Ebook Irwin & rippe''s manual of intensive care medicine (6/E): Part 2

(BQ) Part 2 book Irwin & rippe''s manual of intensive care medicine has contents: Surgical problems in the intensive care unit, hematologic problems in the intensive care unit, neurologic problems in the intensive care unit, transplantation,... and other contents.

88 D i s o rd e rs of H e m osta s i s Ad a m C u ke r a n d S u m a n L Sood I THE BLE E D I N G PAT I E NT: G E N ERAL P R I N C I PLES A Etiology Bleeding disorders (Table 88- ) may be secondary to the following: a Defects in the activity of platelets b Defects in the activity of one or more coagulation factors (coagulopathy) c Congenital causes d Acquired causes Hematology consultation is often necessary if the cause of bleeding is not immediately apparent and/or if specialized laboratory testing is required for diagnosis B Diagnosis Clinical presentation a Identify the site of bleeding i Platelet disorders tend to cause mucocutaneous bleeding (e.g., epistaxis, oral, gastrointestinal [GI] , genitourinary, ecchymosis) ii Coagulopathies (i.e., deficiencies in the activity of coagulation factors) tend to cause deep soft tissue bleeding (e.g., into joints and muscles) iii Bleeding from a single site (e.g., a surgical site, GI tract) warrants evaluation for an anatomic cause of bleeding 637 638 I SECT I O N • H E M AT L G I c p R B L E M s I N T H E I c u TA B L E 8 - Selected Congen ital a n d Acq u i red B l eed i n g D isorders Mechanism Congen ita l Acq u i red Defects i n platelet activity• Qual itative p latelet d i so rders von W i l lebra n d d iseaset Defects in coagu lation H e m o p h i l ia A H e m o p h i l ia B oth e r factor d eficienc ies M ed ications R e n a l d isease Myelodysplasia Myeloprol iferative d isord e rs Vita m i n K d eficie ncy Liver d i sease Exposu re to a nticoagula nts DIC Tra u ma Acq u i red factor i n h i bitors 'For defects i n platelet function due to th rom bocytopen i a , see C h a pter 89 'Deficiency of van W i l l e bra nd factor leads to red uced b i n d i n g of platelets to sites of vasc u l a r i nj u ry a n d t o one a n other DIC, d isse m i n ated i ntravasc u l a r coagulati o n b Obtain the personal and family bleeding history i Congenital disorders: life-long history of bleeding, posmve family history Exceptions are possible (e.g., mild hemophilia) ii Acquired disorders: often no previous history of bleeding, no family history c Perform a careful physical examination i Skin: ecchymosis, petechiae, or nonpalpable purpura ii Hemarthrosis: warm, swollen joints iii Mucosa! surface abnormalities (e.g., nasal or oral pharyngeal mucosa) Perform tiered laboratory evaluation a Initial testing i Complete blood count (exclude thrombocytopenia, assess for anemia) ii Prothrombin time (PT) and activated partial thromboplastin time (aPTT) (to exclude coagulopathy; see Figure 88- and Table 88-2) (a) Prolonged PT may indicate defect in tissue injury (also known as extrinsic) pathway of coagulation (b) Prolonged aPTT may indicate defect in contact (also known as intrinsic) pathway of coagulation (c) Prolonged PT and aPTT may indicate single defect in com­ mon pathway of coagulation or multiple defects Tissue i nj u ry pathway Contact pathway Contact factors: Tissue factor � PT Common pathway XII, H MWK, prekal li krein x I x XI a PTT i ! Fibri nogen v 1 - Thrombin Fibrin clot Figure 88- The coagulation cascade may not fully represent the process of coagulation in vivo, where activation of coagulation usually is initiated through the tissue injury (also known as extrinsic) pathway of coagulation, which subsequently can activate the contact (also known as intrinsic) pathway through thrombin-mediated activation of factors VIII and XI (not shown) The tissue injury system involves binding of activated factor VII to tissue factor and activa­ tion of factor X, whereas the contact system involves activation of factor XI by contact factors such as factor XII and subsequent activation of factor IX, which in conjunction with activated factor VIII subsequently activates factor X The common pathway involves the activated fac­ tor X-mediated cleavage of factor II to yield rhrombin, which cleaves fibrinogen to form fibrin clot The fibrin clot is strengthened through the cross-linking action of factor XIII (not shown) aPTT, activated partial thromboplastin time; PT, prothrombin time TA B L E 8 - Selected Causes o f a Prolonged Activated Part i a l Thromboplast i n Ti me (a PTT) a n d/or Prothro m b i n Ti me (PT)' I solated p ro l onged a PTT Isolated prolonged PT Prolonged a PTT and PT H e pa r i n expos u re L u p u s a nticoagulantb Deficiency (or i n h i bitor) of factors V I 1 , IX, or XI Defi ciency of contact fa ctors (XI I , H M WK, or preka l l i kre i n ) b v o n W i l lebra n d d i seasec Wa rfa rin expos u re Vita m i n K d eficiency Liver synthetic dysfu nction Conge n i ta l d eficiency of facto r VI I DIC Liver synthetic dysfu nction S u prathera pe utic wa rfa r i n or heparin Expos u re t o d i rect thro m b i n i n h i b itors (a rgatroba n , d a b igatra n ) Congentia l d eficiency of factors 1 , V, or X Hypo- or dysfi brinogenemia Su perwa rfa rin exposu red Vita m i n K d eficie ncy Expos u re to FXa i n h i b itors ( riva roxa ba n , a pixa ba n ) e M i ld D I C 'B leed i n g d isorders that typically d o not featu re a prolongation i n t h e a PTT or P T i n c l u d e , but a re n o t l i m ited t o , platelet fu nction d isorders, v o n W i l lebrand d isease, FXl l l defi ciency, a ntiplasm i n or plas m i n ogen a ctivator i n h i btor- deficiency, and d isorders of the vasc u lature or i ntegu ment ( e g , Ehlers-Da n los, Osler-We ber-Rend u , scu rvy) b N ot associated with bleed ing 'VWD (especi a l ly type ) a lso may featu re a norm a l a PTT "S u pe rwarfa r i n pesticides i n c l u d e brod ifaco u m , bromod iolone, cou mafury l , and d ifenaco u m D I C , d isse m i n ated i ntravasc u l a r coagu lati o n ; H M WK, h igh molec u l a r weight k i n i noge n ' M a y not prolong P T a n d A PTT 640 I SECT I O N • H E M A T O L O G I C P R O B L E M S I N T H E I C U b Specialized testing i Mixing study ( : mix of patient and normal plasma) to detect when an inhibitior may be present (a) Indication: prolonged PT or aPTT (b) If prolongation completely corrects with mixing -7 suggests factor deficiency (c) If prolongation does not completely correct with mixing -7 suggests that an inhibitor is present (either specific to an individual coagulation factor or nonspecific, such as a lupus anticoagulant) ii Measurement of individual coagulation factor levels (a) aPTT prolongation: request factors VIII, IX, and XI (b) PT prolongation: request factors II, V, VII, X, and fibrinogen (c) von Willebrand factor (VWF) levels (d) Platelet function studies (e) FXIII levels I I ACQU I R E D D I S O R D E RS OF H E M OSTAS I S A Antithrombotic therapy induced General Principles a The medication administration history can suggest bleeding due to anticoagulant and antiplatelet agents that is common in the ICU See chapter 90 on Antithrombotic therapy in critically ill patients B Vitamin K deficiency Pathophysiology a Inadequate dietary intake of vitamin K b Malabsorption of fat-soluble dietary vitamin K c Decreased production of vitamin K by intestinal flora (which may be destroyed by antibiotics) Diagnosis a Prolonged PT (corrects with mixing) b Decreased levels of vitamin K-dependent clotting factors (II, VII, IX, and X) Treatment a Phytonadione (vitamin K ) administration b May be given PO or IV at a dose of to IO mg/day i IV dosing associated with small risk of anaphylaxis (a) Administer over 30 minutes with close monitoring (b) Smaller doses (e.g., mg) advised ii SC dosing is discouraged due to erratic absorption c Treatment may be given empirically without confirmatory laboratory studies i PT should begin to normalize within several hours of IV admin­ istration of vitamin K1 • C Coagulopathy of liver disease C h a pter 88 • D i sorders of H e m ostas i s I 641 Pathophysiology a Deficiency of hepatically synthesized clotting factors including the vitamin K-dependent factors (II, VII, IX, and X) and factors V, XI, XII, and fibrinogen b Owing to any cause of liver disease that impairs synthetic function Diagnosis a Prolonged PT ± prolonged aPTT b Decreased levels of fibrinogen, factors II, V, VII, IX, X, XI, and XII i Factor VIII, which is not produced in hepatocytes, is typically normal or elevated c Other laboratory evidence of liver disease (e.g., decreased albumin, elevated alanine aminotransferase/aspartate aminotransferase) Treatment a Blood products i Should be administered only if bleeding, at high risk of bleeding, or when an invasive procedure is planned ii Isolated mildly-moderately prolonged clotting times without bleeding not sufficient grounds for treatment iii Ongoing treatment may be required until liver synthetic defi­ ciency is resolved (e.g., by definitive treatment, such as liver transplantation, or recovery following shock liver) b Fresh frozen plasma (FFP) i Usual dose: infusions of approximately to mL/kg (usually to 250 mL units) ii Severe hepatic failure and ongoing bleeding: consider continuous infusion (FFP drip) iii Goal: cessation in bleeding (a) A target INR of :::; i is often cited but may be difficult to achieve iv Be alert for signs of volume overload c Cryoprecipitate i Usual dose: units per infusion is expected to increase fibrino­ gen levels by 50 mg/dL (a) Goal: cessation in bleeding and/ or fibrinogen of ;::: s o to 00 mg/dL d Follow aPTT, PT, fibrinogen, and complete blood count every to hours if actively bleeding D Disseminated intravascular coagulation (DIC) Pathophysiology a Uncontrolled activation of coagulation, which paradoxically may lead to bleeding due to consumptive deficiencies of multiple clotting factors and platelets Etiology a Infection/sepsis b Malignancy (e.g., acute promyelocytic leukemia, Trousseau syn­ drome) 642 SECT I O N • H E M A T O L O G I C P R O B L E M S I N T H E I C U c Obstetrical complications (e.g., placental abruption; hemolysis, elevated liver enzymes, and low platelet count [HELLP] syndrome; amniotic fluid embolism) d Tissue damage (e.g., trauma, burns) e Vascular abnormalities (e.g , abdominal aortic aneurysm, giant hem­ angioma) f Toxic procoagulant molecules (e.g , snake bite) g Fat embolism (e.g., fracture of long bones, sickle cell crisis) Diagnosis a Presence of an underlying etiology b Laboratory testing i Decreased fibrinogen (due to consumption) ii PT/aPTT may be prolonged (due to consumption of clotting factors) iii Thrombocyropenia may be present (due to accelerated platelet consumption) iv Increased o-dimer, a measure of cross-linked fibrin degradation products (due to accelerated fibrin degradation) v Red blood cell fragments (schisrocytes) may be present on blood smear Treatment a Treatment of the underlying cause (e.g., antibiotics for sepsis, delivery for pregnancy related) b Hemostatic therapy (for dosing, see Table 88-3) TA B L E 8 - M a nagement o f Disse m i n ated l ntravasc u la r Coagu lation ( D I C) : B l ood Prod ucts• Ta rget l a boratory para meter Component Typ i c a l dose Assoc iated laboratory para m eterb N o c l i n ic a l l y significant bleed i n g C l i n ica l ly sign ificant b l eed i n g >20-50 K/µL P latelets d osec Platelet co u nt >10 K/µL >80- 00 mg/d l >80- 00 m g/d l Cryo p rec i p itate u n its F i b r i n ogen FFP ::; x u p per 3-5 u n its a PTT/PT l i m it norma l reference nge 'Tra nsfuse blood p rod ucts o n ly if c l i n ica lly sign ifica nt b leed i n g or h igh risk of bleed ing 'Before tra n sfusion , esta blish base l i n e platelet count, PT, a PTT, a-d i m e r, a n d fibrinoge n Fol low laboratory para m eters every 4-6 h u ntil D I C resolves and u nderlying cond ition successfu lly treate d 'O n e d o s e o f platelets is e q u a l t o u n it o f si ngle-donor platelets or a fou r or six p a c k o f pooled ndom donor platelets F F P , fresh froze n plasma; a PTT, a ctivated pa rti a l t h rom boplasti n t i m e ; PT, proth rom b i n t i m e C h a pter 88 • D i sorders of H e m ostas i s I 643 i Should be given only to patients with high risk for bleeding, with clinically significant bleeding, or in need of invasive procedures (a) Platelet transfusion (b) Cryoprecipitate (c) FFP (d) Coagulation tests (PT, aPTT, fibrinogen, platelet count) should be monirored frequently to assess response to hemo­ static therapy ii For refractory bleeding (e.g., mucocutaneous oozing, ongoing bleeding from catheter exit sites) despite above measures, con­ sider low-dose heparin (a) Typical dose: to 10 units/kg/h ( no bolus) (b) Avoid in intracranial/GI bleeding, placental abruption, and imminent surgery E Trauma-induced coagulopathy Pathophysiology a Major contributor is massive volume resuscitation with fluids or packed red blood cells (PRBCs) , which are deficient in clotting factors and platelets, leading to dilutional thrombocytopenia and coagulopathy b Other possible contributing factors i Acidemia (impairs activity of clotting cascade) ii Hypocalcemia (impairs activity of calcium-dependent clotting factors) iii Hypothermia (impairs platelet function) iv Concurrent DIC Diagnosis a Clinical presentation i Persistent bleeding from mucosa! and serosal surfaces and wound and vascular access sites following major trauma b Thrombocytopenia c Prolonged PT and aPTT (correct with mixing; deficiency of multiple clotting factors can be demonstrated but is rarely necessary) d Hypofibrinogenemia Treatment a Liberal transfusion of platelets, FFP, and cryoprecipitate i Goals: aPTT/PT :5 x upper limit of normal; fibrinogen 2: 00 mg/dL; platelets > 0,000/µL b Body and fluid warming to treat hypothermia c Correction of electrolyte and acid-base disturbances d Consider tranexamic acid, recombinant factor VIia (rhFVIIa) , or prothrombin complex concentrate in otherwise uncontrolled bleed­ ing (further studies warranted) F Acquired hemophilia Pathophysiology a Neutralizing autoantibodies against endogenous coagulation factor VIII 644 I SECT I O N • H E M A T O L O G I C P R O B L E M S I N T H E I C U Etiology a Malignancy b Autoimmune disease (e.g , rheumatoid arthritis, systemic lupus ery­ thematosus) c Postpartum state d Idiopathic (50% of cases) Diagnosis a Prolonged aPTT (does not correct with mixing) b Low or unmeasurable factor VIII activity level c Inhibitor titer using the Bethesda assay; reported in Bethesda units (B.U.) Treatment a Control of bleeding i Low-titer inhibitors (80%-100% for major bleed i ng or proced u res Tro ugh leve l s s h o u l d be performed to e n s u re adeq uate dosing For VW D , adju nctive to either DDAVP- or VW Fconta i n i ng facto r VI 11 conce ntrate for treatment of m u cosa I bleed i ng Avoid if active he matu ria , D I C F DA-a pproved for treatment of heavy menstrua l bleed i ng Avoid if active hematu ria , DIC ,300 mg PO Tl D for a maxi m u m of d ays 'I ntra nasal formu lation (Stimate) a lso ava i la b l e ; d ose for a d u lts weigh i n g >50 k g is 50 µg (one spray) i n each nostri l 'RCoF, R i stocetin cofactor, a measure o f VWF activity D DAVP, desmopress i n a cetate; VWF, von W i l l e bra nd factor; RCoF, ristocetin cofactor; VWD , v o n W i l lebrand d isease; D I C , d isse m i nated i ntravasc u l a r coagu lati o n 1 74 I n dex Monophasic waveforms, 34 Monosodium urate (gout), 07 Monosodium urate crystals, 1 Monro-Kellie doctrine, Morphine, l l , 8 Morphine sulfate, 229 Motility disorders, Motor innervation, Motor neuron disease, 028 Mucin clots, 1 Mucociliary clearance, 338, 373 Mucocutaneous bleeding, 637 Mucor species, 397, 070 Mucosa! biopsies, Mucosa! ulceration, of the gastroesophageal junction, 85 Mucositis, 475 Multicenter InSync Randomized Clinical Evaluation (MIRACLE) , 290 Multidrug-resistant tuberculosis (MOR-TB), 507 Multifocal atrial tachycardia (MAT), 279, 292 Multilumen catheter, Multiple acid-base disturbances, 3-4 Multiple myeloma (MM) , 480 Multiple organ failure (MOF), 907 Multiple-organ dysfunction syndrome (M OS), see also Sepsis background, 965 pathophysiology, 965-966, 967£ 968f risk factors, 96 , 962t scoring systems, 965, 966t Muscle biopsy, 025, 026 Muscular dystrophy, 028 Myasthenia gravis (MG), 9, 974, 027 Mycobacteria, 490 Mycobacterium avium complex, 500 Mycobacterium tuberculosis (MTB) , 480, 49 , 497, 500, 504-506, 508, 070 Mycoplasma pneumoniae, 407, 044, 049 Myelop roliferative disorders/myelodysplastic syndrome (MPOs)/(MOS, 645 Myeloproliferative neoplasms (MPNs) bleeding, 699 clinical presentation, 699 diagnosis, 699-700, 700t general principles, 698-699 prognosis, 700 surgical procedures, 699 treatment, 700-70 Myocardial infarction antithrombotic therapy, 248 arrhythmias complicating, 255, 256t, 257t background, 246, 247t left ventricular dysfunction (pump failure) , 250-25 mechanical complications, -253, 252f, 253f, 254t pathophysiology, 246, 248f pericarditis, 255 prognosis after, 246 recurrent ischemia/infarction, 246-248, 249f right ventricular infarction, 249-250 thromboembolism, 253, 255 Myocardial infarction (MI), 25, 2, -282, 283t Myocarditis, Myonecrosis, 948, 957 Myopericarditis, 90 �-myosin heavy chain, 74 Myosin-binding protein, 74 Myositis, Myxedema coma active heating in, 606 clinical features, 605t diagnosis, 605-606 general principles, 604 myocardial band (MB) fraction, 606 parenteral administration of thyroid hormone, 607 pathophysiology, 605 signs, 606 symptoms, 605 treatment, 606-607, 607t N Na• correction for hyperglycemia, 1 49 N-acetylcysteine (NAC), 562 Nachlas tube, Naegleria fowleri, 044 Naloxone, 879, 982 Narcotics, 54 , l l 44t Nasal CPAP, 375 Nasogastric aspiration, 534 Nasogastric tube, 036 Nasopharyngeal airway, 2, 3f, Nasopharyngeal bleeding, Nasotracheal intubation, 38 Native valve endocarditis (NVE), 464 Near-infrared spectroscopy, 1 Nebulizers, 372 Necrosis, 85 Necrotizing fasciitis, 867-869 Necrotizing muscle infection, 869 Needle cricothyrotomy, I n dex Neisseria meningitidis, 457t, 459, 46 , 480, 487, 702, 938, 044 Nesidioblastosis, 635 Neurochemical monitoring, 1 Neurogenic bladder dysfunction, 02 Neuroimaging, 99 Neuroleptic malignant syndrome (NMS) diagnosis, 395 etiology, 394 general principles, 394 pathophysiology, 394-39 treatment, Neurological examination, 98 Neurological monitoring categories, 98 Neurological problems, in ICU altered consciousness, 979-984 brain death, 976 carbon monoxide (CO) poisoning, 039-1 040 cerebral fat embolism syndrome, decompression sickness, 040- 04 depressed state o f consciousness, 974 diagnosis, 97 4-977 electrical injuries, 039 general principles, 973-974 hiccups, - 042 metabolic encephalopathy, 986-989 monitoring ICP and state of consciousness, 97 neurological calculations, 1 peripheral nerve disorders, 042 prevention of further damage, 977 primary, 974 prognostic and ethical considerations, 977 respiratory support, 976 secondary neurological disease in, 977 secondary severe medical disease in, 977 status epilepticus, 977 suicidal hanging, 038 Neuromuscular blocking agents (NMBAs) , 1 6-1 17, 024, 025 Neuro-oncological problems, in ICU hydrocephalus, 032- 033 increased intracranial pressure (I CP) , - 032 postoperative complications, 034-1035 seizures, 033 spinal tumors, 035-1 036 systemic complications secondary to brain tumors, 036- 037 Neuroprognostication, 5 Nicardipine, 2 Nifedipine, l l 44t Nimodipine, 2 I 1 75 Nitrate therapy, 229 Nitrates, 243 Nitric oxide, 374 Nitrogen dioxide (N0 2) , 379 Nitroglycerin, 2 Nocardia species, 457t, 483, 490, 070, 093 Nonclostridial myonecrosis, 869 Noncompliant LV, 175 Noncompressing effusions, Nondepolarizing neuromuscular blocking (NMB) agents, 1 Non-dihydropyridine calcium channel blockers, 271 Nondihydropyridines, 2 Nonexertional ("classic") heat stroke, 39 Noninflammatory arthritis, 07 Noninvasive positive pressure ventilation (NPPV), 363-364 Nonmalignant islet cell adenomatosis, 629 Nonsteroidal anti-inflammatory drug (NSAIDs), 93, 522, 799t-80 l t, 877, 885, 886 Norfloxacin, 538 Normothermia, 53 Nose, Nosocomial pneumonia, 404, 530 Nosocomial sinusitis, 443 complications, 397 diagnosis, 397 etiology, 397 incidence, 397 sphenoid sinusitis, 398 treatment, 397-398 Nucleoside reverse transcriptase inhibitors (NRTis)-based therapy, 500 Nutritional assimilation, 582 Nutritional calculations, 1 52 Nutritional support, in ICU diagnosis, 1-582 enteral feeding, 82-5 83 general principles, laboratory tests, 1-582 parenteral feeding, 583 pathogenesis, subjective global assessment (SGA) , 582 treatment, 82-5 83 Nutritional therapy, 408 Obesity-hypoventilation syndrome, 320 Obliterative hepatocavopathy, 5 Obstetric hemorrhage, 887 1 76 I n dex Obstetric patient management, in ICU amniotic fluid embolism, 887 burn injuries, 888 cardiovascular risk, 884 diagnostic radiation exposure, 884-885 gastrointesinal risk, 884 hematologic risk, 884 hemolytic uremic syndrome (HUS)/ thrombotic thrombocytopenic purpura (TTP) , 888 hypertensive disorders of pregnancy (preeclampsia), 886 maternal physiologic adaptation to pregnancy, 884 medications and pregnancy, 885 obstetric hemorrhage, 887 renal risk, 884 respiratory risk, 884 trauma, 888 urinary tract infection (UT!), 884 Obstruction, of airway, Octreotide, 78, 535, 573 Ocular compartment syndrome, 5 , 957 Odynophagia, 92 Oncologic emergencies epidural spinal cord compression (ESCC) , 742-744 hypercalcemia, 744-746, 745t malignant pericardia! effusion, 747 superior vena cava (SVC) syndrome, 738-740, 739t tumor lysis syndrome (TLS), 740-742, 74 l t Open lung biopsy, 408 Open tracheostomy, 65-66 Opioids, 1 5- 1 6, 802t-803t Opium, 573 OPS!, see Overwhelming postsplenectomy infection (OPS!) Optimal endotracheal tube position, Orbital cellulitis, 397 Organ failure, see Sepsis Orthopnea, 332 Orthosis (bracing) , 036 Orthostatic hypotension, Osmolar gap, 1 49 Osmotic demyelination, 421 Osteoarthritis, 07 Osteochondroma, 07 Osteomyelitis, 397, 444 Osteoradionecrosis, 374 Otogenic infections, 398 Overwhelming postsplenectomy infection (OPS!), 487, 488 Oxacillin, 454t Oxygen therapy, 309-3 0, 374 Oxygenation, 54 Oxytocin antagonists, 325 p Pacemaker infection, 292 Pacemaker nomenclature codes, 291 t Pacemaker syndrome, 292 Pacemaker-mediated tachycardia (PMT), 292 Pacing partial arterial carbon dioxide pressure (Paco2), 25, 297 in COPD, i n pregnant woman, 328r Packed red blood cells (PRBCs), 643 Pain management, of critically ill complications, 882 definition and pathogenesis, 875-876 diagnosis concept of patient-focused sedation and analgesia, 877 delirium, 877 intensity, 876 location, 876 moniroring the degree of sedation, 877 quality of sensation, 876 drugs for, 880-882 general principles, 875 treatment, 877-879 Palmar blushing, 20 Palpitation, 347 Pamidronate (Aredia), 623 Pancreatic duct obstruction, PAo / Fio ratio, 298 Papilledema, 03 Paracentesis complications, 76 contraindications, 75 general principles, 74 indications, 74-75, 75r procedure, 76 Parathyroid hormone (PTH), 622 Parenchymal pressure transducer devices, 00 Parenteral anticoagulants, 242 Parenteral feeding, 583 Parenteral nutrition, 544, 577 Parenteral therapy, 1 Parenteral thiamine, 598 Parietal layer, 90 Parkinson disease, I n dex Paroxysmal nocturnal hemoglobinuria (PNH) clinical presentation, 702 diagnosis, 702 general principles, 70 1-702 prognosis, 703 treatment, 702-703 Partial arterial of carbon dioxide pressure (Paco 2) , 32 Partial arterial of oxygen pressure (Pao, ) , 32, 297 Partial cuff deflation techniques, 376 Pasteurella multocida, 865 Patellar tap, 06 Patient-controlled analgesia (PCA), 880 Patient-controlled epidural analgesia (PCEA), 880 Pedal edema, Penetrating atherosclerotic ulcer (PAU), 204-205 Penetrating trauma, during pregnancy, 888 Penicillin G procaine, l l 44t Penicillins, 327, 885 Peptic ulcer disease, 52 , 522 Peptostreptococcus, 40 Percent oxyhemoglobin saturation (Sao2), 32 Percutaneous bedside tracheosromy, 54 Percutaneous coronary intervention (PCI), 237 Percutaneous dilarational rracheostomy, Percutaneous endoscopic jejunostomy (PEJ), 91 Percutaneous suprapubic cystostomy complications, 04 contraindications, 03 indications, 02 postprocedure considerations, 04 procedure, 03-1 04 Percutaneous tracheostomy, 66-67 Percutaneous rransheparic embolization, 78 Percutaneous ventricular assist device, 65- 66 Pericardia! disease, critical care constrictive pericardiris, 95-197 general principles, 90- pericardia! effusion and cardiac ramponade, 93-1 pericardiris, - 93 Pericardia! effusion, 40 Pericardia! space, 19 Pericardia! tamponade, 94, Pericardiocentesis, 19 complications, definition, 39 diagnostic studies, 43 1 77 diagnostic vs therapeutic, 39 diseases affecting pericardium, 39 pericardia! anatomy, 39 postprocedure considerations chest radiograph, 43 monitoring, 42 transthoracic echocardiogram, 43 procedure considerations, 40 fluid evacuation, 42 material preparation, 40 needle advancement, 42 needle entry site selection, needle insertion, -42 patient preparation, 40 sire preparation, tamponade, 42 Pericardiris, 255 diagnosis, 1-1 93, 92f treatment, 93 Pericardium, 90 Perioperative hypertension, 1 Peripheral edema, 69 Peripheral nerve disorders, 042 Peritoneal access, 439 Peritoneal defense mechanisms, 844 Peritoneal dialysate, 439 Peritoneal dialysis (PD), 436, 439 Peritoneal signs, 549 Peritonitis, 439 Permanent pacemakers (PPMs) complications, 292 general principles, 290, 29 t indications, 290, 29 l t monitoring, 293 procedure, 292 Pesticides, 804r-8 l 4r Pharmacologic calculations, 1 50, 1 52 Pharyngeal abscess, 64 Phenobarbital, 394, 033 Phenothiazines, 54 , 879 Phenylephrine, 6, l l 44r Phenylpropanolamine, l l 44r Phenytoin, 556, 596, 033 Phlebitis, 265 Phosphate binders, 626 Phosphodiesterase inhibitors, 670t, 671 Phosphorus disorders, 625-626 Phytonadione, 688 Pigmented villonodular synovitis, 07 Piperacillin/razobactam, 452r, 484, 493 Plague (Yersinia pestis}, 383 Plasma glucose concentration and hyperglycemia, 87 1 78 I n dex Plasma osmolality (Posm), 9, 421 Plasma potassium disorders general principles, 424 hyperkalemia, 426 hypokalemia, 424-425 Plasma sodium (PNa) disorders as a determinant of plasma osmolaliry, general principles, Plasmapheresis, 706 Plasmodium falciparum, 5 Plastic syringes, 33 Platelet disorders, 637 Platelets, 724-726, 725t Pleural disease complications, 5 diagnosis, etiology, general principles, 353 pathophysiology, 353-354 treatment, 354-3 5 Pleural effusion, 45 Pleural fibrosis, 320 Pleural symphysis, 48 Pneumocystis jirovecii, 405, 480, 483, 490, 492, 493, 070, 079, 093 Pneumocystis pneumonia (PCP) , 735, 1 28 diagnosis, 496 etiology, 495 pathogenesis, 495 treatment, 496t, 497 Pneumomediastinum, 328 Pneumonia, 63, 949 clinical presentation, 406 community-acquired (CAP), 404 diagnosis, 407-408 diagnostic testing, 407-408 etiology, 405-406 history, 407 in ICU patients, 404 laboratory tests, 407 nosocomial, 404, 530 pathogenesis:, 405 physical examination, 407 serology, 407 sputum examination, 407 rreatment, 408-409 ventilator-associated (YAP) , 404 Pneumothorax, 45, 50, , 328, 328t diagnosis, 356 etiology, 5 general principles, 5 pathophysiology, 35 5-356 thoracic trauma, , 953 rreatment, 356-357 Polyarteritis nodosa (PAN), 1 29 Polycythemia vera (PV) bleeding, 699 clinical presentation, 699 diagnosis, 699-700, 700t incidence of, 699 treatment, 70 Polydipsia, 034 Polymerase chain reaction tests, 94 Polymorphonuclear (PMN) cell count, 1 Polymyositis, 07, 1 5-1 1 Polyuria, 034 Portal gastropathy, 522 Portal hypertension, 533, 564 Portopulmonary hypertension, 566 Positive end-expiratory pressure (PEEP) , 56, 64, 363, Post-cardiac arrest diagnosis, general principles, 50 neuroprognostication, 5 persistent precipitating pathology, post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, systemic inflammatory response syndrome (SIRS) , treatment coronary revascularizarion, 53-1 54 glucose control, 54 hemodynamics, 54 induced hypothermia, 52- oxygenation, 54 persistent precipitating pathology, 54 seizures, 54 ventilation, , l 52t Post-cardiac arrest syndrome (PCAS), 50 Postdural puncture headache (PPH), 96-97 Postextubation, Postmyocardial infarction pericarditis, Postobstructive diuresis, 04 Postresuscitation syndrome, 388 Posttransplant lymphoproliferative disease (PTLD), 068, 07 Potassium phosphate, 593 Pralidoxime, 383 Prasugrel (Effient) , 666t Prazosin, l l 44t Predisposition, infection, response and organ dysfuncrion (PIRO), 964-965 Prednisone, 644 Preemptive analgesia, 878 Pregnancy, 75 I n dex Premature ventricular contractions (PVCs), 264 Prerenal azotemia, 427 Pressors, 885 Pressure control (PC) , 359-360 Pressure support (PS) , 359 Pressure ulcers epidemiology, 872 pathophysiology, 872 prevention, 872-873 wound classification, 873 wound management, 873-874 Procainamide, 265, 272t, 1 44t Prognathic ability, Prognostication, 43-1 44 Propafenone, 266, 272t Propofol, 1 3, 8 Propranolol, 272t, 596 Propylthiouracil (PTU) , 603 Prostacyclin, 438, 706 Prosthetic valve endocarditis (PYE) , 86-1 87, 464 Prosthetic valve thrombosis, 86 Protamine, 682 Protected specimen brush (PSB) cultures, 407 Proteus mirabilis, 490 Proteus species, 471 Prothrombin time (PT) , 638-640, 639t Proron pump inhibitors (PP!s) , 529, 544 Providencia species, 471 Pseudocysts, 578 Pseudogout, 1 Pseudohemoptysis, 330 Pseudomembranous croup, 400 Pseudomonas aeruginosa, 37 , 398, 452t 454t, 457t, 480, 482 484, 486, 492 Pseudomonas species, 468, 47 , 943 Psoriatic arthritis, 07 Psychiatric issues, in ICU suicide, 1 37- 1 39, l 38t treatment of agitation and delirium, 1 32-1 36 Pulmonary arterial circuit, 332 Pulmonary artery catheter (PAC), standard, 25 clinical uses, 30 insertion procedure, 26-28 Pulmonary artery catheterization cardiac output measurement, 28-29 complications, 29 indications, 25-26 objectives, 25 I 1 79 PA perforation, 29 postprocedure considerations, 28-30 pressure and waveform interpretation, 28 procedure, 26-28 types of catheters, 25 Pulmonary artery occlusion pressure (PAOP), 28 Pulmonary calculations, 1 48 Pulmonary capillaritis, 1 30 Pulmonary compromise, 542 Pulmonary disease, 566 Pulmonary edema, 325 Pulmonary embolus, 036 Pulmonary histoplasmosis, Pulmonary hypertension classification, 345, 346t computerized tomography, 349 definitions, 345 diagnosis, 347-3 50 etiology, 34 , 34 t laboratory evaluation, 348 normal pulmonary circulation, 345-346 radiographic findings, 348 right heart catheterization, 349 RV pressure overload, 346-347 transthoracic Doppler echocardiography (DE), 348-349 treatment, 350-3 ventilation-perfusion lung scan (V/Q scan), 349 Pulmonary parenchymal disease, 320 Pulmonary toxicity, 736 Pulmonary vascular resistance, 1 48 Pulmonary vasodilator therapy, 350 Pulsation, 37 Pulse contour analysis, 22 Pulse Index Continuous Cardiac Output (PiCCO) , 894 Pulse oximetry, 20, 893 Pulseless ventricular tachycardia (VT) , 33 Pulsus paradoxus, 94 Pump failure, from inspiratory respiratory muscle fatigue, 365 P2Y12 inhibitors, 664, 666t Pyelonephritis, 04 Pyrazinamide, 506, 507 Pyrimethamine, 499 Q Quadriplegia, 64 Quadruple-lumen catheter, 26 Quetiapine, 1 1 80 I n dex Quinidine gluconate, 5 Quinine, R Radial artery cannulation, 17, 20-2 Radiation therapy, I 036 Radiographic contrast media anaphylaxis, 1 23-1 24 Raloxifene, 707 Receptive aphasia, 983 Recombinant tissue plasminogen activator (r-TPA), 86 Rectal biopsy, 77 Rectal ulcers, 522 Red blood cells (RBCs) , 724, 725t Reflex tachycardia, 2 Refractory bleeding, 643 Remifentanil, 1 Renal failure, 1 in ALF, from myoglobinemia, Renal replacement therapy (RRT), 437 Reperfusion syndrome, 957 Reperfusion therapy, 240-242, 240f, 24 t Respiratory acid-base disorders, 299-300 Respiratory acidosis, 299, 300t, 1 50 Respiratory alkalosis, 299, 1 Respiratory compensation, Respiratory failure extrapulmonary causes diagnosis, 320-32 differential diagnosis, 320 etiology and pathophysiology, 9-320 general principles, hypercapnic respiratory failure, 320 laboratory testing, and lateral curvature o f the spine (scoliosis) , 320 measurements of MIP and MEP, 320 medical history analysis, 320 peripheral nervous system dysfunction, 319 supplemental oxygen for, 32 systemic myopathies, 320 techniques of airway hygiene, 321 treatment, 321 upper airway obstruction, 320-32 use of mechanical ventilatory assistance, 321 viral capacity measurements, 320 management of diagnosis, 30 I and efficiency of gas exchange, 297 general principles, 297-298 pathophysiology, 298-300, 300t treatment, -302 in pregnancy diagnosis, 325 etiology, 322-325, 324t general principles, 322, 323t heparin therapy, 327 hypotension, 326 intubation of the pregnant patient, 326 and maternal malnutrition, 326 mechanical ventilation (MV) , 326 nutrition, 326 radiology, 325 reversal of hypotension, 326 treatment, 326-328, 326t, 328t Respiratory infections, 325 Respiratory monitoring, 20, 376-377 Restrictive cardiomyopathies (RCMs) background, 76-1 77 diagnosis, 77- 178, I 77f pathophysiology, 77 prognosis, 78 treatment, 178 Resuscitation of burns, 945 gastroesophageal balloon tamponade, 80 for hemorrhagic shock (HS) end points, 905 fluid, 904 pitfalls, 905-906 response to, 904-905 Reteplase (Retavase) , 684t Reticular activating system (RAS) , 979 Return of spontaneous circulation (ROSC), 50 Rhabdomyolysis, 957 Rheumatoid arthritis (RA), 07, 1 07-1 08, 1 09t- l l l l t, 1 general principles, 1 07 neurological problems, 1 08 pulmonary, 1 08 treatment, 1 08, 1 09t- l I l l t Rheumatologic disorders, in ICU antiphospholipid antibody syndrome, 1 crystal arthropathy, 1 2-1 1 3, I 1 3t idiopathic inflammatory myositis, 1 5- 1 rheumatoid arthritis, 1 07-1 08, 1 09t- l l I l t, 1 scleroderma, 1 6- 1 septic arthritis, 1 3-1 1 5, I I 14t systemic lupus erythematosus, 1 Rhinoscleroma, 400 I n dex Rhonchi, 304 Rib fractures, 952 Ricin, 383 Rickettsia rickettsii, Rifampin, 506, 507 Rifaximin, 566 Right ventricle ejection fraction (RVEF), 26 Right ventricular infarction, 249-250 Riluzone, 93 Ritodrine, 325 Rituximab, 706, 1 28 Rocky Mountain spotted fever (RMSF) diagnosis, general principles, pathogenesis, treatment, Rocuronium, 1 Romiplostim, 709 Ruxolotinib, 70 RV ejection fraction PAC, 25 s Salicylate, 632 Salmonella species, 480, 487, 490, 492, 493 Salmonella typhi, 044 Schistosomiasis, 044 Schizophrenia, 1 34 Scleroderma, I 07, 1 6- 1 Scleroderma renal crisis, 1 Sclerotherapy, 78, 535-536 Secondary extremity compartment syndrome, 955, 957 Secondary prophylaxis, 502 Sedative hypnotic, l 4t-820t Seizures, 033 Seldinger technique, 04 Selective serotonin reuptake inhibitors (SSRis) , 1 45, l 145t Self-adhesive pads, 35 Semiopen tracheostomy, 67 Sengstaken-Blakemore balloons/tube, , 82f, 536 Sepsis, 641 cholestasis of, 5 diagnosis clinical presentation, 963 inflammatory source identification, 963-965 , 964t predisposition, infection, response and organ dysfunction (PIRO), 964-965 general principles definitions, 959, 960-96 l t, 961 epidemiology, I 1 81 multiple-organ dysfunction syndrome background, 965 pathophysiology, 965-966, 967f, 968f scoring systems, 965, 966t pathophisiology end-organ consequences, 963 infection, 961 mediators, 963 pathogen induction, 961-962 toll-like receptors, 962-963 treatment antibiotics and source control, 970 early goal-directed therapy, 968-970 sepsis care adjuncts, 970-971 time-dependent disease, 966, 968, 969t Septic arthritis, 06, 444, 1 3-1 1 5, l 14t Septic shock, 959 Seronegative spondyloarthropathy, 07 Serotonin reuptake inhibitors, 395 Serotonin-norepinephrine reuptake inhibitors (SNRis) , 1 45-1 146, 1 45t Serratia species, 471 Serum creatine kinase (CK) , 025 Serum osmolality, 1 49 Serum procalcitonin, 447 -4 Serum sickness, 07 Serum T3 concentrations, Serum T4 concentrations, Sevelamer, 626 Severe acute respiratory syndrome (SARS), 325 diagnosis, general principles, pathogenesis, treatment, Severe neutropenia, 79 Shock cardiogenic, 892, 896-897 classification, 890-892 definition, 890 description, 890 diagnosis, 893 distributive, 892, 897 endocrine, 892 etiology, 890-892 hemodynamic monitoring, 894-895 hypovolemic, 890-89 , l t, 96 obstructive, -892, 96 pathophysiology, 892-893 resuscitation end points, 895 treatment, 895-896 1 82 I n dex Sick euthyroid syndrome, in ICU alterations in serum-binding proteins, 609-6 alterations i n the pituitary-thyroid axis, 609 diagnosis, 2-6 etiology, 608 general principles, 608 L-T3 treatment, pathophysiology, 608-6 stages, 0-6 thyroid function tests, 2-6 4, 3t treatment, 4-6 Sinopulmonary infections, 443 Sinus tachycardia, 34 Sinusoidal obstruction syndrome, 5 Skin and soft tissue infections, 443-444 Skin puncture, 3, Slow continuous ultrafiltration (SCUF), 437 Slow low efficiency dialysis (SLED), 437 Smallpox (Vario/a major}, 382 Smoke inhalation, 380-38 Snake bite, 642 Sniffing position, Sodium nitroprusside, 2, 885 Sodium phosphate, 626 Sodium thiosulfate, 383 Sonography, 557 Sorbitol-containing medication suspensions, 542 Sotalol, 272 t Sphenoid sinusitis, 398 Spinal cord trauma airway management, 928 American Spinal Injury Association (ASIA) grading scale, 924, 925t assessment of spinal column stability, 927, 927f, 928f decompressive surgery, 929 epidemiology and clinical significance, 924 hospital management, 928-929 initial assessment and stabilization, 926 neurological decompression, 929 neurological injury, 924-925, 925t neuroprotective agents, 93 pathophysiology, 926 restorative/regenerative strategies, 93 sequelae and complications, 929-93 steroid dosage, 929 treatment, 928-929 Spine injuries, 65 Splanchnic vasoconstriction, 528 Spondyloarthropathies, 07 Spontaneous bacterial peritonitis (SBP), 565-566 Spontaneous perforation, 840 Staphylococcal enterotoxin B, 382 Staphylococcus aureus, 50, 340, 405, 439, 444, , 457t, 464, 465, 468, 469, 47 , 475, 480, 483, 485, 490, 0, 865, 943 Staphylococcus epidermidis, 439 Staphylococcus species, 566 Statins, 243 Status epilepticus, nonconvulsive, 973, 977, 983 Steatohepatitis, 5 Stem cell transplant (SCT), 479, 485 Stenotrophomonas maltophilia, 458t Sternal fracture, 953 Sternocleidomastoid muscle (SCM) , 12 Stinging insect venom anaphylaxis, 1 23 Storage pool disorders, 650 Streptococcus, 044, 049 Streptococcus bovis, 464 Streptococcus mitis, 464 Streptococcus mutans, 464 Streptococcus pneumoniae, 340, 45 8t, 459, 46 , 480, 487, 490, 492, 0, 938, 044 Streptococcus pyogenes, 475 Streptococcus sanguis, 464 Streptococcus species, 566 Streptomycin, 506, 507, 7, 885 Stress ulcer syndrome (SUS) complications, 530 definition, 527 description, 527 diagnosis, 528 etiology, 527 mortality rates, 527 mucosa! damage, 528 pathogenesis, 528 prognosis, 527 treatment, 528-530 Stroke, 974 Stroke volume, calculation of, 122 Strongyloides stercoralis, 070 ST-segment elevation myocardial infarction acute kidney injury, 244 adjunctive antithrombotic therapy, 242-243 antiischemic therapy, 243 cardiac biomarkers, 238 complications, 244 diagnosis, 237-238, 238t, 239t differential diagnosis, 237 I n dex ECG, 237-238 general principles, 237 glycemic control, 244 history, 23 pathophysiology, 237 physical examination, 237 reperfusion therapy, 240-242, 240f, 24 l t Subarachnoid fluid-coupled devices, 00 Subarachnoid tumor, 032 Subclavian vein (SCV) , Subdural devices, 00 Subdural empyema, 397 Submandibular space infection, Succinylcholine, 1 6, 1 Sucralfate, 529 Sugiura procedure, 537 Suicidal hanging, 038 Suicide description, 1 37 general principles, 1 37 risk factors, 1 37, 1 38t treatment, 1 37-1 39, 1 38t Sulfonamides, 885 Sulfonylurea overdose, 629 Sulfonylureas, 629 Sulfur dioxide (S0 2) , 379 Superior mesenteric artery (SMA) embolism, 859 thrombosis, 85 9-860 Superior vena cava (SVC) syndrome diagnosis, 738-739, 739t etiology, 738 glucocorticoids, 740 supportive care, 740 treatment, 739-740 Suppurative jugular venous thrombosis, Supraglottitis airway management, 400 antibiotics, 400 characteristic presentation, 399 clinical evaluation, 399 clinical presentation, 398 corticosteroids, 400 diagnostic tests, 399 differential diagnosis, 400 etiology, 399 helium-oxygen mixture, 400 pathogenesis, 399 Supraventricular tachycardias (SVTs) atrial fibrillation, 27 , 273-276, 274f, 275f atrial fibrillation post-cardiac surgery, 276 atrial flutter, 276 atrioventricular nodal reentrant tachycardia (AVNRT), 276-277 I 1 83 atrioventricular reentrant tachycardia (AVRT) , 277 definition, 268 diagnosis, 268-270, 269f ectopic atrial tachycardia, 278 management of, 270, 27 l f, 272t-273t MAT, 279 mechanisms underlying, 268 specific arrhythmias and therapies, 271-279 Wolff-Parkinson-White syndrome (WPW), 277-278 Surgery acute mediastinitis, 84 1-842 acute pancreatitis, 50-85 compartment syndrome o f abdominal cavity, -864 epistaxis, 837-839 esophageal perforation, 840-841 intra-abdominal infections, 844-849 mesenteric ischemia, 857-860 necrotizing fasciitis and other soft tissue infections, 865-871 pain management, 875-882 pressure ulcers, 872-874 wound infections, 447 Surgical debridement after fluid resuscitation, 868 Sympathomimetics/pressor agents, 541 Synchronized intermittent mechanical ventilation (SIMV) , 367 Syncope, autonomic control/reflex-mediated, 221 of cardiac etiology, cardiac evaluation, 9-22 , 220t causes, 6, 7t-2 8t diagnosis, 7-22 differential diagnosis, etiology, 6, 7t-2 8t general principles, history, indication fo r implantation of ICD in patients with, 222t indications for cardiac tests in patients with, 220t initial diagnostic evaluation, 7, laboratory tests, 2-lead electrocardiogram, neurological evaluation, 22 pathophysiology, physical examination, 8-2 psychiatric evaluation, l 8t treatment, 22 1-223 1 84 I n dex Syndrome of inappropriate antidiuretic hormone secretion (SIADH), Synovial fluid analysis, Systemic asphyxiant, 823t-827t Systemic inflammatory response syndrome (SIRS), , 955, see also Sepsis Systemic lupus erythematosus (SLE), 07, 1 16 Systemic opioid analgesia, 879 Systemic vascular resistance, 1 48 T Tachyarrhythmias, 282, 284, 284t, Tachycardia, 89 , Tamoxifen, 707 Tamponade, 94-1 Target organ damage (TOD), 208 Tazobactam, 484, 493 T-cell immunosuppression diagnosis, 492-493 etiology, 492 general principles, -492 pathophysiology, 492 treatment, 493-494 Telangiectasia, 522 Temperature monitoring, in ICU, 1 Tenecteplase (TNKase), 684t Terbucaline, 325 Tetanus diagnosis, 477 general principles, 477 pathogenesis, 477 treatment, 477-478 Tetracycline, 885 Thalidomide, 707-708 Therapeutic hypothermia (TH) clinical application of, 388 general principles, 387 induction phase, 388 maintenance phase, 388 pathophysiology, 388 rewarming phase, 388 Thermal diffusion, 99 Thermistor, 26 Thermodilution, Thiazide diuretics, 596 Thiazides, l 44r Thiazolidinediones, 629 Thoracentesis general principles, indications and contraindications, interpretation o f pleural fluid analysis, 61 posrprocedure considerations, 60 procedure, 8-60 Thoracic aortic aneurysm (TAA) , 205 Thoracic trauma diagnosis, 1-952 etiology, general principles, immediate lifesaving interventions, 952 treatment, 952-953 Thoracic vertebrae, Thoracotomy, 952 Thrombocytopenia, 642, 734 Thromboembolic disease, 322-323 Thromboembolic-deterrent (T.E.D.) hose, 037 Thromboembolism, 34, 253, 255, 276, 327 Thrombohemorrhagic events, in myeloproliferarive neoplasms bleeding, 699 clinical presentation, 699 diagnosis, 699-700, 700r general principles, 698-699 prognosis, 70 surgical procedures, 699 treatment, 700-70 Thrombolysis, 86 Thrombolyric therapy, 695 Thrombosis, 22-23 Thrombotic thrombocytopenic purpura (TTP) , 888 Thyroid autoantibodies, 614 Thyroid cartilage, 64 Thyroid emergencies myxedema coma, 604-607 thyroid storm, 600-604 Thyroid stimulating hormone (TSH), 609 Thyroid storm clinical features, 601 r diagnosis, 600-603, 602r general principles, 600 pathophysiology, 600 treatment, 603, 604r Thyroid tumors, 64 Thyromental distance, Thyrotoxicosis, 623 Thyroxine (T4), 608 Ticlopidine (Ticlid), 666t Tidal volume (Vt) , Tigecycline, 453t Tilt table rest, 220r, 22 Tinzaparin (Innohep), 675r Tirofiban, 230, 669t Tissue Doppler imaging, Tissue ischemia, 956 I n dex Tocolytic-induced pulmonary edema, 325, 328t Tocolytics, 886 Toll-like receptors (TLRs), 962-963 Torsades de pointes (TDP), 1 36 Total parenteral nutrition (TPN)-related liver injury, 5 Toxic megacolon definition, 548 endoscopy, 5 history, 548-549 laboratory studies, 549-5 physical examination, 549 radiologic studies, 5 surgery, 5 1-552 treatment, 50-5 52 Toxic procoagulant molecules, 642 Toxic shock syndrome (TSS), 870-871 diagnosis, 475 general principles, 475 pathogenesis, 475 treatment, 475-476 Toxoplasma cruzi, 070 Toxoplasma gondii, 490, 492, 044, 070, 093 Toxoplasma species, 94 Toxoplasmic encephalitis (TE) diagnosis, 499 etiology/pathogenesis, 499 general principles, 498-499 treatment, 499 TPN steatosis, 5 Trachea, Tracheal stenosis, 67 Tracheobronchial aspiration, 542 Tracheobronchitis, 340 Tracheoinnominate artery fistula, 67-68 Tracheostomy, 338 anatomy of trachea, 63-64 general principles, 63 indications, 64 for obese people, 64 open technique, 65-66 percutaneous technique, 66-67 percutaneous vs open tracheostomy, 68 postprocedure considerations, 67-68 semiopen, 67 Transcranial Doppler flow velociry, 99 Transcutaneous electrical nerve stimulation (TENS), 878 Transesophageal echocardiography (TEE), 36, 125, , 82, 84, 86, 200, 466 indications, l 30t I 1 85 limitations, 129 postprocedure considerations, special preparations for, 29t standard examination, 26, 29-1 Transfusion therapy acute hemolytic transfusion reaction (AHTR), 727 allergic transfusion reaction, 729 citrate toxiciry, 729 cryoprecipitate, 726-727 delayed hemolytic transfusion reaction, 727 febrile nonhemolyric transfusion reaction, 729 fresh frozen plasma (FFP/FP24) , 726 infectious risks, 727, 728t platelets, 724-726, 725t red blood cells, 724, 725t transfusion risks, 727-729, 728t Transfusion-associated circulatory overload (TACO), 728-729 Transfusion-related acute lung injury (TRALI) , 304, 727-728 Transjugular intrahepatic portosystemic shunt (TIPS), 78, 525, 536-537, 655 Translaryngeal intubation, 3 Transplantation challenges, 5 considerations heart, 5 hematopoietic cell, 5 kidney, 054 liver, 054 lung, 5 pancreas and islet, 054 small bowel, 054 general principles, 052- heart transplant recipients early allograft failure, 095 general principles, 092 heart-lung recipients, 096-1 097 immunosuppression, 094- 095 postoperative considerations, 093- 094 infection diagnosis, 070- general principles, 069-1 070 pathogenesis, 070 therapy, 07 kidney transplant recipients general principles, 073 intraoperative care, 074 perioperative care, 074 1 86 I n dex Transplantation (Continued) postoperative considerations, 074- 076 pretransplant evaluation, 073-1 074 malignancy diagnosis, general principles, 07 pathogenesis, 07 therapy, 072 organ shortage and solutions, 053- 054 pancreas transplant recipients general principles, 077 intraoperative considerations, 078-1 079 postoperative care and considerations, 079- 084 pretransplant evaluation, 077-1 078 rejection complications, 069 diagnosis, 067-1 068 general principles, I 067 pathogenesis, I 067 therapy, 068- 069 Transport of critically ill patients care provided, caution, equipment considerations, essentials, indications, monitoring, patient evaluation, 6-9 postprocedure considerations, procedure, 6-9 team composition, transport physiology, Transthoracic Doppler echocardiography (DE) , 348-349 Transthoracic echocardiography (TTE) , 466 Transverse myelitis (TM) , 044, 046 Trauma, 64 abdominal, 933-940 advanced trauma life support (ATLS), 1 AMPLE, 1 causes of, centers and trauma systems, complications, 888 general principles, 888 initial trauma care, 1 measuring injury severity/performance improvement/trauma registries, 2-9 military experience, spinal cord, 924-93 treatment, 888 Trauma-induced coagulopathy, 643 Trauma/internal derangement, 07 Traumatic asphyxia, 953 Traumatic brain injury (TB!) cardiopulmonary complications, 922 cerebral salt wasting, 922 coagulopathy, 922 deep venous thrombosis and pulmonary embolus, 922 diabetes insipidus, 922 diagnosis, 920-92 , 920t etiology, 9 ICP monitoring, 92 , 922 nutrition, 922 pathophysiology, 9-920 principles, 9 seizures, 922 syndrome of inappropriate antidiuretic hormone (SIADH), 922 treatment, 921-922 Traumatic compartment syndromes complications, 957 diagnosis, 956-957 etiology, 955 general principles, 5 pathophysiology, treatment, Trendelenburg position, , 326 Treponema pallidum, 044 Trichosporon species, 483 Tricyclic antidepressants (TCAs) , 1 46 Triiodothyronine (T3), 608 Trimethoprim-sulfamethoxazole (TMPSMX), 455t, 476, 497, 1 44t Triple airway maneuver, Tropomyosin, 74 Troponin T, 74 Trousseau sign, 623 Trousseau's syndrome, 64 Tube migration, Tube thoracostomy, 952 Tuberculin skin test (TST) , 504, 505 Tuberculosis (TB), 325 complications, 508 diagnosis, 497, 505-506 etiology, 497, 504 general principles, 497, 504 pathogenesis, 497 pathophysiology, 504-505 treatment, 497, 506-508 Tularemia diagnosis, 6-5 general principles, pathogenesis, treatment, I n dex Tumor compression, of the spinal cord, 035 Tumor lysis syndrome (TLS), 736 Cairo-Bishop definition, 74 l t diagnosis, 74 etiology, 74 pathophysiology, 740 prevention and treatment, 74 -742 Tumor necrosis factor (TNF)-a, 608 Type deiodinase (D I ) , 608 Type deiodinase (D2), 608 u Ulcerative colitis, 548 Ulcerative colitis/regional enteritis, 07 Ultrasonographic-guided cannulation, 22 Ultrasound, see Intensive care unit Umbilicus, 73, 76 Unfractionated heparin (UFH) , 23 , 327, 67 , 672t, 690, 694, 695t, 704-705, 710 Unintentional hypothermia diagnosis, 386 etiology, 385 general principles, 385 pathogenesis, 38 5-386 treatment, 386-387 Unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) anticoagulant therapy, 231-232 antiplatelet therapy, 230-23 coronary revascularization, 232, 233f definition, 224 diagnosis, 224-225 dual-antiplatelet therapy, 233 ECG changes in, 225 GP IIb/IIIa inhibitors, 227 initial evaluation and risk stratification, 225-227, 226t, 227t invasive vs conservative strategy, 230 long-term secondary prevention., 232-233, 234f management, 227-234 pathophysiology, 224 physical examination, 225 sequence of events in, 224 scents, 232 thrombolysis in myocardial infarction (TIMI) risk score for, 226-227, 227t thrombolytic therapy, 232 treatment strategy, 227, 228f I 1 87 Upper airway infections deep space neck infections, 401-403 nosocomial sinusitis, 397-398 otogenic infections, 398 supraglottitis, 398-400 Uremia, 078 Urethral catheterization, 02, 04 Urinary bladder, 02 Urinary Legionella antigen, 407 Urinary tract infections (UTis) , 443 catheter-associated, 472 complications, 47 , 474 diagnosis, 72 etiology, 471 Gram-negative bacteria, 471 Gram-positive bacteria, 47 noncatheter-associated, 471 nosocomial, 471 pathophysiology, 471-472 requiring ICU, 471 treatment, 472-473 urinalysis, 72 Urine chloride concentration, Urologic complications, posttransplantation, 075 Ursodeoxycholic acid, 557 v Vagus innervation, Valsalva maneuver, 270 Valve replacement, , 82 Valvular heart disease, 80-1 87 Vancomycin, 408, 439, 454t, 476, 484, 546, 5 , 572-573, 885 Vancomycin-resistant enterococci (VRE) , 47 , 473 Variceal bleeding clinical presentation, 534 diagnosis, 534 endoscopy, 534 mortality rate, 533 pathophysiology, 533-534 portal hypertension, 533 resuscitation, 534 treatment, 534-538 Varicella, 325 Varicella zoster virus (VZV) , 94, 484, 044 Varicella-zoster infection, 325 Varices, 522 Vascular abnormalities, 642 Vascular disease, 430 Vascular ectasias, 522 Vasculitis, 07, 522 1 88 I n dex Vasculitis, in ICU central nervous system, 1 30- 1 Churg-Strauss syndrome (CSS), 1 28- 1 29 cryoglobulinemic, 1 29-1 30 granulomatosis with polyangiitis (GPA) , 1 27-1 28 microscopic polyangiitis, 1 28 polyarteritis nodosa (PAN), 1 29 pulmonary capillaritis, 1 30 Vasoactive pharmacologic therapy and balloon tamponade, combined technique, 78 Vasopressors for hemorrhagic shock, 906 mean arterial pressure and cardiac dysfunction, 969-970 spinal tumors, I 036 Vecuronium, 1 Venipuncture, 1 , Venlafaxine, 1 45-1 46 Venous air embolism, 324, 324t, 328t Venous blood gas (VBG), 32 Venous cannulation, 37 Venous drainage flows, I 02 Venous thromboembolism (VTE) clinical presentation, -693 diagnosis, 693, 693t, 694t general principles, 690 prevention, 690-69 , 69 ! t, 692t treatment, 693t-698t, 694-698 Ventilation, , 15 t Ventilator-associated pneumonia (VAP) , 53, 397, 404 Ventilator-dependent, with tracheostomy, 376 Ventricular fibrillation, 394 Ventricular hypertrophy, 40 Ventricular myocardium, 77 Ventricular tachycardia (VT), 33 definitions, 258 diagnosis, 25 9-260, 260f, 26 f, 262f ECG criteria, 259-260, 260f, 26 f, 262f monomorphic, 258, 259f nonsustained, 258 pharmacologic therapies, 264-266 polymorphic, 258, 259f sinusoidal, 258, 259f treatment, 260-264 Ventriculoperitoneal (VP) shunt, 94 Verapamil, 175, 272t Vidarabine, I 048 Videolaryngoscopes, Viral cultures, 94 Viral infections, 735 Virchow triad, 709 Visceral layer, Viscosity, of synovial fluid, 1 Visual evoked potentials (VEPs), I O I Vitamin K antagonists (VKAs) , 673, 680t-68 t Von Willebrand disease (VWD), 646t, 649-50, 838 Voriconazole, 455t, 485 V/Q mismatch, 299, 301 w Warfarin, 243, 273t, 686t, 688, 860, I 037 Water deficit in hypernatremia, 1 49 Weaning noninvasive positive-pressure ventilation (NPPV) , 367 SB trial, 367 Wernicke encephalopathy, 598 West Nile Virus (WNV), 94 diagnosis, general principles, pathogenesis, treatment, Whipple triad, 628 Whole bowel irrigation, 832b Withdrawal syndrome, 827t-83 I t Wolff-Parkinson-White syndrome (WPW), 277-278 Wound exploration, 73 Wounds botulism, 476 classification, 873 infection, I 075 management, 873-874 WWHHHHIMPS mnemonic, 1 33, 1 33t z Zero drift, 20 Zero referencing, 20 Zoledronate (Zometa), 623 ... Boccardo P Treatment of bleeding in dialysis patients Semin Dial 20 09 ;22 :27 9 -28 6 A review of the pathophysiology and management of bleeding in patients with end-stage renal disease with a focus... 80% of cases) : mild-to-moderate quantitative defi­ ciency ofVWF b Type (20 % to 30% of cases) : functional (qualitative) deficiency of VWF c Type (rare) : severe quantitative deficiency ofVWF... Clin North Am 20 2; 26: 32 1-344 An evidence-based, systematic approach to the diagnostic evaluation ofa patient with a bleeding diathesis Tripodi A, Mannucci PM The coagulopathy of chronic liver