(BQ) Part 2 book Neurocritical care board review has contents: Cardiovascular physiology, cardiovascular diseases, pulmonary physiology and fundamentals of mechanical ventilation, respiratory diseases, renal diseases, infectious diseases,.... and other contents.
II General Critical Care: Pathology, Pathophysiology, and Therapy Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 203 6/19/2013 4:45:48 PM Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 204 6/19/2013 4:45:49 PM 15 Cardiovascular Physiology David J Powner QUESTIONS The four determinants of cardiac output include: A Diastolic time B Heart rate C Systolic time interval D Arterial pulse–pressure variation E All of the above F None of the above Complete the following equation: Pressure = × Resistance A Afterload B Volume C Flow D Heart rate E Impedance ANSWERS TO THIS SECTION CAN BE FOUND ON PAGE 209 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 205 205 6/19/2013 4:45:49 PM GENERAL CRITICAL CARE: PATHOLOGY, PATHOPHYSIOLOGY, AND THERAPY The components of the equation for oxygen content of blood (mL O2/100 mL blood) include: A Partial pressure of O2 in central venous blood B Oxygen saturation in blood drawn slowly from a pulmonary artery catheter (PAC) C Cardiac output D Partial pressure of CO2 in arterial blood E Solubility coefficient of oxygen in blood The partial pressure or percent hemoglobin saturation of oxygen in blood drawn slowly from a pulmonary artery catheter (PAC) is intended to evaluate: A Oxygen consumption by lung tissue B Relationship of oxygen delivered versus consumed by all body tissues C Oxygen absorption across the alveolar–capillary membrane D Oxygen transport (mL O2/minute) E None of the above To compare cardiovascular parameters among patients and to normalize values, measurements may be “indexed” by dividing the measured value by: A Body mass index B Body weight C Creatinine-height index D Cardiac output E None of the above The ejection fraction measured by echocardiography primarily evaluates: A Myocardial contractility B Valvular incompetence or stenosis C Cardiac output D Venous preload E Vascular resistance The thermodilution method of cardiac output measurement by iced-saline injection utilizes all variables listed here except: A Temperature of the pulmonary artery blood B Distance between the injection port and the thermistor C Transpulmonary gas temperature D Volume of saline injected The normal partial pressure of oxygen in a properly collected mixed venous blood sample is: A 40 mmHg B 65 to 70 mmHg C 100 mmHg D 65% to 70% E None of the above 206 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 206 6/19/2013 4:45:49 PM CARDIOVASCULAR PHYSIOLOGY: Questions Anatomic mixing of venous blood from the superior and inferior venae cavae occurs in the: A Right atrium B Pulmonary artery C Left atrium D Pulmonary veins E None of the above 10 The pulmonary artery “wedge” or occlusion pressure is intended to reflect and direct therapy as a surrogate of: A The ejection fraction B Left ventricular end-diastolic volume (LVEDV) C Right ventricular end-diastolic pressure D Afterload E None of the above 11 Which cardiac variable listed here increases in proportion to preload? A Left ventricular (LV) systolic filling B Mitral stenosis C Left atrial dp/dt during atrial fibrillation D Contractility E Right atrial systole during atrial fibrillation 12 Although “shunt” has been discussed throughout sections about the lung, the actual evaluation is measured as the QS/QT or ratio of the blood “shunted” around the lung as a fraction (or percentage) of the total cardiac output flow, that is, shunt flow/total flow Stated another way, it is the percentage of cardiac output that does not effectively participate in full oxygenation, acting as though it has never been to the lung The complex formula for this important ratio is QS/QT = (CcO2 − CaO2)/(CcO2 − CvO2) A pulmonary artery catheter (PAC) is required to measure what variable needed in this formula? A CcO2 B CaO2 C Cardiac output D CvO2 E None because a PAC is not needed 13 The arterial pulse pressure variation is used by some cardiac output monitoring devices to suggest that the patient will benefit from what intervention? A Preload augmentation B Afterload reduction C Vasopressor (e.g., norepinephrine) administration D Inotropic (e.g., dopamine) support E Resumption of normal sinus rhythm 207 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 207 6/19/2013 4:45:49 PM GENERAL CRITICAL CARE: PATHOLOGY, PATHOPHYSIOLOGY, AND THERAPY 14 Arterial pressure waveform analysis is used by several commercially available devices to measure cardiac output These devices calculate the cardiac output after using arterial waveform analysis to define: A The dp/dt of left ventricular (LV) diastole B LV ejection time (speed) C Stroke volume (SV) D First derivative of the rate of rise of the first 0.04 seconds of the arterial pressure during systole E The area under the curve of the diastolic relaxation waveform 15 The oxygen saturation in blood drawn from a thoracic central venous catheter has been suggested as a clinically satisfactory replacement for what hemodynamic parameter? A Oxygen-carrying capacity of pulmonary blood B Oxygen content of arterial blood C Arteriovenous O2 difference D Oxygen transport into the systemic circulation E None of the above 208 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 208 6/19/2013 4:45:49 PM 15 ANSWERS The answer is B The four determinants of cardiac output are preload, afterload, heart rate, and contractility Heart rate is a straightforward measurement, except when myocardial efficiency is altered by various dysrhythmias i Afterload (or more properly, impedance) is usually evaluated by the equation for systemic vascular resistance index (SVRI): SVRI = 80 (MAP − CVP)/CI where MAP, mean arterial pressure; CVP, central venous pressure; CI, cardiac index (cardiac output/body surface area [BSA]) (Normal: 1,600–2,400 dyne·second·m2/cm5) ii Contractility is usually measured in the ICU as the ejection fraction obtained by echocardiography Other measures, such as the dp/dt (rate of rise of left ventricular (LV) pressure) during initial LV systole, may be more accurate, but are not available at bedside Another estimate of contractility is LV stroke work index (LVSWI) as work done during systole This parameter requires a pulmonary artery catheter (PAC) and is calculated as: LVSWI = 0.0136 (MAP – PCWP) × SVI where PCWP, pulmonary capillary wedge (occluded) pressure; SVI, stroke volume index (CI/heart rate) (Normal: 40–60 g·m/m2) iii Preload is the volume of blood returning to the heart (usually per minute), best measured as the left ventricular end-diastolic volume (LVEDV) This volume has traditionally been represented by a pressure, variously available as the pulmonary artery occlusion (wedge) pressure, which corresponds to the left atrial pressure that represents LV end-diastolic pressure (LVEDP) Another clinical estimate has been the pulmonary artery diastolic pressure when any of the preceding pressures are unavailable As a function of physiology, for a pressure to represent a volume, especially as 209 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 209 6/19/2013 4:45:49 PM GENERAL CRITICAL CARE: PATHOLOGY, PATHOPHYSIOLOGY, AND THERAPY a trended variable overtime, their relationship, that is, ΔP representing a ΔV, must be constant This relationship, ΔV/ΔP, defines LV compliance, which is not constant, particularly during sepsis, hypertension, or coronary artery–induced myocardial dysfunction In addition, changes in thoracic pressure that affect venous return during mechanical ventilation may make interpretation of these pressures more difficult Therefore, defining preload remains difficult because of the imprecise methodology used to measure it (1,2) The answer is C This is a fundamental equation in many aspects of physiology and is modified for cardiovascular issues as: Blood pressure = Cardiac output × Systemic vascular resistance As a flow variable, the units of cardiac output are L/minute These relationships highlight the interdependency of cardiac output and changes in vascular constriction to maintain blood pressure In clinical therapy, of course, one must treat one of the determinants of cardiac output (Answer 1) to affect change in cardiac output The answer is E The oxygen content of arterial blood in mL O2/100 mL blood is determined by the equation: CaO2 = (Hgb × 1.37 × SaO2) + (PaO2 × 003) where Hgb, hemoglobin in g/dL; SaO2, the % Hgb saturation at the given FIO2; 003, the solubility coefficient of oxygen in blood (Normal: 18 to 20 mL O2/dL) Oxygen delivery (transport) (VDO2 or DO2) extends the O2 content in mL/100 mL blood to the oxygen carried forward to tissues by the cardiac output (L/minute): DO2 = CaO2 × CO × 10 (Normal: 900–1,100 mL O2/L/minute) As oxygen is delivered to body tissues, some is consumed and some enters the venous circulation to return via the superior and inferior venae cavae to the right atrium These caval streams of blood not mix fully until both enter the right ventricle, and the residual venous oxygen enters the pulmonary artery as the mixed venous oxygen Sampling of the mixed venous blood by aspirating from a PAC allows calculation of the mixed venous content of oxygen (CvO2), from measurement of the partial pressure of O2 (PvO2; normal 40 mmHg), blood Hgb, and Hgb saturation (SvO2; normal 0.66–0.74) from a mixed venous blood gas: CvO2 = (Hgb × 1.37 × SvO2) + (PvO2 × 003) (Normal: ~15 mL/dL) The amount of oxygen consumed (VO2) by all tissues is the difference between what was delivered and what remained in the circulation within mixed venous blood The a-vDO2: a-vDO2 = CaO2 − CvO2 (Normal: 3.6–5.0 mL/dL) When adjusted by the cardiac output to calculate consumption for the whole body: VO2 = (CaO2 – CvO2) × CO × 10 (Normal: 200–300 mL/minute) All of the preceding values can be indexed by dividing the parameter by the patient’s BSA, providing the ability to compare patients of different body habitus Clinically, oxygen delivery index (DO2I) and oxygen consumption index (VO2I) may be compared: Normal DO2I is 530 to 600 mL/minute/m2; VO2I is 110 to 160 mL/minute/m2 210 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 210 6/19/2013 4:45:49 PM CARDIOVASCULAR PHYSIOLOGY: Answers Therefore, it is possible and clinically important to compare oxygen supply to oxygen consumed by the entire body Organ-specific demand/supply relationships would be important, but are unavailable unless the specific arteries to and veins from individual organs are cannulated Because of the unique isolated anatomy of the brain, its supply and consumption have been explored using arterial oxygen delivery and venous return obtained from the jugular vein Another variable derived from this information is the oxygen extraction ratio that provides perspective on the fraction or percentage of oxygen delivered that is used by the body during normal or stressed metabolism Oxygen extraction may be increased during hypoperfusion to compensate for reduced delivery Extraction may appear to be reduced by anatomic arteriovenous connections such as in liver disease or may actually be reduced when mitochondrial oxygen uptake is inhibited in sepsis or cyanide poisoning O2 extraction = VO2/DO2 (Normal: 0.22–0.28) As cardiac output falls, the slower flow through tissue capillaries, and perhaps increased O2 extraction within that tissue bed, removes maximal amounts of arterial oxygen, thereby reducing the amount of venous oxygen that returns to the circulation This, of course, decreases the CvO2 and its components, PvO2 and SvO2, assuming hemoglobin concentration remains constant Because the PvO2 is diminished by the O2 solubility factor, the SvO2 has become the commonly used surrogate for the CvO2 in monitoring the mixed venous:arterial O2 relationship Continuous monitoring of SvO2 is available via specialized PACs, allowing abnormalities to be trended During clinical conditions (e.g., sepsis) that reduce oxygen uptake by mitochondria, more O2 remains in the venous blood, and mixed venous content and SvO2 rise Similarly, in patients with therapeutic or pathophysiological arteriovenous shunts, venous O2 and SvO2 rise (3) The answer is B See Answer for a full explanation of the value of monitoring the SvO2 Mixed venous samples are processed via a blood gas analyzer as an arterial specimen Care must be taken that blood is not drawn too quickly from the PAC, because oxygenated blood may be pulled backward through the capillary and cause an erroneous elevation in the PvO2 from which the SvO2 is abstracted The answer is E The “indexing” of many parameters allows a normal value for that parameter to be determined among patients with differing body configurations Body surface area (BSA) is most easily available from a Dubois body surface chart but can be calculated from complex equations (2,3): BSA (m2) = [√ Height (cm) × Weight (kg)]/3,600, or BSA = 0.007184 × Weight0.425 × Height0.725 The answer is A Contractility is one of the four determinants of cardiac output LV stroke work (see Answer 3) has been used as an estimate of contractility and reflects work done by the left ventricle to overcome outflow impedance Contractility is difficult to quantify in the ICU setting because of its interdependence with preload, afterload, and heart rate The ejection fraction (Normal: >55%–60%) obtained by echocardiography is most often used clinically 211 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 211 6/19/2013 4:45:49 PM GENERAL CRITICAL CARE: PATHOLOGY, PATHOPHYSIOLOGY, AND THERAPY Contractility is abnormal in several neurological conditions associated with large amounts of catecholamine release from the brain “Myocardial stunning,” evidenced by decreased contractility, is documented in subarachnoid hemorrhage and particularly during the evolution of brain death in some patients This pattern appears similar to the Takotsubo cardiomyopathy documented in patients with pheochromocytoma and other syndromes associated with high catecholamine release (4) The answer is C The traditional thermodilution method of measuring cardiac output has evolved from Stewart’s original work in the 1890s to the traditional method of injecting iced or room temperature saline into the pulmonary artery This injection of a known quantity of injectate at a known temperature into a flowing bloodstream also of known temperature induces a temporary temperature change in the pulmonary artery blood as it passes a temperature sensor (thermistor) a known distance from the site of injection The Stewart-Hamilton equation (2) to determine the cardiac output from this thermodilution method is: CO = [60 × Vi × Ci × Si × Kcal × Kcor × (Tb − Ti)]/[Cb × Sb × ∫ΔTb(t)dt] where Vi, injectate volume (mL); Ci and Cb, specific heats of injectate and blood (constants); Kcal, calibration constant; Si and Sb, specific gravity of injectate and blood (constants); Kcor, temperature loss constant; Tb and Ti, baseline blood and injectate temperatures; integral term, area under thermal curve of temperature change versus time Continuous cardiac output pulmonary artery catheters (PACs) use similar changes in pulmonary blood temperature, but instead generate a burst of heat (not cold) into the bloodstream, and the change in blood temperature is sensed along a thermistor filament within the catheter The answer is A See Answer for a more complete discussion Abnormal PvO2, either below or above normal, will help evaluate the predominant abnormality in cardiovascular performance or oxygen debt (when O2 delivery does not meet need) It is helpful to note the PvO2, although the SvO2 is used more extensively Because blood gas analyzers not directly measure the SaO2 or SvO2, as does an oximeter or cooximeter, it is useful to ensure that the saturation (venous or arterial) presented by the blood gas analyzer is consistent with the measured PaO2 or PvO2 The extrapolation from partial pressure to saturation is, of course, a reflection of the oxyhemoglobin dissociation curve The “30–60-90” guideline is a useful rule of thumb describing Hgb-association parameters: At a PaO2 or PvO2 of 30 mmHg, there is 60% Hgb saturation, and at PaO2 or PvO2 of 60 mmHg, Hgb is 90% saturated The answer is E Streaming of blood from the superior and inferior venae cavae into the relatively small right atrium does not achieve full mixing Mixing occurs in the right ventricle (5) 10 The answer is B As discussed in Answer 1, the intention of the pulmonary artery (PA) wedge (or PA-occlusion pressure [PAoP]) is to evaluate cardiac preload, a volume, not pressure, measurement Although a direct conversion of pressure to volume is not possible, the relationship between the two could be useful as a relative trend in their values over time as therapy changes However, to be useful even as a trended value, there must 212 Zakaria_87574_PTR_CH15_10-06-13_203-216.indd 212 6/19/2013 4:45:49 PM INDEX hypoglycemia, 127 hypokalemia, 415–416, 423–424 and Cushing’s syndrome, 302, 312 hyponatremia and central pontine, 300, 308 etiologies of, 124, 128 euvolemic, 128 and extrapontine myelinolysis syndromes, 300, 308 fluid restriction to reduce free water intake, 304, 313–314 and osmotic demyelination, 300, 308 secondary to diuretic use, 113 and subarachnoid hemorrhage, 22, 29, 123, 128 tolvaptan for, 124, 129 hypopituitarism, radiation therapy and, 122, 127 hyporeflexia, 299, 306–307 and cerebral vasospasm, 21, 26 hypotension and brain death, 362, 367 duration of, prior to antimicrobial therapy in septic shock, 321, 328 second hour of, 321, 328 see also blood pressure hypothermia, 96, 101, 147, 154 acidosis and, 309 after cardiac arrest, 142, 150 and brain death, 362 cardiac arrest and, 161, 170–171 coagulopathy and, 309 electroencephalogram for, 60, 67 increased ICP and, 162, 170–171 induced, for perihematoma edema, 6, 13 shivering and, 162, 170 hypothyroidism, 122, 127, 304, 315 and hyponatremia, 123, 128 lithium effects on, 127 hypovolemia, 124 hypoxemia, 251, 282 peripheral chemo-receptors for, 239, 249 hypoxia aspiration and hypoxia and, 373, 378 brain structures sensitivity to, 147, 154 fat embolism syndrome and, 373, 378 pulmonary contusion and, 373, 378 transfusion-related acute lung injury and, 373, 378 IAP see intra-abdominal pressures ibuprofen, for bacterial meningitis, 81 ICH see intracerebral hemorrhageICP see intracranial pressure idebenone, for Friedreich’s ataxia, 222, 230 idiopathic thrombocytopenic purpura (ITP) antiplatelet antibodies for, 334, 339–340 IE see infective endocarditis I:E ratio, 246, 258 immune reconstitution inflammatory syndrome (IRIS), 88 IMSCTs see intramedullary spinal cord tumors incentive spirometry, 244, 255 infectious diseases, 319–330 infective endocarditis (IE) embolic stroke and, 80, 85–86 hemorrhagic stroke and, 80, 85–86 meningitis and, 80, 85–86 inferior vena cava, 404 blood streaming from, 207, 212 filter placement, for venous thromboembolism, 221, 230 inflammatory diseases, 107–118 inflammatory myopathy and succinylcholine-induced hyperkalemia, 74, 75–76 informed consent, 384, 387–388 infracted posterior papillary muscle, murmur caused by, 233 infratentorial bleeds cerebral angiography for, 12 surgical hematoma evacuation for, 5, 12 inhalational anthrax, 323, 329 inhalation injury, 376, 381 INR see international normalized ratio inspiratory airway pressure, 248, 262 inspiratory capacity, 244, 255 inspiratory forces, 270, 280 inspiratory gas distribution to apneic patients, 248, 261 inspiratory process, 277 446 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 446 6/19/2013 4:42:25 PM INDEX inspiratory reserve volume (IRV), 269, 278 institutional review board (IRB) expedited review, 392, 395 insulin plus nebulized beta-adrenergic drug, for metabolic acidosis, 301, 309–310 international normalized ratio (INR) elevated, treatment of, 341–342 International Subarachnoid Aneurysm Trial (ISAT), 22, 28 intra-abdominal hypertension, 379 intra-abdominal pressures (IAP), 404 intracerebral hemorrhage (ICH) anticoagulant-associated, 160, 168 with intraventricular involvement of the third and fourth ventricle, 160 phenylephrine for, 188, 198 secondary to coagulopathy, 336, 341–342 spontaneous hypertensive, 160, 168 surgical hematoma evacuation for, 5, 12 intracranial hypertension, rebound, 161, 169 intracranial pressure (ICP), 39, 46 elevation, nitroprusside-induced, 163, 172 increased, and hypothermia, 162, 170–171 mannitol effect on, 36, 41–42, 400, 408 monitor, 160, 168 position in monitoring cerebral perfusion pressure, 22, 29 monitoring, indications for, 39, 46 sodium chloride for, 186, 196 waveforms, 159, 168 intramedullary spinal cord tumors (IMSCTs), 133, 136–137 intraventricular hemorrhage, intraventricular tPA for, 13 intravenous immunoglobulin (IVIg) for bacterial meningitis, 81, 88 for Guillain–Barré syndrome, 74, 77 for myasthenia gravis, 73, 76 intraventricular tissue plasminogen activator, for intraventricular hemorrhage, 13 ionized hypercalcemia, 306 ionized hypocalcemia, 306 ipecac-induced myopathy, 72, 75 IRB see institutional review board IRIS see immune reconstitution inflammatory syndrome IRV see inspiratory reserve volume ISAT see International Subarachnoid Aneurysm Trial Ischemic colitis, symptoms of, 352, 358 ischemic stroke BP management for, 222, 230 fatal brain edema, risk factor for, 162, 171 isocitrate dehydrogenase mutation, 135–136 isoniazid for respiratory failure, 323, 329 for tuberculous meningitis, 91 isotonic IV fluids, for rhabdomylosis, 101 ITP see idiopathic thrombocytopenic purpura IV diclofenac, for controlling fever after left-middle cerebral artery infarction, 15 IVIg see intravenous immunoglobulin jugular venous bulb saturation (SjvO2), 402, 410–411 justice (fairness), 386, 390 juvenile absence epilepsy phenytoin for, 52, 64 K08, 395 K23, 394–395 K99/R00, 394–395 King’s College Criteria, 350, 356 Klebsiella pneumonia, 322, 328 kyphoscoliosis, 244, 255 labetalol for blood pressure, 219, 227 for hypertension, 27 during pregnancy, 143, 151 lacosamide and atrioventricular block, 190, 200 lactated Ringer’s bolus, applications of, during hypovolemic shock, 372, 378 Lambert–Beer law, 404 Lambert–Eaton myasthenic syndrome, 139 lap belt injuries, vasodilation for, 173 laquinimod, for lymphocyte reduction, 114 447 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 447 6/19/2013 4:42:25 PM INDEX lasix, 223, 231, 385, 389 for metabolic alkalosis, 290, 295 LeForte II fracture, 43 LeForte III fracture, 43 left carotid endarterectomy, electroencephalogram of, 61, 67–68 left hemispheric cerebral infarction, acute, 51, 63 left-middle cerebral artery infarction, 8, 15 left temporal lobe, periodic lateralized epileptiform discharges in, 56, 66 left upper lead, 398, 405 Legionella pneumophila, 329 lenticulostriates, hypertrophy of, 9, 16 leukocytosis, 147, 154 levetiracetam and intracerebral hemorrhage, 12 for seizure, 131, 135 lidocaine and brain death, 362 for topical anesthesia of the airway, 268, 277 limb girdle muscular dystrophy, ECG for, 221, 229 limbic encephalitis, 139 Lindegaard index, 402, 411 linezolid, 319 lisinopril, for acute right hemiparesis, 11 Listeria monocytogenes, 80, 86 -induced bacterial meningitis, ampicillin for, 183, 192 West Nile virus infection and, 88 lithium effects on hypothyroidism, 127 toxicity, 100 electroencephalogram for, 57, 66 hemodialysis for, 287, 293 vasopressin for, 300, 307–308 lithium carbonate, for amyotrophic lateral sclerosis, 71, 75 liver cirrhosis and osmotic demyelination syndrome, 124, 129 liver failure, acetaminophen overdose and, 96, 100 liver transplantation, 350, 356 for acute liver failure, 144, 151 treated with tacrolimus and central pontine, 300, 308 and extrapontine myelinolysis syndromes, 300, 308 and osmotic demyelination, 300, 308 LMWH see low-molecular weight heparin lorazepam, 101 and malignant hyperthermia, 102 for status epilepticus, 64 loss of refluxes, 76 “lover’s triad,” 373, 379 low-molecular weight heparin (LMWH) for chronic stable atrial fibrillation poststroke, 185, 194 for thrombocytopenia, 341 see also heparin low-T3 syndrome see nonthyroidal illness syndrome Lugol’s solution, for hyperthyroidism, 123, 127 lumbar puncture brain CT scan before, 83, 91 for Guillain–Barré syndrome, 74, 77 postural headache following, 79, 84 Lundberg A wave, 161, 169 LV stroke work index (LVSWI), 209 LVSWI see LV stroke work index lymphocyte trafficking, reduction of, 107, 114 mafenide acetate (Sulfamylon), for burns, 375, 380 magnesium, for reversible cerebral vasosconstriction syndrome, 427 magnesium sulfate, for preeclampsia, 145, 153, 155 magnetic resonance imaging (MRI) of brain without contrast, 177, 180–181 diffusion, for cerebral vasospasm, 21, 26 diffusion-weighted imaging, for diffuse axonal injuries, 38, 44 for eclampsia, 143, 150 for posterior reversible encephalopathy syndrome, 153–154 magnetic resonance venography, for venous sinus thrombosis, 24 448 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 448 6/19/2013 4:42:25 PM INDEX malaria, 80, 86–87 malignant glioma and venous thromboembolism, 333, 339 malignant hyperthermia (MH), 100 autosomal dominant, ryanodine receptor patterns associated with molecular abnormalities in, 96, 101 malignant pericardial effusion and cardiac tamponade, 224, 233 Mallory–Weiss syndrome, 350, 355 malnutrition and osmotic demyelination syndrome, 124, 129 mannitol for intracranial pressure, 36, 37, 41–42, 43, 47, 400, 408 serum testing, 307 Marburg’s variant, of demyelinating disease, 110, 116 massive PRBC transfusion and metabolic alkalosis, 290, 295 maxillary sinusitis, 323, 329 maximal inspiratory pressure (MIP) see negative inspiratory force McDonald diagnostic criteria, for multiple sclerosis, 111, 116 measles and acute disseminated encephalomyelitis, 112, 117 mechanical obstruction, 274 mechanical ventilation, 239–262 assist-control mode of, 247, 259 pressure-limited, 246, 258 volume-limited, 246, 257 Medicare, 386, 390 mefloquine, 80 MELAS see mitochondrial encephalopathy with lactic acidosis and stroke-like episodes Memphis criteria, for cerebrovascular injury, 43 meningeal carcinomatosis, 417, 424–425 meningioma, 133, 136–137 meningitis aseptic, 109 bacterial See bacterial meningitis cryptococcal, 81, 87 flavivirus infection and, 82, 88 infective endocarditis and, 80, 85–86 posttraumatic CSF fistulae and, 43 tuberculous, 83, 90–91 West Nile virus infection and, 88 meropenem for Listeria monocytogenes-induced bacterial meningitis, 194 for pseudomonal infections, 326, 330 MESCC see metastatic epidural spinal cord compression metabolic acidosis diuretics for, 290, 295 insulin plus nebulized beta-adrenergic drug for, 301, 309–310 massive PRBC transfusion and, 290, 295 metabolic disorders, 66 metabolic encephalopathy and consciousness disturbance, 160, 168 metastatic brain tumors, in adults, 132, 136 metastatic epidural spinal cord compression (MESCC) symptoms of, 133, 137 treatment for, 133, 137–138 metastatic lung cancer, hypercalcemia and, 304, 314 methyldopa, for hypertension during pregnancy, 143, 151 methylene blue, for methemoglobinemia, 104 methylprednisolone for acute spinal cord injury, 43 for transverse myelitis, 115 metronidazole, for Alzheimer’s dementia, 83 MG see myasthenia gravis MGMT see O-6-methylguanine methyltransferase MH see malignant hyperthermia MI see myocardial infarction midazolam and brain death, 362 for short-term sedation, 186, 195 for status epilepticus, 64 midline shift after initial injury, persistent effects of, 421, 428 Miller–Fisher syndrome, 425 449 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 449 6/19/2013 4:42:26 PM INDEX milrinone mechanism of action, 189, 198 for regulating cardiac output, 189, 198 for reversible cerebral vasosconstriction syndrome, 427 minute volume (MV), 269, 278 miosis, 97, 101 MIP see maximal inspiratory pressure missed bowel injury, septic from, 375, 380 mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 143, 150–151 diagnosis of, 148, 155 mitral valve stenosis, 220, 228 modified Rankin Score, 10 morphine, for breathing difficulties, 385 Moyamoya disease, 16 right-middle cerebral artery, surgical bypass of, 4, 11–12 MRI see magnetic resonance imaging MS see multiple sclerosis multiple sclerosis (MS), 107 corticosteroids for, 111, 116 McDonald diagnostic criteria for, 111, 116 rituximab for, 111, 116 tumefactive, 111, 117 murmur, caused by infracted posterior papillary muscle, 233 muscular dystrophy Duchenne, 221, 229 facioscapulohumeral, 221, 229 limb girdle, 221, 229 and succinylcholine-induced hyperkalemia, 72, 75–76 MV see minute volume myasthenia gravis (MG), 72 acetylcholine esterase inhibitor overdosing, impact of, 72, 76 anti-MUSK antibodies and, 72, 76 high-dose initiation therapy for, 73, 76 intravenous immunoglobulin for, 73, 76 mechanical ventilation, indications for, 73, 76 plasma exchange for, 73, 76 myelogenous leukemia antibodies against platelets, 334, 340 myelosuppression, ganciclovir and, 187, 197 myocardial infarction (MI) carotid stenting for, 11 catheter-based reperfusion therapy for, 221, 229–230 contraindications to fibrinolytic therapy for, 224, 232 myoglobinemia, high-voltage burns and, 376, 381 myonecrosis, 17 myopathy cardiomyopathy, 27, 218, 227 inflammatory, 72, 75–76 ipecac-induced, 72, 75 myxedema coma, 125, 127, 129 myxopapillary, 137 NaCl infusion, for acute renal failure, 287, 293 NaHCO3, for contrast-induced acute kidney injury, 288, 294 naloxone (Narcan) adverse effects of, 186, 196 for opiate overdose complications, 98, 101 naltrexone, for cholinergic poisoning, 104 NASCET see North American Symptomatic Carotid Endarterectomy Trial NASCIS (National Acute Spinal Cord Injury Studies) trial, 43–44 nasogastric tube (NGT) suction overall volume depletion due to, 286, 292–293 natalizumab (Tysabri) -associated progressive multifocal leukoencephalopathy, 116 for relapsing remitting multiple sclerosis, 110 National Conference of Commissioners on Uniform State Laws, 361 National Institutes of Health (NIH) Stroke Scale, 7, 8, 15 nausea and vomiting, 385, 389–390 NCPE see noncardiogenic pulmonary edema NCSE see nonconvulsive status epilepticus negative inspiratory force (NIF), 244, 256 negative predictive value, 393, 395 Neisseria meningitidis, 86 450 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 450 6/19/2013 4:42:26 PM INDEX neomycin and acute liver failure, 144, 152 nephrogenic diabetes insipidus and hyponatremia, 289, 294–295 neurocardiogenic (vasovagal) syncope, diagnosis of, 234 neurocysticercosis, 81, 87 neuroendocrine disorders, 121–129 diabetes insipidus, 121, 126 neurogenic pulmonary edema (NPE), 22, 28–29, 220, 228–229 neuroleptic malignant syndrome (NMS), 100 neuromuscular disease, succinylcholine for, 189, 199 neuromyelitis óptica (NMO), 114–115 neuron-specific enolase level, and cardiac arrest, 162, 171 neuro-oncology, 131–139 neurosarcoidosis, 113, 118 neurotrauma, 35–47 NGT see nasogastric tube suction nicardipine for blood pressure, 221, 229 for controlling hypertyension in SAH, 21, 27 for hypertension during pregnancy, 143, 151 NIF see negative inspiratory force nifedipine, for high-altitude pulmonary edema, 231 NIH see National Institutes of Health nimodipine for delayed cerebral ischemia, 175, 179 for reversible cerebral vasosconstriction syndrome, 427 for subarachnoid hemorrhage, 23, 30 NIPPV see noninvasive positive pressure ventilation nitric oxide, for primary pulmonary hypertension, 270, 280 nitroglycerin, for blood pressure, 150 nitroprusside for blood pressure, 150 for hypertyension, 27 -induced ICP elevation, 163, 172 NMDA see N-methyl-d-aspartate receptor encephalitis N-methyl-d-aspartate (NMDA) receptor encephalitis, 108, 114 NMO see neuromyelitis óptica NMS see neuroleptic malignant syndrome NOMI see nonocclusive mucosal ischemia noncardiogenic pulmonary edema (NCPE), 268, 274–275 nonconvulsive focal right frontal-temporal seizure, electroencephalogram for, 59, 67 nonconvulsive status epilepticus (NCSE), 421, 428 in ICU setting, 62, 68 nondepolarizing neuromuscular blockers, 364, 369 noninferiority trial, 391, 394 noninvasive positive pressure ventilation (NIPPV), 270, 281 nonocclusive mucosal ischemia (NOMI), 425 nonsteroidal anti-inflammatory drugs (NSAIDs) for gastrointestinal/genitourinary disorders, 351, 357 nonthyroidal illness syndrome, 302, 311 norepinephrine for elevating BP in cerebral vasospasm, 29 for patients presenting in septic shock, 408 normal saline (NS) infusion for acute renal failure, 287, 293 for contrast-induced acute kidney injury, 288, 294 North American Symptomatic Carotid Endarterectomy Trial (NASCET), 11 nosocomial urinary tract infection, Escherichia coli and, 188, 197 NPE see neurogenic pulmonary edema NS see normal saline infusion NSAIDs see nonsteroidal anti-inflammatory drugs O-6-methylguanine methyltransferase (MGMT), 135 obsessive–compulsive disorder (OCD), 286 obstructive hydrocephalus, ICP monitoring for, 160 OCD see obsessive–compulsive disorder oculovestibular reflex, evaluation of, 364, 368 ODS see osmotic demyelination syndrome 451 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 451 6/19/2013 4:42:26 PM INDEX Ogilvie’s syndrome, 351, 356–357 olanzapine and weight gain, 191, 201 ON see optic neuritis open depressed skull fracture, criteria for repairing, 36, 42 operative abdominal decompression, for compartment syndrome, 374, 379 ophthalmoplegia, 13 opsoclonus-myoclonus and paraneoplastic syndromes, 134, 139 optic neuritis (ON), 114 orbital cellulitis, 429 orbital wall fracture, 371, 377 oseltamivir, 320, 327 osmolar (osmolal) gap, 307 osmolar therapy, for vasogenic edema, 168 osmotherapy for cerebral venous thrombosis, 13 for hemicraniectomy, 10 osmotic demyelination alcohol abuse and, 300, 308 hypernatremia and, 300, 308 hyponatremia and, 300, 308 liver transplantation treated with tacrolimus and, 300, 308 osmotic demyelination syndrome (ODS) comorbidities predispose to, 124, 129 risk factors of, 125, 129 osteoplastic craniotomy, for subdural hematoma, 42 oxygen content, in blood, 242, 252–253 content, of arterial blood, 206, 210–211 partial pressure saturation of, from PAC, 206, 211 consumption effects, on respiratory quotient, 403, 412 for high-altitude pulmonary edema, 231 normal partial pressure of, 206, 212 oxygenation during mechanical ventilation, determinants of, 242, 253 PAC see pulmonary arterial catheter pacemaker, for C5–C6 quadriplegic patient, 416, 424 palliative care, 385 pancreatitis, 282 alcoholic fluid resuscitation for, 353, 359 gastric decompression for, 353, 359 operative drainage for, 353, 359 diagnosis of, 353, 359 pancuronium, side effects of, 190, 199 PAO2 (partial pressure of oxygen), 243, 254 paradoxic abdominal motion, during spontaneous breathing, 244, 255 paradoxical embolization, 220, 228 paraneoplastic syndromes (PNS) opsoclonus-myoclonus and, 134, 139 paraparesis, etiology of, 164, 172 parenteral nutrition (PN), 425 see also enteral nutrition Parinaud’s syndrome, 161, 169 partial seizures, complex, partial thromboplastin time (PTT) elevation and traumatic cerebral contusions, 44 patent foramen ovale (PFO) closure, 9, 16 Patient Protection Affordable Care Act, 390 PComm see posterior communicating artery aneurysm PCP see phencyclidine intoxication PEEP see positive end-expiratory airway pressure pelvic fractures, binder placement for, 372, 378 pelvic trauma, extra-peritoneal rupture and, 354, 360 penicillins, for aseptic meningitis, 109 pentobarbital, for intracranial pressure, 47 peptic ulcer type I, 357 type II, 357 type III, 357 type IV, 357 pericarditis, 224, 232 ECG for, 221, 229 peri-mesencephalic subarachnoid hemorrhage, cerebral angiography for, 30–31 periodic lateralized epileptiform discharges (PLEDs) in left temporal lobe, 56, 66 452 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 452 6/19/2013 4:42:26 PM INDEX perioperative neurosurgical care, 175–181 peripheral vascular disease, 397 peripheral vascular injury, attention to physical examination findings for, 372, 378 PFO see patent foramen ovale closure PFT see pulmonary function testing phase I trial, 391, 394 phencyclidine (PCP) intoxication, 99, 103 phenobarbital for seizure, 87 for status epilepticus, 64 phentolamine, for adrenergic-induced hypertension, 28 phenylephrine, 189, 198 effect on β-receptor, 189, 198 for elevating BP in cerebral vasospasm, 22, 29–30 for intracranial hemorrhage, 188, 198 for patients presenting in septic shock, 408 phenytoin, 190, 200 for juvenile absence epilepsy, 52, 64 for left hemispheric cerebral infarction, 51, 63 for seizure, 87 for traumatic brain injury, 38, 45 pheochromocytoma, 122, 126 physostigmine, for cholinergic poisoning, 104 piperacillin–tazobactam, for communityacquired pneumonia, 321, 328, 329 pituitary apoplexy, 133, 136 plasma exchange, for myasthenia gravis, 73, 76 plasma metanephrines, for von Hippel–Lindau disease, 122, 126 Plasmodium, 86 Plasmodium falciparum, 86 Plasmodium malariae, 86 Plasmodium ovale, 86 Plasmodium vivax, 86 Plateau airway pressure, 247, 260 Plateau wave, 161, 169 platelet dysfunction, desmopressin for, 335, 340 PLEDs see periodic lateralized epileptiform discharges pleural fluid effusion, 270, 279 PML see progressive multifocal leukoencephalopathy PN see parenteral nutrition pneumobilia, 422, 428–429 pneumonia aspiration, 269, 274, 277, 282 community-acquired, 271, 282, 321, 328, 329 ventilator-associated, 324, 329 pneumonitis, chemical, 274 Pneumonia Severity Index, 328 pneumothorax, 293 PNS see paraneoplastic syndromes Poiseuille’s Law, 247, 260 poliomyelitis, West Nile virus infection and, 88 polyethoxylated castor oil (Cremophor EL), for bleeding, 194 polyneuropathy, 17 polyuria, 285, 292 cerebral salt wasting for, 289, 294 following brain death, 303, 312 portable hyperbaric chambers, for highaltitude pulmonary edema, 231 positive end-expiratory airway pressure (PEEP) auto-, 246, 258–259 functional residual capacity increased by, 248, 262 positive IgG for aquaporin antibody testing, 115 positive predictive value, 395 positive pressure ventilation (PPV), 270, 280–281 decreased preload, 280 detrimental effects of, 281 noninvasive, 270, 281 reduced afterload, 281 postanoxic coma, 66 posterior communicating artery (PComm) aneurysm, 24, 28 posterior fossa subdural hematoma, 35, 41 posterior reversible encephalopathy syndrome (PRES) cyclosporine, 115 magnetic resonance imaging for, 153–154 453 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 453 6/19/2013 4:42:26 PM INDEX posterior reversible encephalopathy syndrome (PRES) (cont.) risk factors of, 142, 150 tacrolimus for, 109, 115 posttraumatic CSF fistulae CSF otorrhea for, 37, 43 CSF rhinorrhea for, 37, 43 posttraumatic seizures development, risk factors for, 39, 45 in TBI patients, 45 postural headache, following lumbar puncture, 79, 84 potassium translocation from intracellular space into serum, 300, 308 PPH see primary pulmonary hypertension PPV see positive pressure ventilation pralidoxime, for cholinergic poisoning, 99, 103 predictive value negative, 393, 395 positive, 395 prednisone, for myasthenia gravis, 73, 76 preeclampsia headache and, 142, 149 magnesium sulfate for, 145, 152 see also eclampsia preload, 209–210 premature ventricular complex (PVC), 227 preoxygenation, 401, 409 PRES see posterior reversible encephalopathy syndrome pressure-limited assist/control ventilation, 248, 261 pressure-limited mechanical ventilation, 246, 258 primary pulmonary hypertension (PPH) calcium channel blockers for, 270, 280 nitric oxide for, 270, 280 prostacyclin for, 270, 280 PROACT II trial, 10 progressive multifocal leukoencephalopathy (PML), 88 natalizumab-associated, 116 pathology of, 110, 116 progressive spondylotic cervical myelopathy, surgery for, 176, 179–180 progressive systemic sclerosis, 115 prophylactic antibiotics, for basilar skull fracture, 36, 42 prophylactic anticonvulsants, for traumatic brain injury, 38, 45 prophylactic hypothermia, in traumatic brain injury, 38, 44–45 prophylactic seizure therapy and intracerebral hemorrhage, 12 propofol adverse effects of, 186, 196 as emulsion, 186, 196 for status epilepticus, 52, 64 propranolol for hyperthyroidism, 123, 127 for subdural hematoma, 303, 313 propylthiouracil, for hyperthyroidism, 123, 127 prostacyclin, for primary pulmonary hypertension, 270, 280 protamine dose, to neutralize heparin, 185, 194 protamine sulfate, for heparin overdose, 338, 344 prothrombin complex concentrate, for intracerebral hemorrhage, 343 pseudomonal infections, meropenem for, 326, 330 Pseudomonas aeruginosa, 326 pseudovasculitis, 16 ptosis, 24 PTT see partial thromboplastin time pulmonary angiography, for pulmonary embolism, 333, 339 pulmonary arterial catheter (PAC), 399, 406 pulmonary artery wedge pressure, 207, 212–213 pulmonary compliance, 240, 249–250 dynamic, 243, 253 static, 243, 253 pulmonary conductance, 240, 243, 249, 253 pulmonary contusion and hypoxia, 373, 378 pulmonary edema defined, 274 hydrostatic, 275 noncardiogenic, 268, 274–275 454 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 454 6/19/2013 4:42:26 PM INDEX pulmonary elastance, 243, 250, 253 pulmonary embolism, pulmonary angiography for, 333, 339 pulmonary function testing (PFT), 245, 256–257 pulmonary vascular resistance, 241–243, 251–252 pulse oximeter, accuracy of, at lowest blood pressure, 398, 405 pulsus paradoxus and cardiac tamponade, 222, 230 pupils position, during brain death, 364, 368 p value, 393, 395 PVC see premature ventricular complex pyrazinamide, for tuberculous meningitis, 91 quadrantanopsia, 28 Quantiferon-TB Gold test, 320, 327 quetiapine, for extrapyramidal symptoms, 191, 201 quinine, for cerebral malaria, 80, 86–87 R01, 392, 395 radiation therapy and hypopituitarism, 122, 127 for metastatic epidural spinal cord compression, 133, 138 randomization process, 391, 394 randomized control study, 395 random oscillations from arm-restraining clinical technician, BP measurement variation by, 398 rapid, shallow breathing index (f/VT), 245, 256 rapid diagnostic tests (RDTs), 86 rapid influenza diagnostic test, from throat swab, 320, 327 rapid sequence intubation (RSI), 268, 276–277 RAS see reticular activating system rationing care, 386, 390 RCH see remote cerebellar hemorrhage RCVS see reversible cerebral vasoconstriction syndrome RDTs see rapid diagnostic tests recombinant tissue plasminogen activator (rt-PA), 164, 172–173 red lens test, 14 reflectance spectrophotometry, 397 reflex airway closure, 274 regional wall motion abnormalities (RWMA), 27 relapsing remitting multiple sclerosis (RRMS), 112 CSF examination for, 110, 116 natalizumab for, 110 remote cerebellar hemorrhage (RCH), 178, 181 renal diseases, 285–296 renal insufficiency and osmotic demyelination syndrome, 124, 129 residual volume (RV), 269, 278, 279 respect (for moral and religious values), 383, 387 respiratory diseases, 267–283 reticular activating system (RAS), 168 reversible cerebral vasoconstriction syndrome (RCVS), 16, 419, 427 rhabdomyolysis, aggressive fluid repletion for, 72, 75 Rickettsial disease, doxycycline for, 327 rifampicin, for tuberculous meningitis, 91 rifampin, for bacterial meningitis, 184, 193, 194 right carotid artery stenosis, carotid endarterectomy for, 178, 181 right facial sensory loss, right frontal subdural hemorrhage, electroencephalogram for, 62, 68 right-middle cerebral artery surgical bypass of, for Moyamoya disease, 4, 11–12 territory, delineated hypodensity in, 165, 173 right upper extremity incoordination, rituximab for multiple sclerosis, 111, 116 for transverse myelitis, 115 rocuronium and malignant hyperthermia, 102 RRMS see relapsing remitting multiple sclerosis RSI see rapid sequence intubation rt-PA see recombinant tissue plasminogen activator 455 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 455 6/19/2013 4:42:26 PM INDEX RV see residual volume RWMA see regional wall motion abnormalities SAH see subarachnoid hemorrhage SAMMPRIS see Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial SBO see small bowel obstruction SCAST trial, 14 scopolamine patch, for breathing difficulties, 385, 389 SDH see subdural hematoma second hour of hypotension, 321, 328 selective serotonin reuptake inhibitors (SSRI) and SIADH syndrome, 286 sensitivity, 392, 395 sepsis, CVP-guided resuscitation for, 322, 328 serotonin syndrome, 95, 100 serum calcium, 299, 306 serum mannitol testing, 307 serum osmolality, 300, 307 serum transaminases, 350, 356 serum tumor markers, 353, 360 Sheenan’s syndrome, hydrocortisone for, 301, 310–311 shivering and hypothermia, 162, 170 short QT interval, 21, 26–27 shunt equation, 213 SIADH see syndrome of inappropriate antidiuretic hormone sickle cell disease -induced hypoxia, 290, 295–296 transcranial doppler monitoring for, 5, 12 sigmoid diverticulosis, 351, 357 sigmoid volvulus, sigmoidoscopy for, 352, 358 silver sulfadiazine (Silvadene), for burns, 380 sinusitis endotracheal tube early transfer to oral route and, 323, 329 maxillary, 323, 329 SIRS see systemic inflammatory response syndrome SjvO2 see jugular venous bulb saturation SLE see systemic lupus erythematous sleep-disordered breathing, heart failure and, 222, 230 SMA see superior mesenteric artery small bowel obstruction (SBO), 351, 357 small brainstem lesion and consciousness disturbance, 160, 168 sodium bicarbonate, for TCA poisoning, 97, 101 sodium chloride, for intracranial pressure, 186, 196 somatosensory evoked potentials (SSEPs), 17 median nerve, 59, 67 convulsive, 57, 66 nonconvulsive, 62, 68, 421, 428 propofol for, 52, 64 specificity, 395 spectrophotometry, 404 SPIKES protocol, 390 spinal cord infarction, 9, 16–17 spinal epidural abscess, Staphylococcus aureus infection and, 82, 88–89 spinal tap, 19 spindle coma, 54, 65 spontaneous breathing trials, use of, 245, 256 SSEPs see somatosensory evoked potentials SSRI see selective serotonin reuptake inhibitors Staphylococcus aureus infection and spinal epidural abscess, 82, 88–89 β-stimulating catecholamines, for adrenergic-induced hypertension, 28 Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, 11 stereotactic aspiration, for Alzheimer’s dementia, 83 steroid-induced complications, associated with external ventricular drainage, 177, 180 STICH see Surgical Trial in Intracerebral Haemorrhage trial STOP trial, 12 Streptococcus agalactiae, 86 456 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 456 6/19/2013 4:42:26 PM INDEX Streptococcus pneumonia-induced bacterial meningitis, dexamethasone for, 183, 192–193 streptomycin, for tuberculous meningitis, 91 “string of pearls” sign, 351 stroke cryptogenic, 16 embolic, 80, 85–86 hemorrhagic, 80, 85–86 ischemic, 162, 171, 222, 230 patients, blood pressure management in, 7, 14–15 and subarachnoid hemorrhage, 20 thrombotic, 246, 257 stunned neurogenic myocardium, 26–27 subarachnoid hemorrhage (SAH), 19–31 with altered mental status, ICP monitoring for, 160 aneurysmal, 416, 424 cerebral angiography for, 23, 30–31 clinical change after clinical drain placement, 20, 25 continuous electroencephalography monitoring for, 23, 30 CT scan for, 19, 24 ECG changes associated with, 219, 227–228 Fisher Grade 3, 401, 409 and hyperreninemic hypoaldosteronism syndrome, 305, 315 hyponatremia and, 123, 128 initial clinical grade of, 23, 30 nimodipine for, 23, 30 peri-mesencephalic, 30–31 stroke and, 20 subdural hematoma (SDH) acute, 36, 42 in older patients, surgery for, 36, 42 posterior fossa, 35, 41 propranolol for, 303, 313 right frontal, 62, 68 valproic acid for, 190, 200 subependymoma, 137 subfalcine herniation, 167 subluxation with spinal cord transaction, for cerebrovascular injury, 37, 43 suboccipital craniectomy, for infratentorial bleeds, 12 substituted judgment, 384, 388 succinylcholine -induced hyperkalemia critical illness neuropathy and, 72, 75–76 inflammatory myopathy and, 72, 75–76 muscular dystrophy and, 72, 75–76 and malignant hyperthermia, 102 for neuromuscular disease, 189, 199 sudden severe throbbing headache and eclampsia, 141, 149 superior mesenteric artery (SMA) occlusion of, 352, 357–358 superior venae cavae, blood streaming from, 207, 212 surface cooling, 8, 15 surgery for ophthalmoplegia, 132, 136 for progressive spondylotic cervical myelopathy, 176, 179–180 Surgical Trial in Intracerebral Haemorrhage (STICH) trial, 12 SVR see systemic vascular resistance SVRI see systemic vascular resistance index syndrome of inappropriate antidiuretic hormone (SIADH), 22, 29, 74, 77 distinguished from cerebral salt wasting syndrome, 123, 128 and hyponatremia, 123, 128 SSRI inhibitors and, 286, 292 syndrome of the trephined, 40, 46–47 systemic inflammatory response syndrome (SIRS), 320, 327 systemic lupus erythematous (SLE) CNS manifestations of, 113, 118 dexamethasone for, 303, 313 systemic vascular resistance (SVR), 378, 400, 408 systemic vascular resistance index (SVRI), 209 tacrolimus liver transplantation treated with and central pontine, 300, 308 457 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 457 6/19/2013 4:42:26 PM INDEX tacrolimus (cont.) and extrapontine myelinolysis syndromes, 300, 308 and osmotic demyelination, 300, 308 for posterior reversible encephalopathy syndrome, 109, 115 Takotsubo cardiomyopathy, 27 TB see tuberculosis skin test TBI see traumatic brain injury TCA see tricyclic antidepressant TCD see transcranial doppler ultrasound technetium-labeled (Tc99m-HMPAO) radionuclide sintigraphy, for brain death, 363, 368, 369 temozolomide, for grade IV glioblastoma, 135 TENS see transcutaneous electrical nerve stimulation teriflunomide, for lymphocyte reduction, 114 terminal delirium, 389 terminal extubation, 385, 389 Terson’s syndrome, 24 theophylline, for C5–C6 quadriplegic patient, 416, 424 thermometer probe, placement of, 400, 407 thiamine intake and Wernicke’s encephalopathy, 147, 154 thiazide diuretics plus angiotensin converting enzyme inhibitors, 15 plus angiotensin receptor blockers, 15 plus beta-blockers, 15 for BP management in stroke patients, 14–15 third nerve palsy with pupillary sparing, 22, 28 thoracic central venous catheter oxygen saturation in blood, 208, 214 thoracic corpectomy, for metastatic epidural spinal cord compression, 133, 138 thrombocytopenia antibodies against platelets, 334, 340 thrombolysis, for stroke, 8, 15 thrombolytic therapy, contraindications to, 165, 173 thrombotic stroke, respiratory support for, 246, 257 thyroid hormone therapy, for myxedema coma, 129 thyroid storm, 123, 127 thyrotoxicosis, 313 amiodarone and, 127 type 1, 127 type 2, 127 TIA see transient ischemia attack tick-borne infectious diseases, doxycycline for, 327 tidal volume (TV), 269, 278 tissue plasminogen activator (t-PA), 419 intraventricular, for intraventricular hemorrhage, 13 for left hemispheric cerebral infarction, 63 TLC see total lung capacity TM see transverse myelitis tolvaptan, for hyponatremia, 124, 129 tonsillar herniation, 167 total lung capacity (TLC), 269, 278, 279 total work of breathing, 269, 277 toxic–metabolic disorders, 95–104 t-PA see tissue plasminogen activator tracheal aspiration of secretions, 324, 329 tracheostomy, advantages of, 270, 280 transcranial doppler (TCD) ultrasound for cerebral vasospasm in middle cerebral artery, 23, 31 monitoring for sickle cell disease, 5, 12 transcutaneous electrical nerve stimulation (TENS), 223, 231–232 transfuse packed red blood cells to target hematocrit, 322, 328 transfusion-related acute lung injury and hypoxia, 373, 378 transient ischemia attack (TIA) carotid endarterectomy for, 3, 11 crescendo, 11 transurethral sphincterotomy, for bladder dysfunction, 353, 359 transverse myelitis (TM), 114, 164, 172 acute partial (incomplete), 117 trauma acute massive hemothorax following, 374, 379 458 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 458 6/19/2013 4:42:27 PM INDEX with isolated live injury, nonoperative management for, 374, 379–380 traumatic brain injury (TBI) decompressive hemicraniectomy for, 38, 45 hormone deficiencies after, 303, 312 ICP monitoring for, 160 prophylactic anticonvulsants for, 38, 45 prophylactic hypothermia in, 38, 44–45 traumatic cerebral contusions, partial thromboplastin time elevation and, 44 traumatic injuries to spine and extremities, high-voltage burns and, 376, 381 Trendelenburg positioning, 399, 406–407 tricuspid valve vegetation, 82, 89 tricyclic antidepressant (TCA) overdose and brainstem abnormalities, 145, 153 poisoning, sodium bicarbonate for, 97, 101 trimethoprim–sulfamethoxazole for bacterial meningitis, 81 for Listeria monocytogenes-induced bacterial meningitis, 194 troponin T (cTnT), 222, 230–231 Trousseau sign, 306 tuberculin skin test, 327 tuberculosis (TB) skin test, 267, 273–274 tuberculous meningitis, 83, 90–91 tubular obstruction, 291, 295–296 tumefactive multiple sclerosis, 111, 117 TV see tidal volume type I error, 393, 395 type II error, 395 UDDA see Uniform Determination of Death Act uncal herniation, 167 unfractionated heparin for chronic stable atrial fibrillation poststroke, 185, 194 subcutaneous, for pulmonary thromboembolism, 218, 227 Uniform Determination of Death Act (UDDA), 361, 366 upward tentorial herniation, 167 uremic encephalopathy, 143, 151 signs and symptoms of, 146, 153 uremic twitch syndrome, 153 urinary tract infections (UTIs) cefepime for, 188, 197 ceftriaxone for, 188, 198 Escherichia coli-induced nosocomial, 188, 197 gentamycin for, 198 predisposing factors for, 188, 197 U.S Department of Health and Human Services, 395 UTIs see urinary tract infections vaccines, for bacterial meningitis, 81, 88 valacyclovir, for acute renal failure, 187, 197 valproate, for status epilepticus, 64 valproic acid and brain death, 362 overdose and brainstem abnormalities, 145, 153 for subdural hematoma, 190, 200 valve replacement surgery delay, heart failure and, 83, 89 vancomycin for Alzheimer’s dementia, 83 for bacterial meningitis, 121, 184, 193 for community-acquired pneumonia, 321, 328, 329 for infectious endocartitis, 325, 330 for thrombocytopenia, 325, 330 vascular injury, angiography evaluation of neck for, 371, 377 vascular malformations, 19–31 vasoconstriction for Call–Fleming syndrome, 16 complete resolution of, for reversible cerebral vasoconstriction syndrome, 16 vasodilation, for lap belt injuries, 173 vasogenic edema, 160, 168 vasopressin effect on β-receptor, 189, 198 for elevating BP in cerebral vasospasm, 30 for lithium toxicity, 300, 307–308 vasopressors, for mitral vegetation/ regurgitation, 325, 330 VD/VT (dead space), 244, 255 459 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 459 6/19/2013 4:42:27 PM INDEX vegetative state of consciousness, 164, 172 venous angiomas see developmental venous anomalies venous sinus thrombosis, magnetic resonance venography for, 24 venous stenosis, 406 venous thromboembolism (VTE) inferior vena cava filter placement for, 221, 230 malignant glioma and, 333, 339 ventilation:perfusion mismatch, 242, 253 ventilator-associated pneumonia antibiotic therapy for, duration of, 324, 329 diagnosis of, 324, 329 ventilator mode, 271, 281 ventricular dysrhythmias and brain death, 362, 367 ventricular fibrillation, risk associated with, 98, 102 ventricular ischemia precordial leads, positioning of, 398, 406 ventricular tachycardia (VT) ablation, 225, 234 ventriculostomy infections, 39, 46 for infratentorial bleeds, 12 placement, complications associated with, 40, 47 verapamil, for reversible cerebral vasosconstriction syndrome, 427 vertebral artery dissection, 7, 14 viral infection, 224, 232 vision loss refractory to IV steroids, 108 vital capacity forces, 269, 270, 278, 279–280 vital capacity maneuver, 245, 256 vitamin K for acute liver failure, 145, 152 for bleeding, 185, 194 volume-limited mechanical ventilation, 246, 257 von Hippel–Lindau disease, 122, 126 plasma metanephrines for, 122, 126 von Willebrand disease (vWD), 337, 343–344 type I, 343 type II, 343 type III, 343 VT see ventricular tachycardia ablation VTE see venous thromboembolism vWD see von Willebrand disease Wallenberg syndrome, 14 warfarin plus amiodarone, 184, 193–194 anticoagulant effect of, 184, 193 for bacterial meningitis, 184, 193 -induced deficit of factor VII, 164, 172 -induced skin necrosis, 341 as procoagulant, 184, 193 for stroke, 8, 15 Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) trial, 11 WASID see Warfarin–Aspirin Symptomatic Intracranial Disease trial Weber’s syndrome, 28 weight gain, olanzapine and, 191, 201 Wernicke’s encephalopathy, thiamine intake and, 147, 154 West Nile virus (WNV) infection, 80, 85 and meningitis, 88 and poliomyelitis, 88 West zone abnormalities, 241, 252 West zone lung physiology, 269, 278 West zones, distribution of, 399, 407 WNV see West Nile virus infection xanthochromia, 20 ziprasidone and QTc interval prolongation, 191, 200 Uploaded by [StormRG] 460 Zakaria_87574_PTR_Index_10-06-13_433-460.indd 460 6/19/2013 4:42:27 PM ... (DO2I) and oxygen consumption index (VO2I) may be compared: Normal DO2I is 530 to 600 mL/minute/m2; VO2I is 110 to 160 mL/minute/m2 21 0 Zakaria_87574_PTR_CH15_10-06-13 _20 3 -21 6.indd 21 0 6/19 /20 13... cardiomyopathy (HOCM) D Aortic coarctation 20 0 20 0 180 180 160 160 140 140 120 120 100 100 80 80 60 60 40 40 20 20 PVC 0 9 :25 :33 AM 9 :25 :34 AM 9 :25 :35 AM 9 :25 :36 AM 9 :25 :37 AM A 48-year-old man with a... peptide (BNP) E Matrix metalloproteinase (MMP) 22 2 Zakaria_87574_PTR_CH16_10-06-13 _21 7 -23 8.indd 22 2 6/19 /20 13 8:47:30 PM CARDIOVASCULAR DISEASES: Questions 22 A 49-year-old woman with multiple sclerosis