Critical Care Study Guide

Springer Science+Business Media, LLC

Critical Care Study Guide Text and Review

With 249 Figures and 280 Tables

Editor

Gerard J. Criner, MD

Professor of Medicine Division of Pulmonary and Critical Care Medicine

Temple University School of Medicine Philadelphia, Pennsylvania

• Deputy Editor

Gilbert E. D' Alonzo, DO

Professor of Medicine Division of Pulmonary and Critical Care Medicine

Temple University School of Medicine Philadelphia, Pennsylvania

Springer

Illustrators

Susan E. Gilbert, CMI Faith A. Cogswell

Gerard J. Criner, MD Professor of Medicine Division of Pulmonary and

Critical Care Medicine Temple University School of Medicine Philadelphia, PA 19140, USA

Library of Congress Cataloging-in-Publication Data

Gilbert E. D'A1onzo, DO Professor of Medicine Division of Pulmonary and

Critical Care Medicine Temple University School of Medicine Philadelphia, PA 19140, USA

Critical care study guide I [edited by] Gerard J. Criner, Gilbert E. D'Alonzo. p.; em.

Includes bibliographical references and index. ISBN 978-0-387-95164-5 ISBN 978-1-4757-3927-5 (eBook) DOI 10.1007/978-1-4757-3927-5 1. Critical care medicine. I. Criner, Gerard J. II. D 'Alonzo, Gilbert E. [DNLM; 1. Critical Care--Handbooks. 2. Critical Illness-Handbooks. WX 39 C9347 2002]

RC86.7.C754 2002 616'.028----dc2 2001049251

Printed on acid-free paper. © 2002 Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc. in 2002

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+ Business Media, LLC, except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information stor­age and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not iden­tified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Production coordinated by Chernow Editorial Services, Inc., and managed by Terry Kornak; manufacturing supervised by Joe Quatela. Typeset by Matrix Publishing Services, Inc., York, PA.

9 8 7 6 5 4 3 2 I

ISBN 978-0-387-95164-5 SPIN 10785270

Preface

Critical care medicine is a dynamic and exciting arena where complex pathophysiologic states requiring extensive knowledge and clinical acumen are commonly found. Caring for critically ill patients requires an extensive knowledge of basic pathophysiology, as well as awareness of the appropriate diagnostic tests and therapeutic interventions. Because this knowledge base crosses many different disciplines, introduction to caring for the intensive care patient, while exciting, may also be intimidating.

This textbook is designed toward making the dynamic environment of the critical care unit understandable and the approach to the patient both logical and successful. The book contains three components: (1) description of the procedural tasks commonly performed for the critically ill patient, (2) explanation of the most common pathophysiologic states en­countered, and (3) description of specific disease entities with details of their differential di­agnosis, diagnostic strategy, and therapeutic plan.

This book also uses several educational approaches that we have found useful in our own teaching sessions and prior textbooks. Clinical cases introduce chapters and highlight chap­ter segments to emphasize clinical relevancy. As an additional study aid, margin notes high­light important teaching points and facilitate easy review of chapter content. To consolidate the principles outlined in each chapter, review questions with full text explanations are pro­vided at the end of each chapter. All these elements help reinforce the most important mes­sages for the reader.

This textbook is the effort of many individuals across many disciplines who practice at Temple University School of Medicine. Nonetheless, only evidence-based literature is used to provide the basic concepts and therapeutic and diagnostic strategies presented; the con­tent does not represent the convention of care endorsed by any single institution.

GERARD J. CRINER, MD

v

Acknowledgments

Writing textbooks is not easy; in critical care medicine, especially, it requires the efforts of many individuals. The editor wholeheartedly appreciates the efforts of all the contributors to this textbook and many others who made publication of this textbook a reality. These indi­viduals include Darlene Macon for her secretarial support, Dr. Gilbert D' Alonzo for his ed­itorial assistance, and the editorial staff at Springer.

Last but not least, I would like to acknowledge the everlasting support of my wife, Helga, and family. Their patience and help provides the necessary nurturing personal environment required to successfully accomplish professional endeavors.

GERARD J. CRINER, MD

vii

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vn Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Part I Critical Care Procedures

Airway Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 L. JILL KRASNER AND NEIL W BRISTER

2 Oxygenation Without Intubation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 WISSAM CHATILA

3 Blood Gas Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 JOSEPH CROCETTI AND SAMUEL I<RACHMAN

4 Hemodynamic Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 UBALDO J. MARTIN AND SAMUEL KRACHMAN

5 Drainage Tube Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 MICHAEL S. LAGNESE AND JOHN M. TRAVALINE

6 Implantable Devices for Cardiac Pacing and Defibrillation . . . . . . . . . . . . . . . . 81 HENRY H. HSIA

7 Enteral Feeding Tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 03 DAVID E. CICCOLELLA

8 Common Procedures in the Intensive Care Unit: Thoracentesis, Lumbar Puncture, Paracentesis, and Pericardiocentesis . . . . . . . . . . . . . . . . . . . 115 V ADIM LEYENSON

9 Noninvasive Monitoring in the Intensive Care Unit ...................... 128 FRANCIS C. CORDOVA AND NATHANIEL MARCHETII

10 Endoscopy in the Intensive Care Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 GILBERT E. D'ALONZO AND DAVID FRIEDEL

11 Radiologic Imaging in the Critically Ill Patient ......................... 159 PHILLIP M. BOISELLE

ix

x CONTENTS

Part II Pathophysiologic Disease States Encountered in the Critically lll Patient

12 Neurologic Illness and Critical Care ................................. 183 GILBERT E. D'ALoNzo, JoHN M. TRAVALINE, AND MARIA RosELYN LIM

13 Respiratory Failure ............................................. 200 GERARD J. CRINER

14 Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 PAUL MATHER AND GILBERT E. D'ALONZO

15 Cardiac Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 ROBERT SANGRIGOLI AND HENRY H. HSIA

16 Gastrointestinal Hemorrhage ...................................... 267 GILBERT E. D' ALONZO AND DAVID FRIEDEL

17 Hepatic Failure ................................................ 279 WISSAM CHATILA

18 Pathophysiology of the Sepsis Syndromes ............................ 286 MICHAEL S. LAGNESE AND DAVID E. ClCCOLELLA

19 Acute Renal Failure ............................................ 300 UBALDO J. MARTIN AND GERALD M. O'BRIEN

20 Bleeding Diathesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 RONALD RUBIN

21 Nutrition Assessment and Nutrition Support in Intensive Care Unit Patients .... 339 JOSEPH I. BOULLATA AND FRANCIS C. CORDOVA

22 Oxygen Content, Delivery, and Uptake ............................... 355 JOSEPH CROCETTI AND SAMUEL KRACHMAN

23 Circulatory Shock .............................................. 369 V ADIM LEYENSON

24 Neuromyopathies in the Critically Ill ................................ 381 FRANCIS C. CORDOVA, MARIE ROSELYN LIM, AND GERARD J. CRINER

25 Disorders of Thermoregulation ..................................... 406 FREDERIC H. KAUFFMAN

26 Infections in the Intensive Care Unit ................................ 419 GREGORY J. RossiNI AND WISSAM CHATILA

27 Critical Care Endocrinology ...................................... 444 CLARKE U. PIATT AND KATHLEEN J. BRENNAN

28 Evaluation and Management of Toxicologic Emergencies ................. 461 FREDERIC H. KAUFFMAN AND THOMAS NUGENT

29 Metabolic Disturbances of Acid-Base and Electrolytes ................... 485 NoAH BRAD ScHREmMAN AND GERALD M. O'BRIEN

30 Special Problems in the Critically Ill Trauma Patient ..................... 507 MICHAEL BADELLINO AND GILBERT E. D' ALONZO

31 Ethics in Critical Care ........................................... 519 JOHN M. TRAVALINE AND FRIEDRICH KUEPPERS

32 Psychologic Dysfunction in the Intensive Care Unit Patient ................ 535 YAROSLAV LANDO AND GERARD J. CRINER

33 Host Defenses ................................................ 545 FRIEDRICH KUEPPERS

Part III Specific Treatments in the Critically Ill Patient

34 Mechanical Ventilation .......................................... 559 CLARKE u. PIATT, UBALDO J. MARTIN, AND GERARD J. CRINER

35 Noninvasive Ventilation .......................................... 594 UBALDO J. MARTIN AND GERARD J. CRINER

36 Weaning from Mechanical Ventilation ............................... 615 UBALDO J. MARTIN AND GERARD J. CRINER

37 Mechanical Hemodynamic Support ................................. 627 SCOTT A. SCHARTEL

38 Pharmacologic Hemodynamic Support of Shock States ................... 651 DAVID E. CrccoLELLA

39 Antiarrhythmic Drug Management .................................. 674 HENRY H. HsiA

40 Dialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 693 L.l. ARMANDo SAMUELS AND GERALD M. O'BRIEN

41 Use of Blood Products .......................................... 707 CATHY LITTY AND JAY HERMAN

42 Advanced Cardiopulmonary Resuscitation ............................ 721 FREDERIC H. KAUFFMAN

43 Antimicrobials ................................................ 738 WISSAM CHATILA

44 Use of Analgesics and Sedatives in Critical Care ....................... 757 RODGER E. BARNETTE AND GERARD J. CRINER

45 Prophylactic Regimens in the Intensive Care Unit ....................... 770 WALTER A. WYNKOOP AND GILBERT E. D 'ALONZO

46 Use of Neuromuscular Blocking Agents in the Intensive Care Unit .......... 784 RODGER E. BARNETTE AND GERARD J. CRINER

4 7 Hypertensive Crisis ............................................. 797 KATHLEEN J. BRENNAN

CONTENTS xi

xii CONTENTS

Part IV Appendices

APPENDIX A Commonly Used Parenteral Medications and Dosage Recommendations for Adult Therapeutics .............................................. 811

APPENDIX B Commonly Used Calculations ......................................... 817

Index .......................................................... 829

Contributors

MICHAEL BADELLINO, MD

Associate Professor of Trauma Surgery, Department of Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA

RODGER E. BARNETIE, MD

Professor of Anesthesiology, Department of Anesthesiology, Temple University School of Medicine, Philadelphia, PA 19140, USA

PHILLIP M. BOISELLE, MD

Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA

JOSEPH I. BOULLATA, MD

Associate Professor of Pharmacy, Temple University School of Pharmacy, Philadelphia, PA 19140, USA

KATHLEEN J. BRENNAN, MD

Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

NEIL W BRISTER, MD, PHD

Associate Professor of Anesthesiology, Department of Anesthesiology, Temple University School of Medicine, Philadelphia, PA 19140, USA

WISSAM CHATILA, MD

Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

DAVID E. CICCOLELLA, MD

Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

FRANCIS c. CORDOVA, MD

Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

GERARD J. CRINER, MD

Professor of Medicine and Director, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

JOSEPH CROCETII, MD

Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA xili

xiv CONTRIBUTORS

GILBERT E. D'ALONZO, DO Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Temple Univer­sity School of Medicine, Philadelphia, PA 19140, USA

DAVID FRIEDEL, MD Assistant Professor of Medicine, Division of Gastroenterology, Temple University School of Medicine, Philadelphia, PA 19140, USA

JAY HERMAN, MD Professor of Medicine, Temple University Cancer Center, Temple University School of Medi­cine, Philadelphia, PA 19140, USA

HENRY H. HsiA, FACC Cardiovascular Division, University of Pennsylvania Hospital, Philadelphia, PA 19140, USA

FREDERIC H. KAUFFMAN, MD Associate Professor of Medicine, Temple University School of Medicine, Philadelphia, PA 19104, USA

SAMUEL KRACHMAN, MD Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

L. JILL KRASNER, MD Assistant Professor of Medicine, Department of Anesthesiology, Temple University School of Medicine, Philadelphia, PA 19140, USA

FRIEDRICH KUEPPERS, MD Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Temple Univer­sity School of Medicine, Philadelphia, PA 19140, USA

MICHAEL S. LAGNESE, MD Pulmonary Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

YAROSLAV LANDO, MD Pulmonary Associates of Lancaster, 555 North Duke Street, Lancaster, PA 17604-3555, USA

V ADIM LEYENSON, MD Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

MARIA ROSELYN LIM, MD Clinical Neurophysiology Fellow, Medical College of Pennsylvania, Philadelphia, PA 19132,

USA

CATHY LITTY, MD Director, Transfusion Medicine, St. Christophers Hospital for Children, Philadelphia, PA

19134, USA

NATHANIEL MARCHETTI, MD Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

UBALDO J. MARTIN Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

PAUL MATHER, MD Assistant Professor of Cardiology, Division of Cardiology, Temple University School ofMedi­cine, Philadelphia, PA 19140, USA

THOMAS NUGENT, MD Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

GERALD M. O'BRIEN, MD Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

CLARKE U. PIATT, MD Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

GREGORY J. RossiNI, MD Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

RONALD RUBIN, MD Division of Hematology, Temple University School of Medicine, Philadelphia, PA 19140, USA

L.l. ARMANDo SAMUELS, MD Assistant Professor of Medicine, Department of Nephrology and Kidney Transplantation, Temple University School of Medicine, Philadelphia, PA 19140, USA

ROBERT SANGRIGOLI, MD Fellow, Division of Cardiology, Temple University School of Medicine, Philadelphia, PA 19140, USA

NOAH BRAD SCHREIBMAN, MD Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

Scorr A. ScHARTEL, DO Associate Professor of Anesthesiology, Department of Anesthesiology, Temple University School of Medicine, Philadelphia, PA 19140, USA

JOHN M. TRAVALINE, MD Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Tem­ple University School of Medicine, Philadelphia, PA 19140, USA

WALTER A. WYNKOOP, MD Fellow, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA

CONTRIBUTORS xv