate therapy, 753 seizure prophylaxis, 752 treatment, 753 Pregnancy, 730, 731 airway disease, 745 bacterial pneumonia, 745 cystic fibrosis, 746 differential diagnosis of pulmonary conditions in, 744 neuromuscular diseases and central causes, 746 obstructive sleep apnea in, 745 physiologic respiratory changes in, 743–744 pneumothorax in, 746 pulmonary edema, 744 pulmonary embolism in, 746 pulmonary infections in, 745 ventilation strategies in challenges, 746 delivery of fetus, 747 ECMO, 747 goals of ventilation, 747 mechanical ventilation, 747 non-invasive ventilation, 747 prone ventilation, 747 viral pneumonia, 745 Pressors, hypovolemic shock, 43 Procalcitonin (PCT), 186, 679 799 Prokinetic agents, 577 Prolonged mechanical ventilation (PMV) assess expected survival, 251–252 case study, 251 daily tracheostomy collar trials, 252 diagnosis, 251 early mobility, 252 place tracheostomy, 252, 253 Provent14 score, 251, 252 speaking valve trials, 253 survivorship clinics, 254–255 symptom burden, 254–255 timing of tracheostomy, 253–254 tracheostomy removal, 253 transfer benefit to LTAC, 254 weaning from, 275 Prone ventilation, ARDS, 192–193 Prophylactic dialysis, 389 Prophylaxis antibiotics, 359–360 post exposure, 324 seizure, 331, 752 Propofol, 768 Propranolol, 425, 426, 428 Propylthiouracil (PTU), 428 PROTECT trial, pulmonary embolism, 222–223 Prothrombin complex concentrate (PCC), 531 Protocolized Care for Early Septic Shock (ProCESS) trial, 463, 466 Proton pump inhibitor (PPI), 529, 530, 540 Pseudocyst, pancreatic, 546 Pseudomonas, 183, 184 PTSD See Post-traumatic stress disorder (PTSD) Pulmonary artery catheterization (PAC), 106, 291 Pulmonary artery pressure, 288, 289, 291 Pulmonary artery systolic pressure (PASP), 288–289 Pulmonary complications, HCT patient, 634–637 Pulmonary edema, 636, 744, 753 cardiogenic, 738 chest x-ray, 163, 172 non-cardiogenic acute, 744 pre-eclampsia associated, 744 tocolytic induced, 744 Pulmonary embolism (PE), 222 clinical presentation, 223–224 diagnosis, 226 Geneva Score, 223–224 hemodynamically stable, 228–229 IVC filter placement, 229–230 in PEITHO trial, 221, 228 in pregnancy, 746 in PROTECT trial, 222–223 severity, 224–226 treatment, 226–228 Wells criteria, 223–224 Pulmonary Embolism Severity Index (PESI), 225–226 Pulmonary hypertension, 288–289, 292 Pulmonary infections, in pregnancy, 745 Pulmonary transplantation, IPF, 269 800 Pulmonary vascular resistance (PVR), 290 Pulmonary vasculature, 289 Pulseless electrical activity (PEA), 6–7 Pulse pressure variation (PPV), 29, 289 Pulsus paradoxus, 124, 129, 131 Purpura, 605 Purpura fulminans, 322, 622 P2Y12 receptor inhibitors, ACS, 116, 119 Pyuria, 454 Q Quality of Dying and Death (QODD) questionnaire, 775 Quantitative buffy coat (QBC), 506 Quick Sepsis Organ Failure Assessment Score (qSOFA), 459 R Radiocontrast agents, iodinated, 429–430 Radiofrequency catheter ablation, ventricular arrhythmias, 160 Randomized controlled trial (RCT) acute exacerbation of COPD, 200, 201 AKI, 388 diuretics, 385 status epilepticus, 337, 339 VAP, 260 Rapid detection test (RDT), antigen, 506 Rasburicase, 643 Rash maculopapular, 514 petechial, 510 RASS See Richmond Agitation-Sedation Scale (RASS) RCT See Randomized controlled trial (RCT) Recombinant Factor VII, 299 Recombinant Factor VIIa (rFVIIa), 618 to correct coagulopathy, 558 infusion protocol, 557 Recombinant human factor VIIa (rVIIa), 740 Recurrent bleeding, hemoptysis, 238–239 Refractory cardiogenic shock, PCAS, 21–22 Refractory oliguria, 753 Refractory status epilepticus (RSE), 338–341 Rehabilitation, PICS, 282, 284–285 Relative adrenal insufficiency, 435 Renal-dose dopamine, 108 Renal failure, 295, 296 See also Acute renal failure (ARF) in rhabdomyolysis, 395, 396, 398 Renal replacement therapy (RRT), 387, 388, 390, 399, 492, 644–645 Renin-angiotensin-aldosterone system (RAAS), 406 Reperfusion therapy, 228–229, 399 Respiratory failure acute, 694, 695, 698 causes of, 746 in HCT patient, 634, 637–638 Index Resuscitation cardiac arrest management, 5–6 hemodynamic directed, quality assurance, 4, ECPR, 84 for hemorrhagic shock, 41, 46 hypovolemic shock, 41 Return of spontaneous circulation (ROSC), 13, 363, 364 Revascularization, cardiogenic shock, 96–97 Rewarming, for hypothermia, 86–87 active and passive, 86 in cardiac arrest, 89 extracorporeal, 86–87 Rhabdomyolysis antioxidants, 399 bicarbonate therapy, 398 case study, 393–395 causes of, 396–397 complications, management, 398 diagnosis, 395–396 diuretics, 398–399 fluid therapy, 396, 398 free radical scavengers, 399 management, principles, 395 mannitol, 398–399 renal failure in, 395, 396, 398 in skeletal muscle, 395 Rice-field fever See Leptospirosis Richmond Agitation-Sedation Scale (RASS), 241–243 Richmond Agitation Severity Scale (RASS), 765 Rickettsial disease, 521 Right ventricular failure, decompensation, 287–292 Rigid bronchoscopy, 237 Rituximab, 611 diffuse alveolar hemorrhage, 299 Rivaroxaban, 532 Rockall score, 528 RRT See Renal replacement therapy (RRT) RSE See Refractory status epilepticus (RSE) Rumack-Matthew nomogram, 553 S Saline vs Albumin Fluid Evaluation (SAFE) trial, 460 Salivary cortisol testing, 438 SAS See Sedation-Agitation Scale (SAS) SATs See Spontaneous awakening trials (SATs) SBO See Small bowel obstruction (SBO) SBP See Spontaneous bacterial peritonitis (SBP) Scar management, 705 SCCM See Society of Critical Care Medicine (SCCM) Sclerotherapy, 537 Sclerotic skin lesion, 633 Scrub typhus, 521 SE See Status epilepticus (SE) Secondary bacterial peritonitis, 582, 583 Sedation anoxic brain injury, 363, 365, 366 benzodiazepines with, 245–246 Index case study, 241–242 choice, 244–246 and delirium, 246–247 monitoring, 242 spontaneous awakening trials, 246 TBI, 357 Sedation-Agitation Scale (SAS), 242, 243 Seizure management, 767 eclamptic, 752 malaria, 504 PCAS, 18 post-traumatic, 358–359 prophylaxis, 331, 752 TCA toxicity, 61 Sengstaken-Blakemore tube, 540, 541 Sepsis, 193, 453–455 See also Urosepsis AKI, 383, 384, 388 antimicrobial therapy, 462 case study, 457–458 definition and recognition, 458–459 EGDT, 463 fluid management, 459–460 glycemic control and nutrition, 463 hemodynamic response, 460–461 sequella after surviving severe, 467 SIRS criteria in, 466 surviving sepsis campaign bundle, 459, 464 treatment, 462, 464–465 ventilator management, 463 Septic shock, 714–716 antimicrobial therapy, 462 blood pressure target in, 466 case study, 457–458 definition and recognition, 458–459 EGDT, 463 fluid management, 459–460 fluid resuscitation in, 466 glycemic control and nutrition, 463 heart rate control in, 466–467 sequella after surviving severe, 467 steroid replacement in, 438 tissue perfusion, 461 treatment, 462, 464–465 vasopressors, 461–462 ventilator management, 463 Serotonin syndrome (SS), 347, 350 Serum cortisol measurement, 435 Serum creatinine, 376–379 Serum myoglobin, 395 SFA See Superficial femoral artery (SFA) Shared decision making, 774, 775 SHEA See Society for Healthcare Epidemiology of America (SHEA) Shivering, 363, 365, 366 Shock, 510, 511 bedside echocardiography, 25–26, 32–36 cardiogenic, 26, 28–29 case study, 25–26 definition, 26 801 differential diagnosis, 25 distributive, 26, 28 hypovolemia, 27 types, 26–29, 36 volume responsiveness assessment, 29–32 Short acting anti-cholinergic agents, 200 SIADH See Syndrome of inappropriate antidiuretic hormone activity (SIADH) SIRS See Systemic inflammatory response syndrome (SIRS) Site-of-care decisions, CAP, 181–182 SJS See Stevens-Johnson syndrome (SJS) Skeletal muscle, rhabdomyolysis in, 395 Skin eruption, 759–762 Skin mottling, 460, 461 SLE See Systemic lupus erythematosus (SLE) Sleep apnea, in pregnancy, 745 Small bowel obstruction (SBO) acute, 685 CT imaging findings, 685 management, 684–685 standard approach to management, 682 timing of operating for, 684 Society for Healthcare Epidemiology of America (SHEA), 262 Society of Critical Care Medicine (SCCM), 242, 244, 247 Sodium bicarbonate, calcium channel blocker poisonings, 70 Sodium nitroprusside, hypertensive crises, 138, 139 Solid organ injury, blunt See Blunt solid organ injury Somatosensory evoked potentials (SSEPs), 369 SPA See Splenic artery pseudoaneurysm (SPA) Spleen injury scale, 667 Splenectomy vaccinations, 668 Splenic artery pseudoaneurysm (SPA), 669 Splenic injury, blunt, 668, 669 Split thickness skin grafts (STSG), 691 Spontaneous awakening trials (SATs), 242, 246, 283 Spontaneous bacterial peritonitis (SBP) albumin, 585 antibiotic prophylaxis, 585–586 antibiotics, 584–586 case study, 581–582 diagnosis, 582–583 duration of therapy, 586 management, 584 microbiologic etiology, 583–584 NSBB, 585 patient with non-neutrocytic bacterascites, 586 treatment, 584 Spontaneous breathing trial (SBT), 242, 273, 275, 277, 283 Spot sign, 328, 329 SRSE See Super-refractory status epilepticus (SRSE) SS See Serotonin syndrome (SS) Statin therapy, ACS, 114–115 Index 802 Status asthmaticus adjuvant pharmacologic treatments, 211 anesthetics, 212 arterial blood gases, monitoring of, 208 barotrauma, recognizing, 210–211 bronchoscopy, 212 case study, 206 corticosteroids, 207 ECLS, 212 heliox, 211 hyperinflation, 209–210 hypoventilation, 208–209 inhaled bronchodilators, 207 intravenous bronchodilators, 211 lactic acidosis from beta agonist, 211 magnesium, 211 noninvasive positive pressure ventilation, 211–212 permissive hypercapnia, 208–209 ventilator strategies, 208 Status epilepticus (SE), 340–341 case study, 335 cerebrospinal fluid, 337 complications, 342 diagnosis of, 337 EEG, 335–338, 341 electroconvulsive therapy, 342 etiology, 337 goals of treatment, 340–341 medical management, 339 medications, 338 multidisciplinary care, 339 non-convulsive, 341 pharmacologic therapy, 337–338 refractory, 338–339 second-line therapy, 337 systemic complication, 340 treatment options in, 341–342 STE-ACS See ST-segment elevation ACS (STE-ACS) STEMI See ST-segment elevation myocardial infarction (STEMI) Stent-retriever device, 304, 306, 311 Steroid replacement additional testing, 437–438 concurrent fluid management, 437 dose and duration, 436–437 in septic shock, 438 steroid selection, 436 Steroids bacterial meningitis, 320–321 TBI, 360 Stevens-Johnson syndrome (SJS), 759–761 cyclosporine, 762 pathogenesis, 761 supportive care, 761–762 thalidomide, 762 STOPAH trial, 599 Streptococcus pneumonia, 317–319 Strokes See also Acute stroke management rehabilitation in, 310–311 “wake-up,” 309 Stroke volume (SV), 29, 30 Stroke volume variation (SVV), 29, 289 Strongyloides hyperinfection syndrome anti-parasitics, 482–483 case study, 479–480 diagnosis, 482 disseminated infection and hyperinfection, 482 epidemiology, 481 hyperinfection associated with paralytic ileus, 483 life cycle, 481–482 management, principles, 480 severe infections, 483 supportive care and follow up, 483 Strongyloides stercoralis, 481 ST-segment elevation ACS (STE-ACS), 111, 112 ST-segment elevation myocardial infarction (STEMI), 116, 117 complete revascularization in, 118–119 fibrinolytic regimens for, 118 manual thrombectomy during primary PCI in, 119 PCI after successful thrombolysis in, 118 post-cardiac arrest syndrome, 17 STSG See Split thickness skin grafts (STSG) Stuttgart disease See Leptospirosis Subdural hematoma, 358 Superficial femoral artery (SFA), 708, 709 Super-refractory status epilepticus (SRSE), 336, 338, 340–342 Superselective embolization, 565 Supraventricular tachycardias, 150 Surgical Trial in Intracerebral Haemorrahage (STICH), 327 Surrogate decision making, 774 Swamp fever See Leptospirosis Swan-ganz catheter, 104 Swineherd’s disease See Leptospirosis Syndrome of inappropriate antidiuretic hormone activity (SIADH), 406, 413 causes of, 415 diagnostics, 416 Systemic inflammatory response syndrome (SIRS), 459, 625 criteria in sepsis, 466 Systemic lupus erythematosus (SLE), 393 Systolic pressure variation (SPV), 462 T TandemHeart®, 96–98 Tandem Heart pumpTM, 21 TAPSE See Tricuspid annular plane systolic excursion (TAPSE) Targeted temperature management (TTM), 363–364, 366–368 TBI See Traumatic brain injury (TBI) TBSA See Total body surface area (TBSA) T-cell function, 634 Index TEE See Transesophageal echocardiogram (TEE) Therapeutic hypothermia See Hypothermia Therapeutic plasma exchange (TPE), 606, 609, 610 Thermal injury, 702 case study, 701–702 diagnosis, 703 fluid management, 704 fluid resuscitation monitoring, 705 scar management, 705 supportive care, 705 surgical intervention, 704 wound care, 703–704 Thionamides, 428 Thoracic pump theory, Thoracic trauma case study, 657–658 hemothorax, 658, 660–661 lung contusion, 659–660 pneumothorax, 658, 660 rib fractures, 658–659, 661 Thoratec DeviceTM, 21 Thrombectomy endovascular, 306–308 with PCI, 119 Thrombocytopenia, 513, 531, 605 causes of, 616 differential diagnosis, 608 ecchymosis from, 497 Thrombocytosis, 650 Thromboembolism, prophylaxis, 611 Thrombolysis catheter-directed, 227–228, 230 contraindications to, 229, 230 in hemodynamically stable acute PE, 229 hemodynamic benefits, 228 Thrombomodulin-α, 623 Thrombosis, microvascular, 607 Thrombotic microangiopathy, drug-induced, 611, 612 Thrombotic thrombocytopenic purpura (TTP) ADAMTS13 activity level and autoantibody testing, 606, 607 anti-platelet agents, 611 case study, 605–606 diagnosis, 606–607 drug-induced thrombotic microangiopathy, 611 FFP, 609–612 immunosuppressive agents, 610, 611 prevention, 611 TPE, 609 treatment algorithm, 610 venous thromboembolism prophylaxis, 611 Thyroid hormone, 426, 428, 430 replacement, 450 Thyroid stimulating hormone (TSH), 425, 427 Thyroid storm, 426–427 case study, 425–426 diagnosis, 427 clinical tools, 429 criteria, 429 803 etiology, 426 incidence, 426 iodinated radiocontrast agents, 429–430 medication dosing guide, 427 beta-blockers, 428 glucocorticoids, 428 iodine solutions, 428 thionamides, 428 treatment, 427 triggers of, 426 Thyroxine replacement, 449 Tight glycemic control, AKI, 389 Tissue plasminogen activator (tPA), 221, 228 acute stroke management, 305–306 community acquired pneumonia, 185 TKM-Ebola, 493 TLS See Tumor lysis syndrome (TLS) TNF alpha inhibitors, 762 Tocolytic induced pulmonary edema, 744 Total body irradiation (TBI), 633 Total body surface area (TBSA), 701–702 Tourniquet test, 511 Toxic epidermal necrolysis (TEN) syndrome, 759–761 cyclosporine, 762 intravenous immunoglobulins, 762 pathogenesis, 761 supportive care, 761–762 systemic corticosteroids, 762 thalidomide, 762 Toxic shock syndrome, 716 tPA See Tissue plasminogen activator (tPA) TPE See Therapeutic plasma exchange (TPE) Tracheostomy collar trials, 252 Passy-Muir® speaking valve, 253, 254 placement of, 252, 253 for prolonged transition, 278–279 removal, 253 timing of, 253–254 Trans-arterial embolization (TAE), 530 Transcoronary ethanol ablation, ventricular arrhythmias, 160 Transesophageal echocardiogram (TEE), 226 acute aortic syndromes, 164, 166 endocarditis, 173–174 myocardial infarction, 122, 123, 125 Transfusion therapy, hemorrhagic shock, 43 Transjugular intrahepatic portosystemic shunt (TIPS) placement, 536–538, 540 Transpulmonary pressure, ARDS, 194 Transthoracic echocardiogram (TTE), 729 acute aortic syndromes, 164, 166 cardiac tamponade, 130–132 endocarditis, 172–174 myocardial infarction, 124 PASP, 288–289 Trauma, 396, 702 vascular, 710 804 Traumatic brain injury (TBI) analgesia, 357 case study, 355 invasive intracranial pressure monitoring, 358 mechanical ventilation, 356–357 neuromonitoring, 359 neuromuscular paralysis, 357 neuroprotective agents, 360 post-traumatic seizures, 358–359 prehospital and emergency department, 356 primary and secondary, 356 prophylactic antibiotics, 359–360 sedation, 357 severity of, 356, 357 steroids, 360 surgical treatment, 357–358 therapeutic hypothermia, 359 Traumatic cerebral contusion, 358 Triazoles, 474–475 Tricuspid annular plane systolic excursion (TAPSE), 288–289 Tricyclic antidepressant (TCA) toxicity antiarrhythmic drugs, 62 case studies, 57–58 diagnosis, 58–59 EKG finding, 59 extracorporeal elimination, 61 gastrointestinal decontamination, 59–60 hypertonic saline, 61–62 hypotension and vasopressor support, 60–61 intravenous lipid emulsion, 61 plasma alkalinization, 60 seizure management, 61 sodium channel blockade, 58 Triiodothyronine (T3), 450 Trophic feedings, 576 TTP See Thrombotic thrombocytopenic purpura (TTP) Tumor lysis syndrome (TLS) acute renal failure, 644 with AKI, 644 case study, 641 clinical classifications, 642 clinical outcomes, 644 hypouricemic agents, 643 low intensity chemotherapy, 642 monitoring, 643 phosphate binders in, 644 prevention and treatment, 642–643 renal replacement therapy, 644–645 risk stratification for development of clinical, 642 Type A dissections, 166, 168 Type B dissections, 166, 170 U UGIB See Upper gastrointestinal bleed (UGIB) Ultrafiltration (UF), 107 Ultrasound cardiac arrest management, hypertensive crises, 135 Index Undifferentiated shock bedside echocardiography, 25–26, 32–36 case study, 25–26 types, 26–29, 36 volume responsiveness assessment, 29–32 Unfractionated heparin (UFH), 222–223, 227, 622–623 Unstable angina (UA), 112, 114, 116 Upper gastrointestinal bleed (UGIB), 528–530 Urea, 416 Uremic syndrome, hemolytic, 606, 607 Ureteral stent, 454–456 Uric acid, reduction of, 643 Urinary alkalization, 642, 643 Urinary tract infection, 454, 455 obstruction, 454 Urine alkalinization of, 79, 398 output, 376–377 Urosepsis case study, 453 diagnosis, 453–454 empiric anitbiotic choice, 455 empiric antimicrobial administration, 454 indications for imaging, 455 intervention method, 455–456 procedures/surgery, 454 V VAE See Ventilator Associated Event (VAE) VALI See Ventilator associated lung injury (VALI) VAP See Ventilator-associated pneumonia (VAP) Vaptans, 416 Variceal bleeding, 590, 597, 598 Variceal hemorrhage acid suppression, 540 antibiotic prophylaxis, 537–538 balloon tamponade, 540 BRTO, 540–541 case study, 535–536 correction of coagulopathy, 539 endotracheal intubation, 539–540 hemostasis interventions, 536–537 initial resuscitation, 536 red blood cell transfusion, 538–539 surgery, 541 TIPS placement, 536–538, 540 vasoactive medications, 536 vasoconstrictor agents for, 537 Vascular ectasias, 563 Vascular injury, 707, 710–711 Vasculitides, ANCA-ssociated, 298–299 Vasoconstrictor, agents for variceal hemorrhage, 537 Vasodilation acute heart failure, 105 AKI, 389 ARDS, 196 Vasopressin, 536, 555 Vasopressin V2 receptor antagonist (vaptan), 416 Index Vasopressors, 461–462 AKI, 384–385 calcium channel blocker poisonings, 68 cardiogenic shock, 97 hemorrhagic shock, 46 tricyclic antidepressant toxicity, 60–61 VATS See Video-assisted thoracoscopic surgery (VATS) Venoarterial Extracorporeal Membrane Oxygenation (v-a ECMO), 98 Venous thromboembolism (VTE), in ICU case study, 221–222 clinical presentation, 223–224 diagnosis, 226 epidemiology, 222–223 evidence contour, 228–230 PROTECT trial, 222–223 pulmonary embolism severity, 224–226 risk factors, 222 treatment, 226–228 Venous thromboembolism (VTE) prophylaxis, 611, 670 Ventilator Associated Event (VAE), 261 Ventilator associated lung injury (VALI), 189, 194 Ventilator-associated pneumonia (VAP), 576 ATS/IDSA guidelines, 258–260 case study, 257 CDC surveillance definition, 261–262 de-escalate antimicrobial therapy, 259 diagnosis and treatment, 258 duration of antimicrobial therapy, 258–259 invasive vs noninvasive sampling strategies, 259–260 MRSA, 260 multidrug resistant organisms, 258 new and old strategies to prevent, 262 RCT, 260 Ventricular arrhythmias amiodarone, 157–158 anti-arrhythmic drug therapy, 159 beta blockers, 157 cardiac sympathetic denervation, 160 case study, 153–154 diagnosis, 154–156 digoxin immune fab, 159 general measures, 156–157 lidocaine, 158–159 mechanical circulatory support ECMO, 159–160 IABP, 159 radiofrequency catheter ablation, 160 transcoronary ethanol ablation, 160 805 Ventricular assist devices, 21–22 Ventricular septal rupture (VSR) percutaneous closure, 126 timing of surgery, 126 Ventriculoperitoneal (VP) shunts, 323 Ventriculostomy catheter, 323, 358 Video-assisted thoracoscopic surgery (VATS), 185, 472, 658, 660–661 Viral hemorrhagic fever See Ebola virus disease (EVD) Viral illness, acute, 521 Viral myocarditis, 730 Viral pneumonia, 745 Virchow’s triad, 222 Vitamin D supplementation, 193 Volume responsiveness dynamic measures, 29 end-expiratory occlusion, 30 hypovolemic shock, 41 passive leg raising, 31–32 predictors of, 31 static filling pressure, 29 Voriconazole, 474–475 VSR See Ventricular septal rupture (VSR) W “Wake-up” strokes, 309 Waldenstroms macrogloulinemia, 649 Warfarin, 531 Waterborne fever See Leptospirosis Watery diarrhea, 569 Weaning from mechanical ventilation case study, 273 evidence contour, 275–279 management, principles, 274–275 pressure support vs T-tube, 278 protocols, 275–277 telemetry monitoring, 274 Weil’s disease See Leptospirosis Weil-Vasilyev disease See Leptospirosis Wells criteria, for PE, 223–224 Wernicke-Korsakoff syndrome, 597 World Society of the Abdominal Compartment Syndrome (WSACS), 688, 690, 691 Z ZMapp, 493 Zoonosis, 517 .. .Evidence- Based Critical Care Robert C Hyzy Editor Evidence- Based Critical Care A Case Study Approach Editor Robert C Hyzy Division of Pulmonary and Critical Care University of Michigan Ann Arbor... Chicago, IL, USA Abdul W. Raif Jawid, MD  Department of Internal Medicine, Highland Hospital, Alameda Health System, Oakland, CA, USA Anuradha Ramaswamy, MD, FACP  Section of Pulmonary, Critical. .. Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Norman E. Adair, MD  Pulmonary, Allergy and Critical Care Medicine, Wake