BOOK
Surgical Critical Care Handbook, The: Guidelines For Care Of The Surgical Patient In The Icu
(2016)
Additional Information
Book Details
Abstract
This handbook considers topics that have general application to the critically ill patient. Basic pathophysiology and understanding of its role in critical care monitoring and management are covered, followed by a close look at trauma related and non-trauma related entities likely to afflict the critically ill surgical patient.The authors consist of practitioners who are experts in their field. They represent the team approach to critical care management where members from the divisions of anesthesia, internal medicine, respiratory medicine, infectious disease and surgical specialties all contribute in formulating intervention, assessment and management plans for the critically ill surgical patient.By emphasising the surgical conditions requiring critical care, The Surgical Critical Care Handbook will serve as a quick and easy reference for any medical trainee or practitioner aspiring to join the ICU.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Contents | v | ||
| Foreword | ix | ||
| About the Editor | xi | ||
| List of Contributors | xv | ||
| SECTION 1 General Considerations | 1 | ||
| Chapter 1 Preoperative Assessment of the High-Risk Surgical Patient | 3 | ||
| Key Points | 3 | ||
| Chapter Overview | 3 | ||
| Preoperative Screening | 4 | ||
| Assessment of Preoperative CNS risk | 5 | ||
| Assessment of Cardiac Morbidity for Non-Cardiac Surgery | 5 | ||
| Risk Modification | 7 | ||
| Preoperative coronary revascularization | 7 | ||
| Perioperative beta blockade | 8 | ||
| Intensive perioperative management | 8 | ||
| Pulmonary artery catheter | 9 | ||
| Transesophageal echocardiography (TEE) | 9 | ||
| Resource Allocation | 10 | ||
| Type of Surgery: Type of Anesthetic | 10 | ||
| Recommendations | 11 | ||
| Assessment of Risk of Postoperative Pulmonary Complications | 12 | ||
| Clinical assessment of pulmonary risk | 12 | ||
| Evaluation of risk prior to pulmonary resection surgery | 13 | ||
| Risk Modification | 14 | ||
| Perioperative preparation | 14 | ||
| Cessation of cigarette smoking | 15 | ||
| Site of surgical incision | 15 | ||
| Type of anesthesia and analgesia | 16 | ||
| Recommendations | 16 | ||
| Diabetes Mellitus | 17 | ||
| Risk Assessment | 18 | ||
| Risk Reduction | 18 | ||
| Glucocorticoid Supplementation in Chronic Glucocorticoid Users | 20 | ||
| References | 21 | ||
| Appendix 1. Considerations for preoperative Anesthesia assessment | 24 | ||
| Appendix 2. ASA classification | 26 | ||
| Appendix 3. Partial list of risk factors for delirium | 26 | ||
| Appendix 4. Eagle criteria: Surgery specific risk for cardiac complications | 26 | ||
| Chapter 2 Shock: Cardiovascular Dynamics, Endpoints of Resuscitation, Monitoring, and Management | 29 | ||
| Chapter Overview | 29 | ||
| Definition of Shock | 29 | ||
| Classification of Shock | 30 | ||
| Hypovolemic shock | 30 | ||
| Obstructive shock | 31 | ||
| Cardiogenic shock | 31 | ||
| Distributive shock | 31 | ||
| Responses to the Shock State | 32 | ||
| Endocrine and catecholamine release | 32 | ||
| Anaerobic metabolism | 33 | ||
| Reperfusion Injury | 33 | ||
| End Points of Resuscitation | 34 | ||
| Invasive Hemodynamic Monitoring | 36 | ||
| Monitoring Principles that Govern Treatment | 36 | ||
| Preload | 37 | ||
| Myocardial contractility | 39 | ||
| Afterload | 40 | ||
| Summary | 41 | ||
| References | 41 | ||
| Chapter 3 Gas Exchange | 43 | ||
| Chapter Overview | 43 | ||
| The Problem | 44 | ||
| Normal values for arterial blood gases | 44 | ||
| Calculation of VD | 47 | ||
| VA and CO2 | 48 | ||
| Relation between VA and PaCO2 | 48 | ||
| The “steady-state” | 49 | ||
| The Va graph | 50 | ||
| Causes of hypercapnia | 51 | ||
| Alveolar Oxygen Pressure (PAO2) | 52 | ||
| The simplified alveolar air equation for oxygen\r | 52 | ||
| Hypoxemia in the presence of a normal alveolar–arterial O2 gradient | 53 | ||
| Shunt and V/Q Mismatch and their Contribution to Hypoxemia | 54 | ||
| V/Q mismatch as a cause of hypoxemia | 60 | ||
| Summary | 62 | ||
| References | 62 | ||
| Chapter 4 Perioperative Respiratory Dysfunction | 65 | ||
| Chapter Overview | 65 | ||
| Effect of Metabolic Stress, Fluid Volume, Oxygen Requirement, and Nutritional Support on Respiratory Function | 66 | ||
| Elaboration of Extravascular Lung Water in Surgical Patients | 68 | ||
| Hydrostatic pressure | 68 | ||
| Oncotic pressure | 68 | ||
| Capillary permeability | 69 | ||
| Atelectasis and Hypoventilation | 70 | ||
| Age, Position, and Lower Airway Closure | 71 | ||
| Diaphragm Dysfunction and Abdominal Surgery | 73 | ||
| Aspiration | 76 | ||
| Prevention of Perioperative Lung Dysfunction | 77 | ||
| Treatment Principles for Perioperative Respiratory Dysfunction | 79 | ||
| References | 80 | ||
| Chapter 5 Mechanical Ventilation in the ICU | 83 | ||
| Chapter Overview | 83 | ||
| Functions of the respiratory system and its malfunction leading to respiratory failure | 83 | ||
| Goals of Mechanical Ventilation | 84 | ||
| Patient factors | 84 | ||
| Ventilator factors | 85 | ||
| The Alveolar Gas Equation (Age) And Modes of Ventilation | 85 | ||
| Modes of Ventilation | 87 | ||
| Initial Ventilator Settings | 89 | ||
| Other Methods of Mechanical Ventilation | 90 | ||
| Monitoring the Ventilated Patient | 91 | ||
| Liberation from Mechanical Ventilation | 92 | ||
| Trial at spontaneous breathing | 92 | ||
| The slower stepwise liberation process | 92 | ||
| Summary | 94 | ||
| References | 94 | ||
| Chapter 6 Nutrition in the Surgical ICU Patient | 97 | ||
| Chapter Overview | 97 | ||
| Physiologic Adaptation to Fasting States, Stress, and Sepsis | 97 | ||
| Nutrition Assessment | 98 | ||
| General Principles | 100 | ||
| Enteral Nutrition | 101 | ||
| Composition in Different Disease States | 104 | ||
| Parenteral Nutrition | 107 | ||
| References | 112 | ||
| Chapter 7 Management of the Anticoagulated Injured Patient | 115 | ||
| Chapter Overview | 115 | ||
| Epidemiology and Significance | 115 | ||
| General Principles of Managing a Bleeding Patient on Anticoagulant and Antiplatelet Agents | 116 | ||
| Introduction to Common Anticoagulants | 117 | ||
| Warfarin | 117 | ||
| Factor IIa inhibitors (Dabigatran) | 119 | ||
| Factor Xa inhibitors (rivaroxaban, apixaban) | 120 | ||
| Antiplatelet agents | 120 | ||
| References | 122 | ||
| Chapter 8 Pneumonia in the Surgical Intensive Care Unit | 125 | ||
| Chapter Overview | 125 | ||
| Introduction | 126 | ||
| Classification | 126 | ||
| Diagnosis and Microbiology | 127 | ||
| Treatment | 128 | ||
| Management of Organ Failure | 130 | ||
| VAP | 131 | ||
| Risk factors and pathophysiology | 131 | ||
| Prevention | 132 | ||
| Microbiology | 136 | ||
| Diagnosis | 136 | ||
| Treatment | 140 | ||
| References | 142 | ||
| Chapter 9 Hypothermia and Hyperthermia | 145 | ||
| Chapter Overview | 145 | ||
| Maintenance of Temperature | 145 | ||
| Hypothermia | 146 | ||
| Etiology and classifi cation | 146 | ||
| Pathophysiology | 148 | ||
| Diagnosis | 149 | ||
| Management | 150 | ||
| Prognosis | 151 | ||
| Hyperthermia | 152 | ||
| Etiology | 152 | ||
| Pathophysiology | 154 | ||
| Diagnosis | 154 | ||
| Management | 155 | ||
| Prognosis | 156 | ||
| References | 156 | ||
| Chapter 10 Thrombo-Embolism in the ICU patient | 159 | ||
| Chapter Overview | 159 | ||
| Risk for Venous Thromboembolism in the ICU | 159 | ||
| VTE Prevention | 160 | ||
| Diagnosis | 165 | ||
| Treatment | 166 | ||
| References | 169 | ||
| Chapter 11 Broad Principles of Antibiotic Usage and Surgical Antimicrobial Prophylaxis | 171 | ||
| Chapter Overview | 171 | ||
| A Listing And Brief Considerations of Broad General Principles of Antibiotic Usage | 171 | ||
| Surgical Antimicrobial Prophylaxis | 179 | ||
| Classification of Wounds | 181 | ||
| The Key Updates in the Revised Guidelines are | 183 | ||
| Clinical Applications of the Guidelines | 184 | ||
| Common Principles | 184 | ||
| Common Surgical Pathogens | 185 | ||
| Summary | 197 | ||
| References | 198 | ||
| Chapter 12 The Coagulopathic Trauma Patient and Massive Transfusion Protocol | 201 | ||
| Chapter Overview | 201 | ||
| The Coagulopathy of Trauma | 202 | ||
| Platelet dysfunction | 203 | ||
| Fibrinogen consumption and fi brinolysis | 203 | ||
| Triggers for Massive Transfusion Protocols and the Protocols | 205 | ||
| The protocols | 206 | ||
| Point of care parameters and their measurement to guide massive transfusion | 207 | ||
| Massive Transfusion Protocol Logistics | 208 | ||
| MTP TEAM- Roles and responsibilities | 209 | ||
| Responsibilities during MTP | 210 | ||
| MTP Activation criteria | 212 | ||
| MTP initiation | 213 | ||
| Patient Clinical Area | 213 | ||
| Central Locating | 215 | ||
| Portering services | 215 | ||
| Transfusion Medicine Laboratory (TM) | 216 | ||
| Ongoing management during MTP | 217 | ||
| Transfusion Management | 218 | ||
| Supportive Measures | 219 | ||
| Summary | 220 | ||
| References | 220 | ||
| Chapter 13 Geriatric Issues and the ICU | 223 | ||
| Chapter Overview | 223 | ||
| Characteristics of ICU Admissions for the Elderly | 224 | ||
| Outcome following ICU admission for the elderly | 224 | ||
| Physiology of senescence and common organ dysfunctions in the elderly ICU patient and their impact on ICU care | 225 | ||
| Organ System Changes with Ageing | 225 | ||
| Cardiovascular\r | 225 | ||
| Pulmonary | 232 | ||
| Renal | 233 | ||
| Hepatic | 235 | ||
| Gastrointestinal tract\r | 236 | ||
| Issues Unique to the Geriatric Patient and their Impact on ICU Care | 237 | ||
| Central Nervous System\r | 237 | ||
| Polypharmacy | 240 | ||
| Frailty | 241 | ||
| Malnutrition | 241 | ||
| Role of Decreased Immunity, Musculoskeletal Injuries, and Temperature Control in the Elderly ICU Patient | 242 | ||
| Decreased immunity | 242 | ||
| Temperature controlThe decrease in subcutaneous | 243 | ||
| End-of-life Issues, Palliative Careand Withdrawal/Withholding Of Care | 243 | ||
| Summary | 246 | ||
| References | 247 | ||
| Chapter 14 Ethical Issues in the Surgical ICU | 251 | ||
| Chapter Overview | 251 | ||
| Brief History, Hippocrates, Nuremburg, Belmont Commission | 252 | ||
| General Principles of Biomedical Ethics Applied \rto the Critical Care Environment | 252 | ||
| Ethical Principles and the Law\r | 255 | ||
| Withholding and Withdrawing Care\r | 258 | ||
| Clinical Research in the ICU\r | 259 | ||
| Role of the Ethics Committee | 260 | ||
| Summary | 261 | ||
| References | 261 | ||
| SECTION 2 Specific Surgical Disorders | 263 | ||
| (a) TRAUMA | 263 | ||
| Chapter 15 Priorities in Multiple Trauma Management | 265 | ||
| Chapter Overview | 265 | ||
| The Order of Priorities | 266 | ||
| Removal of the spine board | 267 | ||
| Adjuncts to the primary survey and re-evaluation | 268 | ||
| Airway, oxygenation, ventilation, and cervical spine control | 268 | ||
| Cricothyroidotomy | 271 | ||
| Caution-Iatrogenic Tension Pneumothorax | 271 | ||
| Protection of the cervical spine | 272 | ||
| Breathing | 272 | ||
| Circulation | 272 | ||
| Differentiation of Non-hemorrhagic from Hemorrhagic Shock and Confounding Presentations | 275 | ||
| D-neurologic Deficit | 277 | ||
| E-exposure | 277 | ||
| The Secondary Survey | 277 | ||
| Head and neck assessment | 278 | ||
| Transfer to Definitive Care | 278 | ||
| Re-evaluation and Monitoring the Patient | 279 | ||
| Summary | 279 | ||
| References | 280 | ||
| Chapter 16 Thoracic Trauma | 283 | ||
| Introduction | 283 | ||
| Classification of Thoracic Trauma | 284 | ||
| Thoracic Injuries Requiring Immediate Intervention (The “Fearsome Fatal Five”) | 285 | ||
| Tension pneumothorax (one of the fearsome five)\r | 286 | ||
| Open pneumothorax | 289 | ||
| Massive pneumothorax/ tracheobronchial disruption | 290 | ||
| Cardiac tamponade | 291 | ||
| Massive hemothorax (one of the fearsome fi ve) | 293 | ||
| Traumatic Air Embolism | 294 | ||
| Flail Chest | 295 | ||
| Thoracic Injuries that have the Potential to Become Life-Threatening in a Delayed Fashion (The “ Serious Seven”) | 297 | ||
| Pulmonary contusion | 298 | ||
| Blunt cardiac injury (one of the serious seven) | 299 | ||
| Traumatic aortic disruption (one of the serious seven) | 300 | ||
| Esophageal Disruption | 303 | ||
| Diaphragmatic Rupture | 303 | ||
| Rib and Other Chest Wall Fractures | 304 | ||
| Simple Hemopneumothorax | 305 | ||
| Summary | 306 | ||
| References | 306 | ||
| Chapter 17 Abdominal Trauma | 309 | ||
| Chapter Overview | 309 | ||
| General Principles | 310 | ||
| Role of Peritoneal Lavage, CT, Ultrasound, and Laporoscopy in Assessing Abdominal Trauma | 312 | ||
| Selecting the Diagnostic Modality in Blunt Abdominal Trauma | 313 | ||
| General Conduct of the Trauma Laparotomy | 313 | ||
| Abdominal compartment syndrome | 315 | ||
| Nonoperative Management of Abdominal Trauma | 316 | ||
| Highlights in Management of Specific Intra-Abdominal Injuries | 316 | ||
| Summary | 321 | ||
| References | 322 | ||
| Chapter 18 Head Injury | 325 | ||
| Chapter Overview | 325 | ||
| Anatomic Considerations | 326 | ||
| Physiologic Considerations | 327 | ||
| Classification of Head Injuries | 330 | ||
| Classifi cation based on mechanism | 331 | ||
| Classifi cation Based on Morphology | 332 | ||
| Classifi cation based on severity of injuries | 338 | ||
| Interpretation of the CT Scan in Brain Injury | 339 | ||
| Management of the Head Injured Patient | 340 | ||
| General principles | 340 | ||
| The mini-neurologic examination | 342 | ||
| Monitoring Techniques | 342 | ||
| General monitoring parameters | 343 | ||
| Specific monitoring\r | 343 | ||
| Jugular bulb venous oxygen saturation | 344 | ||
| Brain tissue oxygen tension | 344 | ||
| Near infrared spectroscopy | 345 | ||
| Transcranial Doppler (TCD) Ultrasonography | 345 | ||
| Electrophysiologic monitoring | 345 | ||
| Brain Temperature | 346 | ||
| Brain tissue biochemistry | 346 | ||
| The Emergency Neurological Life Support ( ENLS) Algorithm for Initial Management of Intracranial Hypertension | 346 | ||
| Surgical Management | 347 | ||
| General principles | 347 | ||
| Penetrating Wounds | 348 | ||
| Scalp Wounds | 348 | ||
| Depressed skull fractures | 348 | ||
| Intracranial mass lesions | 349 | ||
| Decompressive Craniectomy | 349 | ||
| Medical Management | 350 | ||
| General intensive care measures | 350 | ||
| Other measures | 351 | ||
| Fluid and electrolytes | 352 | ||
| Blood transfusion | 352 | ||
| Ventilation | 352 | ||
| Hyperosmolar therapy | 353 | ||
| Barbiturate coma | 353 | ||
| Hypothermia | 353 | ||
| Anti-seizure therapy | 354 | ||
| Conclusion | 354 | ||
| References | 354 | ||
| Chapter 19 Spine and Spinal Cord Injury | 357 | ||
| Chapter Overview | 357 | ||
| Anatomical Considerations | 358 | ||
| Levels | 359 | ||
| Dermatomes and Myotomes | 359 | ||
| Etiology | 360 | ||
| Pathophysiology | 360 | ||
| Clinical Features and Presentations | 361 | ||
| Spinal Cord Syndromes | 362 | ||
| Investigations: X-ray, CT, MRI | 363 | ||
| Specific Traumatic Spine Injuries | 364 | ||
| Sub-axial Injury Classification (SLIC) Scale | 367 | ||
| Thoracolumbar Injury Classification and Severity Score (TLICS) | 369 | ||
| Penetrating Injuries | 369 | ||
| Vascular Injuries | 370 | ||
| SCIWORA | 371 | ||
| Non-Traumatic SCI | 371 | ||
| Scales and Grading | 372 | ||
| MANAGEMENT | 374 | ||
| Unique Challenges in SCI Management | 375 | ||
| References | 383 | ||
| Chapter 20 Pelvic Fractures | 385 | ||
| Introduction | 385 | ||
| Classification | 386 | ||
| Epidemiology | 389 | ||
| Physical Exam | 389 | ||
| Assessment of pelvic stability | 389 | ||
| Application of Pelvic Binder | 390 | ||
| Assessment of the lower urinary tract | 393 | ||
| Open Pelvic Injuries | 394 | ||
| Neurological examination | 395 | ||
| Radiographic Assessment | 395 | ||
| Initial Management of the Hemodynamically Compromised Patient with a Pelvic Fracture | 396 | ||
| Arterial Inflow Arrest | 397 | ||
| Pelvic Packing | 397 | ||
| Embolization | 399 | ||
| Definitive Management of Pelvic Fractures | 400 | ||
| Postoperative Considerations | 400 | ||
| Summary and recommendations for acute management of pelvic fractures | 401 | ||
| References | 401 | ||
| Chapter 21 Extremity Fractures | 403 | ||
| Chapter Overview | 403 | ||
| Introduction | 404 | ||
| Clinical Assessment | 404 | ||
| Initial Treatment | 406 | ||
| Open Fractures | 408 | ||
| General Management Principles | 409 | ||
| Timing of Surgery | 410 | ||
| The Mangled Extremity | 411 | ||
| Systemic Complications | 412 | ||
| Thromboembolic disease | 412 | ||
| Fat emboli syndrome (FES) | 413 | ||
| Summary and Recommendations for the Acute Management of Extremity Trauma | 415 | ||
| References | 415 | ||
| Chapter 22 Extremity Compartment Syndromes | 417 | ||
| Chapter Overview | 417 | ||
| Introduction | 417 | ||
| Pathophysiology | 419 | ||
| Epidemiology/risk factors | 420 | ||
| Diagnosis | 420 | ||
| Treatment | 423 | ||
| Fasciotomy of the Lower Leg | 423 | ||
| The lateral incision of the lower leg | 425 | ||
| The medial incision of the lower leg | 429 | ||
| Wound Care | 431 | ||
| Complications | 433 | ||
| Fasciotomy of Other Compartments | 434 | ||
| CS and Fasciotomy of the Forearm and Hand | 435 | ||
| CS and Fasciotomy of the Thigh | 435 | ||
| Summary | 436 | ||
| Disclaimer | 436 | ||
| Acknowledgment | 436 | ||
| References | 436 | ||
| Chapter 23 Burns, Cold Injury and Electrical Injury | 439 | ||
| Chapter Overview | 439 | ||
| Acute Burn Management | 439 | ||
| Primary survey | 439 | ||
| Secondary survey | 440 | ||
| Treatment | 441 | ||
| Criteria for transfer to a burn unit and transport safety | 443 | ||
| Airway Management | 444 | ||
| Carbon Monoxide (CO) | 444 | ||
| Direct thermal injury | 444 | ||
| Inhalation injury | 445 | ||
| Fluid Resuscitation and Edema Management | 446 | ||
| Burn Wound Management | 448 | ||
| General | 448 | ||
| Wound management | 449 | ||
| Specifi c wound treatments based on anatomic location | 449 | ||
| Emergency Surgical Procedures | 450 | ||
| Escharotomies versus fasciotomies | 450 | ||
| Surgical excision | 451 | ||
| Other Considerations | 452 | ||
| Deep venous thrombosis/pulmonary embolism | 452 | ||
| Sedation/analgesia | 452 | ||
| Electrical Injury | 453 | ||
| Introduction | 453 | ||
| Epidemiology and incidence | 453 | ||
| Definitions/etiology\r | 453 | ||
| Physics and pathophysiology | 454 | ||
| Factors infl uencing electrical burn severity | 454 | ||
| Body tissue resistance | 456 | ||
| Management | 456 | ||
| Lightning injury | 459 | ||
| Summary | 461 | ||
| Chemical Injuries | 461 | ||
| Management of chemical burns | 462 | ||
| Hydrofl uoric acid | 462 | ||
| Cold Injury | 465 | ||
| Conclusions | 466 | ||
| References | 466 | ||
| Chapter 24 Multiorgan Dysfuntion Syndrome in the Surgical Patient | 469 | ||
| Chapter Overview | 469 | ||
| Respiratory | 471 | ||
| ARDS | 471 | ||
| Ventilation Strategies | 472 | ||
| Prone Positioning | 473 | ||
| Pharmacologic | 473 | ||
| Extracorporeal Membrane Oxygenation ( ECMO) | 473 | ||
| PE | 474 | ||
| Prevention | 474 | ||
| Treatment | 475 | ||
| Cardiovascular | 475 | ||
| Gastrointestinal (GI)/Hepatic | 477 | ||
| Hepatic Dysfunction | 477 | ||
| Ischemic Hepatopathy | 477 | ||
| Cholestasis | 478 | ||
| Stress Related Muscosal Disease | 479 | ||
| Dysmotility/Feeding Intolerance | 479 | ||
| Renal | 480 | ||
| Neurologic | 481 | ||
| Hematologic | 483 | ||
| Labs | 484 | ||
| Medications | 484 | ||
| Timeline | 485 | ||
| Conclusion | 485 | ||
| References | 486 | ||
| (b) NonTRAUMA | 491 | ||
| Chapter 25 Intra-abdominal Sepsis | 493 | ||
| Chapter Overview | 493 | ||
| Epidemiology | 493 | ||
| Definitions | 494 | ||
| Pathophysiology | 496 | ||
| Microbiology | 497 | ||
| Clinical Manifestations and Physical Examination | 498 | ||
| Diagnostic Tests | 502 | ||
| Management | 503 | ||
| Summary | 512 | ||
| References | 512 | ||
| Chapter 26 Bowel Obstruction | 517 | ||
| Overview | 517 | ||
| Introduction | 518 | ||
| Epidemiology/Risk Factors | 518 | ||
| Pathophysiology | 519 | ||
| Diagnosis | 523 | ||
| Treatment | 526 | ||
| Summary | 528 | ||
| Disclaimer | 528 | ||
| References | 528 | ||
| Chapter 27 Mesenteric Ischemia | 531 | ||
| Introduction | 531 | ||
| Anatomy | 531 | ||
| Epidemiology | 532 | ||
| Classification and Pathophysiology | 535 | ||
| Diagnosis | 536 | ||
| Management | 538 | ||
| Summary | 540 | ||
| References | 541 | ||
| Chapter 28 Upper GI Hemorrhage | 543 | ||
| Overview | 543 | ||
| Introduction | 543 | ||
| Epidemiology | 544 | ||
| Risk Factors | 544 | ||
| Pathophysiology | 545 | ||
| Esophagus | 546 | ||
| Stomach | 546 | ||
| Duodenum | 546 | ||
| Stress ulceration | 547 | ||
| Clinical Presentation | 547 | ||
| Initial Resuscitation | 549 | ||
| Diagnostic Evaluation | 551 | ||
| Treatment | 551 | ||
| Outcomes and Complications | 553 | ||
| Summary | 554 | ||
| References | 554 | ||
| Chapter 29 Lower Gastrointestinal (GI) Hemorrhage | 557 | ||
| Introduction and Chapter Overview | 557 | ||
| Epidemiology | 558 | ||
| Pathophysiology and Clinical Features | 558 | ||
| Diverticular disease | 558 | ||
| Ischemic colitis | 559 | ||
| Angiodysplasia | 560 | ||
| Infectious colitis | 560 | ||
| Benign anorectal conditions | 561 | ||
| Neoplasia | 561 | ||
| Investigations and Initial Treatment | 561 | ||
| Localization and intervention | 561 | ||
| Colonoscopy | 562 | ||
| CT angiography (CT and selective catheter) | 563 | ||
| Selective catheter angiography and embolization | 563 | ||
| Embolization | 564 | ||
| Nuclear scintigraphy | 564 | ||
| Surgical intervention | 564 | ||
| References | 565 | ||
| Chapter 30 Acute Pancreatitis | 567 | ||
| Chapter Overview | 567 | ||
| Significance and History | 567 | ||
| Anatomy, Etiology, and Pathophysiology | 568 | ||
| Diagnosis and Classification | 569 | ||
| Classifi cation of acute pancreatitis | 571 | ||
| Medical Management and Outcomes | 571 | ||
| Surgery and Interventional Procedures | 573 | ||
| Pseudocysts | 574 | ||
| Conclusion | 574 | ||
| References | 575 | ||
| Chapter 31 Colorectal Disorders | 577 | ||
| Chapter Overview | 577 | ||
| Colon and Rectal Trauma | 577 | ||
| Introduction | 577 | ||
| Epidemiology | 578 | ||
| Mechanisms and patterns of injury | 578 | ||
| Presentation | 578 | ||
| Diagnosis | 579 | ||
| Treatment | 580 | ||
| Mechanical Large Bowel Obstruction (LBO) | 581 | ||
| Introduction | 581 | ||
| Epidemiology | 582 | ||
| Pathophysiology | 582 | ||
| Presentation | 582 | ||
| Diagnosis | 583 | ||
| Treatment | 583 | ||
| Intestinal Acute Pseudo-Obstruction (APO) | 585 | ||
| Definshed\r | 585 | ||
| Epidemiology | 585 | ||
| Pathophysiology | 586 | ||
| Investigations | 587 | ||
| Treatment | 587 | ||
| Clostridium difficile Colitis | 588 | ||
| Introduction | 588 | ||
| Epidemiology | 590 | ||
| Pathophysiology | 590 | ||
| Presentation | 591 | ||
| Diagnosis | 591 | ||
| Treatment | 592 | ||
| References | 593 | ||
| Chapter 32 The Bariatric Surgical Patient | 597 | ||
| Chapter Overview | 597 | ||
| General considerations in the morbidly obese that could impact ICU care | 597 | ||
| Bariatric Surgery Procedures | 601 | ||
| Classification of Obesity and Criteria for Surgery | 602 | ||
| Evolution of Bariatric Surgery | 602 | ||
| Bariatric Procedures | 603 | ||
| Laparoscopic Adjustable Gastric Band (LAGB) | 603 | ||
| Laparoscopic Sleeve Gastrectomy (LSG) | 604 | ||
| Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) | 605 | ||
| Outcomes | 606 | ||
| Complications | 607 | ||
| Perioperative complications | 608 | ||
| Short-term complications | 609 | ||
| Long-term complications | 611 | ||
| Summary | 613 | ||
| References | 613 | ||
| Chapter 33 The Transplant Patient | 619 | ||
| Chapter Overview | 619 | ||
| Neurologic | 620 | ||
| Cardiovascular | 622 | ||
| Pulmonary | 623 | ||
| Renal | 626 | ||
| Gastrointestinal | 628 | ||
| Graft function | 628 | ||
| GI function/nutrition | 629 | ||
| Biliary complications | 630 | ||
| Hematologic | 631 | ||
| Infectious Disease | 632 | ||
| Immunosuppression | 633 | ||
| Rejection | 634 | ||
| Other Transplant Patients | 634 | ||
| Conclusion | 637 | ||
| References | 637 | ||
| Chapter 34 Soft Tissue Infection in Critical Care | 639 | ||
| Overview | 639 | ||
| Incidence | 639 | ||
| Pathophysiology | 640 | ||
| Classification | 641 | ||
| Presentation | 644 | ||
| Diagnosis | 645 | ||
| Treatment | 646 | ||
| Other Therapies | 648 | ||
| References | 649 | ||
| Chapter 35 The Pediatric Surgical ICU Patient | 653 | ||
| Overview | 653 | ||
| Introduction | 654 | ||
| Bedside Assessment | 656 | ||
| Airway, Lungs, and Ventilation | 658 | ||
| Critical Care of Life Threatening Respiratory Compromise | 662 | ||
| Heart, Vessels, and Circulation | 666 | ||
| Critical Care of Life Threatening Circulatory Compromise | 668 | ||
| Fluids, Electrolytes, and Nutrition | 671 | ||
| Critical Care of Fluids, Electrolytes, and Nutrition | 676 | ||
| Neurological Assessment and Brain Death | 681 | ||
| Life Threatening Pediatric Traumatic Emergencies | 682 | ||
| Critical Care of Life Threatening Pediatric Traumatic Injuries | 684 | ||
| Brain | 685 | ||
| Spine | 688 | ||
| Chest | 688 | ||
| Abdomen | 689 | ||
| Skeleton | 691 | ||
| Physical support | 692 | ||
| Emotional support | 692 | ||
| Burns | 693 | ||
| Disasters | 693 | ||
| Life Threatening Neonatal Surgical Emergencies | 694 | ||
| Critical Care of Life Threatening Neonatal Surgical Emergencies | 694 | ||
| Congenital diaphragmatic hernia | 694 | ||
| Malrotation/midgut volvulus | 695 | ||
| Abdominal wall defects | 696 | ||
| Esophageal atresia with distal tracheoesophageal fi stula | 696 | ||
| Necrotizing enterocolitis | 697 | ||
| Life Threatening Postoperative Surgical Emergencies | 697 | ||
| Use and Misuse of Analgesic and Sedative Agents | 698 | ||
| References | 700 | ||
| Index | 703 |