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Critical Care Emergencies,  An Issue of Emergency Medicine Clinics of North America, E-Book

Critical Care Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book

Evie Marcolini

(2014)

Additional Information

Book Details

Abstract

Drs. Evie Marcolini and Haney Mallemat have assembled an expert panel of authors focusing on: Sepsis, Shock, Assessment and Treatment of the Trauma Patient in Shock, Coagulopathy and Hemorrhage, Vasopressors & Inotropes, Assessing Volume Status, Neurotrauma, Mechanical Circulatory Support, End of life, and more!

Table of Contents

Section Title Page Action Price
Front Cover Cover
Critical Care Emergencies i
Copyright\r ii
Contributors iii
Contents vii
Emergency Medicine\rClinics Of North America\r xi
Foreword xv
Preface\r\r xvii
Shock 747
Key points 747
Introduction 747
Pathophysiology 747
Causes 748
Clinical presentation 749
Initial ED assessment 749
General 749
Pump Assessment 749
Tank Assessment 750
Pipe Assessment 752
Initial ED management 752
Pump Dysfunction 753
Tank Dysfunction 753
Pipe Dysfunction 754
Summary 755
References 755
Early Identification and Management of Patients with Severe Sepsis and Septic Shock in the Emergency Department 759
Key points 759
Epidemiology 759
Definitions 760
Pathophysiology 760
Early identification and risk stratification 761
Importance of Early Identification 761
Vital Sign Abnormalities 762
Screening for Lactate Elevation 762
Organ Dysfunction 762
Screening for Global Tissue Hypoxia 763
Treatment 763
Antibiotics and Source Control 763
Early Goal-Directed Therapy 763
Preload Optimization 763
Afterload Optimization 764
Reversal of Global Tissue Hypoxia 764
Sepsis Bundles 765
Glycemic Control 765
Lung-Protective Ventilation 765
Steroid Replacement 765
Future directions 767
Novel Risk-Stratification Methods 767
Noninvasive Monitoring 767
Novel Therapies 768
Summary 768
References 769
Assessment and Treatment of the Trauma Patient in Shock 777
Key points 777
Introduction 777
Resuscitation 778
Assessment of body compartments 778
Head/Neck 778
Examination 778
Imaging 779
Chest 779
Examination 779
Imaging 781
Abdomen 781
Examination 781
Imaging 782
Compartments 782
Examination 782
Imaging 783
General trends in trauma imaging 784
Spleen 784
Liver 785
Kidney 786
Damage Control 787
Abdominal Compartment Syndrome 788
Summary 788
References 789
Hemorrhage and Coagulopathy in the Critically Ill 797
Key points 797
Introduction 797
The coagulation cascade 798
Monitoring of coagulation 798
Blood and transfusion components 799
Indications for transfusion 800
Massive transfusion protocols and ratios 800
Transfusion in the critically ill 801
Risks and reactions 801
Anticoagulants and reversal of anticoagulants 803
FFP 803
Vitamin K 803
FVII 804
PCC 805
Tranexamic acid 805
Summary 806
References 806
Assessing Volume Status 811
Key points 811
Introduction 811
Physical examination 812
Pulse pressure variation and stroke volume variation 813
IVC distensibility index 814
End-expiratory occlusion test 815
Passive leg raise 815
Devices for hemodynamic monitoring 816
Invasive hemodynamic monitors 817
Noninvasive hemodynamic monitors 818
USCOM 818
NiCOM: Bioreactance 818
Summary 819
References 819
Pressors and Inotropes 823
Key points 823
Introduction 823
Physiology 823
Common pharmacologic agents 825
Septic shock 826
Cardiogenic shock following acute myocardial infarction 827
Acute Decompensated Heart Failure (ADHF) 828
Postcardiopulmonary arrest care 828
Neurogenic shock 829
Anaphylaxis 829
Summary 830
References 830
Emergency Department Antimicrobial Considerations in Severe Sepsis 835
Key points 835
Introduction 835
General Approach to Antimicrobial Selection in ED Patients with Sepsis 836
Important Pharmacokinetic and Pharmacodynamic Principles for the EM Physician 838
Sepsis biomarkers in the ED 841
Clinical Practice Guidelines Review 842
The surviving sepsis guidelines 842
Other sepsis-related guidelines 843
Antimicrobial selection in the era of antimicrobial shortages 844
Summary 845
References 845
Mechanical Circulatory Support 851
Key points 851
Introduction 851
IABP 852
Ventricular assist device 853
Common VAD Complications 855
Infectious Complications 856
Arrhythmias 858
Mechanical Failure 858
ECMO 859
Overview 859
ECMO Pump Set-Up and Cannulation 859
Clinical Uses for ECMO 861
Toxic overdoses 861
Myocarditis 861
ECMO for out-of-hospital cardiac arrest and ECMO-assisted CPR (eCPR) 862
Summary 863
Acknowledgments 863
References 863
Lung-protective Ventilation Strategies and Adjunctive Treatments for the Emergency Medicine Patient with Acute Respiratory ... 871
Key points 871
Introduction 871
Epidemiology/statement of the problem 872
Pathophysiology 872
Oxygenation and hyperoxia 872
Oxygen delivery and heart-lung interactions 872
Hypoxemia 873
Ventilation and hypercapnea 873
ARDS and lung-protective ventilation 874
Selection of optimal tidal volume 875
Limiting inspiratory Pplat 876
Selection of optimal PEEP and open lung recruitment 876
Adjunctive maneuvers 877
Neuromuscular blocking agents 878
Inhaled pulmonary vasodilators 879
Prone positioning 882
Extracorporeal membrane oxygenation 882
Summary 883
References 883
Appendix 1 887
Neurotrauma 889
Key points 889
Introduction 889
Epidemiology 890
Common neurologic injuries associated with trauma 890
Head Injury 890
Blunt injury 890
Critical Care Ultrasonography 907
Key points 907
Introduction 907
Application 1: differentiating shock states 908
Multisystem Protocols 908
Assessment for Cardiogenic Causes of Shock 908
Estimating Fluid Responsiveness Using the IVC 914
Assessment of the Abdomen and Aorta as Potential Causes of Shock 915
Hemothorax and Pneumothorax as Causes for Hypotension 917
Causes of respiratory failure 917
Resuscitative end points 920
Neurologic applications 921
Future directions 921
Summary 923
References 923
Select Topics in Neurocritical Care 927
Key points 927
Introduction 927
Neuromuscular disease 927
Peripheral Demyelinating Disease 928
Pediatric Critical Care 939
Key points 939
General approach to resuscitation of the ill child 939
Common Sources of Severe Illness 940
Ill neonate 940
Septic child 941
Seizures 941
Trauma 942
Procedures 943
Airway 943
Noninvasive Positive Pressure Ventilation 944
Intubation/Rapid Sequence Intubation 944
Difficult Airway 945
“Cannot intubate, cannot ventilate” scenario 945
Intraosseous 946
Central Venous Lines 947
Thoracostomy Tubes 947
Summary 948
References 948
End of Life/Palliative Care/Ethics 955
Key points 955
Introduction 955
Diagnosing dying 956
Syndrome of imminent death 957
Understanding patients’ and families’ preferences: communication at the EOL 957
Goals of care in crashing patients 957
Goals of care in hemodynamically stable but dying patients 960
Bioethics 962
Autonomy/Patient Self-determination 963
Justice 963
Futility 964
Organ Donation and Declaration of Death 965
EOL symptom management 965
Dyspnea 965
Dehydration 967
Disposition 967
Summary 968
References 968
Index 975