SPEC - Textbook of Critical Care E-Book 12 Month Subscription

Jean-Louis Vincent; Edward Abraham; Patrick Kochanek; Frederick A. Moore; Mitchell P. Fink

BOOK

SPEC - Textbook of Critical Care E-Book 12 Month Subscription

Jean-Louis Vincent | Edward Abraham | Patrick Kochanek | Frederick A. Moore | Mitchell P. Fink

(2011)

Additional Information

Book Details

ISBN: 978-1-4377-1568-2
Edition: 6
Language: English
Pages: 1744
Subjects: Anaesthetics
Critical care surgery

Abstract

Textbook of Critical Care, by Drs. Jean-Louis Vincent, Edward Abraham, Frederick A. Moore, Patrick Kochanek, and Mitchell P. Fink, remains your best source on effective management of critically ill patients. This trusted reference - acclaimed for its success in bridging the gap between medical and surgical critical care - now features an even stronger focus on patient outcomes, equipping you with the proven, evidence-based guidance you need to successfully overcome a full range of practice challenges. Inside, you’ll find totally updated coverage of vital topics, such as coagulation and apoptosis in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome; sepsis and other serious infectious diseases; specific organ dysfunction and failure; and many other vital topics. At www.expertconsult.com you can access the complete contents of the book online, rapidly searchable, with regular updates plus new videos that demonstrate how to perform key critical care procedures. The result is an even more indispensable reference for every ICU.

Access the complete contents of the book online at www.expertconsult.com, rapidly searchable, and stay current for years to come with regular online updates.

Practice with confidence by consulting with a "who’s who" of global experts on every facet of critical care medicine.

Implement today’s most promising, evidence-based care strategies with an enhanced focus on patient outcomes.

Effectively apply the latest techniques and approaches with totally updated coverage of the importance of coagulation and apoptosis in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome; sepsis and other serious infectious diseases; specific organ dysfunction and failure; and many other vital topics.

See how to perform key critical care procedures by watching a wealth of new videos online.

Focus on the practical guidance you need with the aid of a new, more templated format in which basic science content has been integrated within clinical chapters, and all procedural content has been streamlined for online presentation and paired with videos.

Section Title	Page	Action	Price
Front cover	Cover
IFC	ii
Textbook of Critical Care	i
Copyright page	iv
Dedication	v
Contributors	vii
contributors, online chapters	xxix
Preface	xxxiii
Table of contents	xxxv
Online contents	xli
Part 1: Common Problems in the ICU	1
Chapter 1: Sudden Deterioration in Neurologic Status	3
? Impairment in Consciousness	3
? Stroke and Other Focal Neurologic Deficits	4
? Seizures	4
? Generalized Weakness and Neuromuscular Disorders	5
? Neurologic Complications of Procedures and Treatments	5
? Evaluation of Sudden Neurologic Change	5
? Monitoring for Neurologic Changes	6
Annotated References	6
Chapter 2: Agitation and Delirium	7
? Agitation	7
? Delirium	7
? Pathophysiology	7
? Assessment	7
? Management	9
? Summary	10
Annotated References	10
Chapter 3: Management of Acute Pain in the Intensive Care Unit	11
? Acute Pain Assessment	11
? Options for Acute Pain Therapy	11
Annotated References	13
Chapter 4: Fever and Hypothermia	14
Chapter 5: Very High Systemic Arterial Blood Pressure	17
? Pathophysiology	17
? Cerebrovascular Disease	17
? Cardiovascular Disease	19
? Renovascular Disease	20
? Excess Catecholamine States	20
? Miscellaneous Conditions	20
? Antihypertensive Medications	21
? Miscellaneous Medications	22
? Summary	23
Annotated References	23
Chapter 6: Low Systemic Arterial Blood Pressure	24
? Initial Evaluation	24
? What Is the Cause?	24
? Treatment	24
Annotated References	26
Chapter 7: Tachycardia and Bradycardia	27
Annotated References	29
Chapter 8: Arterial Hypoxemia	30
? Reduced Alveolar Oxygenation	30
? Diffusion Abnormalities	30
? Ventilation/Perfusion Mismatch	30
? Alveolar-Arterial Partial Pressure of Oxygen Gradient	31
? Reduced Mixed Venous Oxygen	32
Chapter 9: Acute Respiratory Failure	33
? Pathophysiology	33
? Causes of Hypoxic Respiratory Failure	33
? Hypercarbic Respiratory Failure	33
? Clinical Presentation	34
? Management	34
? Prognosis	35
Annotated References	35
Chapter 10: Polyuria	36
? Classification	36
Chapter 11: Oliguria	39
? Definitions and Epidemiology	39
? Pathophysiology	39
? Diagnostic Approach to Oliguria	39
? Treatment of Oliguria	41
? Conclusion	42
Annotated References	42
Chapter 12: Acid-Base Disorders	43
? General Principles	43
? Assessing Acid-Base Balance	43
? Metabolic Acid-Base Disorders	43
? Metabolic Acidosis	44
? Metabolic Alkalosis	49
? Respiratory Acid-Base Disorders	50
? Unified Approach to the Patient with Acid-Base Imbalance	51
Annotated References	52
Chapter 13: Hypernatremia and Hyponatremia	53
? Hypernatremia	53
? Hyponatremia	53
Annotated References	55
Chapter 14: Hyperkalemia and Hypokalemia	56
? Hyperkalemia	56
? Hypokalemia	57
Annotated References	59
Chapter 15: Hypophosphatemia and Hyperphosphatemia	60
? Phosphate Homeostasis	60
? Hypophosphatemia	60
? Hyperphosphatemia	61
Annotated Refernces	62
Chapter 16: Hypomagnesemia	63
? Cellular Physiology and Metabolism of Magnesium	63
? Prevalence and Etiology of Hypomagnesemia in Patients in the Intensive Care Unit	63
? Clinical Signs and Symptoms of Hypomagnesemia	63
? Treatment of Hypomagnesemia	64
Annotated References	64
Chapter 17: Hypercalcemia and Hypocalcemia	65
? Calcium Physiology and Metabolism	65
? Hypocalcemia in Critically Ill Patients	65
? Hypocalcemia in Sepsis and Pancreatitis	66
? Signs and Symptoms of Hypocalcemia	66
? Treatment of Hypocalcemia	66
? Hypercalcemia	67
Annotated References	67
Chapter 18: Hypoglycemia	68
? Incidence of Severe Hypoglycemia	68
? Physiologic Barriers Against Hypoglycemia	68
? Sequelae	69
? Differential Diagnosis	69
? Evaluation	70
? Management	71
Annotated References	71
Chapter 19: Anemia	72
? Epidemiology	72
? Etiology	72
? Laboratory Evaluation of Anemia in the Intensive Care Unit	72
? Management	73
Annotated References	77
Chapter 20 hrombocytopenia	78
? Pathophysiology	78
? Clinical Manifestations and Diagnosis	78
? Prognosis	79
? Treatment	79
Annotated References	80
Chapter 21: Coagulopathy	81
? General Principles	81
? Incidence	81
? Mechanisms	81
? Clinical Manifestations and Diagnosis	81
? Prognosis	82
? Treatment	82
? Conclusions	83
Annotated References	83
Chapter 22: Jaundice	84
? Differential Diagnosis	84
Chapter 23: Management of Gastrointestinal Bleeding	86
? Causes of Upper Gastrointestinal Bleeding	86
? Causes of Lower Gastrointestinal Bleeding	86
? Major Causes of Gastrointestinal Bleeding	86
? Initial Management of Gastrointestinal Bleeding	87
? Further Management of Upper Gastrointestinal Bleeding	88
? Further Management of Bleeding Peptic Ulcers	89
? Further Management of Esophageal Varices	89
? Further Management of Lower Gastrointestinal Bleeding	90
Annotated References	91
Chapter 24: Ileus	92
? Pathophysiology	92
? Clinical Features and Diagnosis	92
? Treatment and Outcome	92
Annotated References	93
Chapter 25: Diarrhea	94
? Criteria	94
? Pathophysiology	94
? Clinical Consequences of Diarrhea	95
? Diagnosis	95
? Treatment	95
? Conclusions	96
Annotated References	96
Chapter 26: Rashes and Fever	97
? Clinical Approach	97
Annotated References	115
Chapter 27: Chest Pain	116
? Initial Approach	116
? History	116
? Physical Examination	116
? Diagnostic Adjuncts	116
? Differential Diagnoses	116
? Conclusion	119
Annotated References	119
Chapter 28: Biochemical or Electrocardiographic Evidence of Acute Myocardial Injury	120
? Electrocardiographic Evidence	120
? Cardiac Biomarkers	120
? Other Biomarkers	121
? Conclusion	121
Annotated References	122
Part 2: Central Nervous System	123
Chapter 29: Biochemical, Cellular, and Molecular Mechanisms of Neuronal Death and Secondary Brain Injury in Critical Care	125
? Global Cerebral Ischemia	125
? Focal Cerebral Ischemia	125
? Traumatic Brain Injury	126
? Key Biochemical and Molecular Mechanisms of Neuronal Secondary Damage	126
? Summary	133
Key Points	133
Annotated References	133
Chapter 30: Critical Neuropathophysiology	134
? Elevated Intracranial Pressure	134
? Hyperperfusion Syndromes	140
? Hyperthermia	141
? Gas Exchange	141
? Hyperglycemia	142
? Sepsis	143
? Sodium	143
? Catecholamines	143
? Summary	144
Key Points	144
Annotated References	145
Chapter 31: Advanced Bedside Neuromonitoring	146
? Monitoring Neurologic Status	146
? Intracranial Pressure and Cerebral Perfusion Pressure	146
? Jugular Venous Oxygen Saturation	147
? Local or Regional Monitoring	148
Acknowledgement	151
Key Points	151
Annotated References	152
Chapter 32: Coma	153
? Anatomy, Pathology, Pathophysiology	153
? Differential Diagnosis	155
? Approach to Coma	156
? The Role of Special Investigations	161
? Prognosis	162
Key Points	165
Annotated References	165
Chapter 33: Cardiopulmonary Cerebral Resuscitation	166
? Epidemiology	166
? Restoring Circulation	166
? Aspects of Cardiac Arrest in Specific Situations	172
? Post–Cardiac Arrest Care to Minimize Brain Injury	174
? Predicting Neurologic Recovery	176
? Rehabilitation	178
? Withdrawal of Support	179
? Summary	179
Key Points	179
Annotated References	179
Chapter 34: Management of Acute Ischemic Stroke	180
? Emergent Stroke Evaluation	180
? Imaging of Acute Stroke	180
? Treatment of Acute Stroke	184
? Special ICU Management Considerations	189
? Summary	189
Key Points	190
Annotated References	190
Chapter 35: Nontraumatic Intracerebral and Subarachnoid Hemorrhage	191
? Intracerebral Hemorrhage	191
? Subarachnoid Hemorrhage	196
Acknowledgments	202
Annotated References	202
Chapter 36: Seizures in the Critically Ill	203
? Epidemiology	203
? Classification	203
? Pathogenesis and Pathophysiology	204
? Clinical Manifestations	205
? Diagnostic Approach	206
? Management Approach	208
Annotated References	211
Chapter 37: Neuromuscular Disorders in the ICU	212
? The Motor Unit and Its Physiology	212
? Muscles of Respiration	212
? Neuromuscular Disorders	213
Annotated References	219
Chapter 38: Traumatic Brain Injury	220
? Pathophysiology	220
? Prehospital Care	223
? Emergency Department Care	223
? Definitive Treatment	224
? Physical Therapy and Rehabilitation	227
? Penetrating Injuries	227
? Mild and Moderate Injury	228
? Prognosis	229
Key Points	230
Annotated References	230
Chapter 39: Spinal Cord Injury	231
? Epidemiology	231
? Etiology	231
? Initial Management	231
? Immobilization and Diagnostic Evaluation	231
? Pediatric Spinal Cord Injury	231
? Pharmacotherapy	232
? Hypothermia	233
? Intensive Care Unit Management	233
? Prognostic Factors for Recovery	235
? Research	236
? Conclusion	236
Key Points	236
Annotated References	236
Chapter 40: Neuroimaging	237
? Methods	237
? Brain	238
? Spine	248
Acknowledgement	249
Key Points	250
Annotated References	250
Chapter 41: Intensive Care After Neurosurgery	251
? Overview	251
? Priorities and Goals of Postoperative Neurosurgical Care	251
? Prevention and Management of Systemic Complications After Neurosurgery	251
? Prevention and Management of Neurosurgical Postoperative Complications	253
? Admission Examination and Monitoring in the Intensive Care Unit	254
? Systemic Monitoring: Cardiopulmonary, Respiratory Status, and Temperature	256
? Brain Monitoring and Specific Therapeutic Approaches	257
? Neuroprotection	260
? Strategies Promoting Cell Survival and Regeneration	261
Key Points	261
Annotated References	261
Chapter 42: Key Issues in Pediatric Neurointensive Care	262
? Issues Unique to Pediatrics	262
? Specific Diseases or Conditions	264
? Critical Central Nervous System Infections	269
? Postoperative Neurosurgical Cases	273
? Other Critical Central Nervous System Disorders in Infants and Children	275
Key Points	275
Annotated References	275
Part 3: Pulmonary	277
Chapter 43: Bedside Monitoring of Pulmonary Function	279
? Pulse Oximetry	279
? Capnometry	281
? Assessment of Pulmonary Mechanics	284
? Assessment of Breathing Pattern and Central Drive	286
Annotated References	287
Chapter 44: Principles of Gas Exchange	288
? Oxygen Exchange	288
? Carbon Dioxide Exchange	292
Annotated References	295
Chapter 45: Arterial Blood Gas Interpretation	296
? Indications for Arterial Blood Gas Sampling	296
? Arterial Blood Gas Sampling	296
? Arterial Blood Gas Analysis	297
? Venous Blood Gas Analysis	302
Chapter 46: Respiratory System Mechanics and Respiratory Muscle Function	303
? Static Behavior of the Respiratory System	303
? Dynamic Behavior of the Respiratory System	305
? Assessment of Respiratory System Mechanics in the Intensive Care Unit	306
? Respiratory Mechanics and Lung Diseases	308
? Respiratory Muscle Function in Healthy Lungs and in Pathologic Conditions	310
? Weaning from Mechanical Ventilation	312
Key Points	313
Annotated References	313
Chapter 47: Heart-Lung Interactions	314
? Airway Pressure, Intrathoracic Pressure, and Lung Volume Relationships	314
? Hemodynamic Effects of Ventilation	316
? Hemodynamic Effects of Ventilation Based on Cardiopulmonary Status	325
Annotated References	327
Chapter 48: Mechanical Ventilation	328
? Device Design Features for Total Ventilatory Support	328
? Physiologic Effects of Positive-Pressure Mechanical Ventilation	328
? Alveolar Recruitment	330
? Adverse Effects of Positive-Pressure Ventilation	331
? Applying Assist-Control Mechanical Ventilation	332
? Conclusion	333
Key Points	333
Annotated References	334
Chapter 49: Patient-Ventilator Interaction	335
? Respiratory Physiology	335
? Patient and Ventilator Variables	335
? Respiratory Drive–Ventilator Trigger Asynchrony	336
? Ventilatory Requirement–Gas Delivery Asynchrony	337
? Inspiratory Time–Ventilator Cycling Asynchrony	337
? Patient-Ventilator Asynchrony During Pressure-Support Ventilation	337
? Total Patient-Controlled Mechanical Support	338
? Proportional Assisted Ventilation (PAV), Proportional Pressure Support (PPS), and Proportional Assisted Ventilation Plus ...	339
? Neural-Adjusted Ventilatory Assistance	339
? Adaptive-Support Ventilation	340
Key Points	340
Annotated References	340
Chapter 50: Weaning from Mechanical Ventilation	342
? The Concept of Liberation and Extubation	342
? Mechanisms Explaining Liberation Failure	342
? Mechanisms Explaining Extubation Failure	343
? Indices to Predict Weaning Outcome	343
? Indices to Predict Extubation Failure	344
? Progressive Withdrawal of Mechanical Ventilation	344
? Unplanned Extubation During Weaning	345
? Summary	345
Key Points	346
Annotated References	346
Chapter 51: Noninvasive Positive-Pressure Ventilation	347
? Rationale	347
? Mechanisms of Action	347
? Indications	347
? Practical Application	350
? Adverse Effects and Complications	352
Key Points	352
Annotated References	353
Chapter 52: High-Frequency Ventilation	354
? Description and Classification	354
? Mechanisms of Gas Transport with High-Frequency Oscillatory Ventilation	355
? Rationale for High-Frequency Oscillatory Ventilation	355
? Current High-Frequency Oscillatory Ventilation Practices in Patients with Acute Respiratory Distress Syndrome	356
? Complications of High-Frequency Oscillatory Ventilation	358
? The Future of High-Frequency Oscillatory Ventilation	358
? Conclusion	358
Key Points	359
Annotated References	359
Chapter 53: Extracorporeal Life Support for Cardiopulmonary Failure	360
? Neonatal Respiratory Failure	360
? Pediatric Respiratory Failure	361
? Adult Respiratory Failure	362
? Cardiac Failure in Children	362
? Cardiac Failure in Adults	362
? Extracorporeal Support During Cardiopulmonary Resuscitation	362
? Other Applications of ECMO	362
? Extracorporeal Life Support in the Future	363
Annotated References	363
Chapter 54: Adjunctive Respiratory Therapy	364
? Methods to Improve Pulmonary Mucociliary Clearance	364
? Aerosol Therapies	365
? Methods to Improve Lung Expansion	366
? Methods to Improve Oxygenation and Ventilation	367
? Summary	368
Key Points	368
Annotated References	368
Chapter 55: Indications for and Management of Tracheostomy	369
? Indications for Tracheostomy	369
? Timing of Tracheostomy in Acute Respiratory Failure	369
? Selection, Maintenance, and Care of Tracheostomy Tubes	370
? Complications	371
Annotated References	372
Chapter 56: Hyperbaric Oxygen in Critical Care	373
? Applications	373
? Critical Care in Hyperbaric Medicine	375
? Adverse Effects	375
Annotated References	376
Chapter 57: Imaging of the Chest	377
? Principles of Imaging in the Intensive Care Unit	377
? Conventional and Digital Radiography	377
? Computed Tomography	377
? Picture Archiving and Communications System	377
? Interpreting the ICU Chest Radiograph	377
? Approach to ICU Chest Imaging	379
? Lung Abnormalities	379
? Conclusion	387
Key Points	387
Annotated References	387
Chapter 58: Acute Lung Injury and Acute Respiratory Distress Syndrome	388
? Epidemiology	388
? Risk Factors	388
? Pathophysiology	388
? Diagnosis	390
? Clinical Course	391
? Treatment	392
? Complications	395
? Clinical Outcomes and Prognosis	396
Annotated References	397
Chapter 59: Aspiration Pneumonitis and Pneumonia	398
? Aspiration Pneumonitis	398
? Aspiration Pneumonia	399
? Conclusions	401
Key Points	401
Annotated References	402
Chapter 60: Severe Asthma Exacerbation	403
? Magnitude of the Problem	403
? Pathophysiology of Acute Airflow Obstruction	403
? Clinical Features	403
? Differential Diagnosis	403
? Peak Flow Measurements	404
? Acid-Base Status	404
? Chest Radiography	404
? Emergency Department Disposition	404
? Oxygen	404
? Pharmacologic Management	405
? Noninvasive Ventilation	406
? Intubation and Mechanical Ventilation	406
? Postexacerbation Management	409
Key Points	409
Annotated References	409
Chapter 61: Chronic Obstructive Pulmonary Disease	410
? Definition and Natural History	410
? Pathology	410
? Physiology	411
? Systemic Effects	412
? Exacerbations	412
? Clinical Features	413
? Intensive Care Unit Referral	413
? Principles of Treatment	414
? Noninvasive Ventilation	415
? Mechanical Ventilation	416
? Nonventilatory Issues	416
? Prognosis	417
Key Points	417
Annotated References	417
Chapter 62: Pulmonary Embolism	418
? Pathophysiology	418
? Clinical Features	418
? Etiology and Pathogenesis	419
? Prevention of Venous Thromboembolism	419
? Assessment of Clinical Probability	419
? Differential Diagnosis	419
?Diagnostic Imaging	419
? Integrated Strategies for Diagnosis of Pulmonary Embolism	422
? Clinical Course of Venous Thromboembolism	422
? Objectives and Principles of Antithrombotic Treatment	422
? Anticoagulant Therapy	423
? Duration of Anticoagulant Therapy and Recurrent Venous Thromboembolism	426
? Fondaparinux and Related Compounds	426
? New Oral Anticoagulants	426
? Thrombolytic Therapy	427
? Inferior Vena Cava Filter	427
? Conclusions	427
Annotated References	427
Chapter 63: Other Embolic Syndromes	428
? Air Embolism	428
? Fat Embolism Syndrome	430
? Amniotic Fluid Embolism	431
Key Points	432
Annotated References	432
Chapter 64: Pulmonary Hypertension	433
? Diagnosis	433
? Treatment	434
? Special Situations in the Intensive Care Unit	435
Annotated References	437
Chapter 65: Pleural Disease and Pneumothorax	438
? Radiologic Signs of Pleural Disease in the Intensive Care Unit	438
? Evaluation of Pleural Effusion in the Intensive Care Unit	439
? Pneumothorax	445
? Bronchopleural Fistula	447
Annotated References	449
Chapter 66: Community-Acquired Pneumonia	450
? Incidence	450
? Risk Factors for Developing Severe CAP	450
? Prognostic Factors	450
? Pathogenesis	452
? Clinical Features	452
? Etiologic Pathogens	454
? Diagnostic Evaluation	458
? Therapy	460
? Prevention	462
Annotated References	463
Chapter 67: Nosocomial Pneumonia	464
? Definitions	464
? Epidemiology	464
? Pathogenesis	465
? Prevention	467
? Diagnosis	472
? Diagnostic Strategies for Hospital-Acquired Pneumonia	473
? Treatment	475
? Implementation of Guidelines	479
Annotated References	479
Chapter 68: Pulmonary Infections in the Immunocompromised Patient	481
? Evaluating the Net State of Immunosuppression	481
? Etiology of Pneumonia in Intensive Care Patients	481
? Diagnostic Approaches	482
? Prognostic Factors for Pneumonia in Intensive Care Patients	483
? Therapeutic Strategies	483
? Conclusions	483
Chapter 69: Lung Transplantation	484
? Historical Perspective	484
? Survival and Demographics	484
? Indications and Procedure Choice	484
? Candidate Selection	484
? Waiting List Considerations	484
? Donor Criteria	485
? Postoperative Care	485
? Intensive Care Unit Issues	488
? Transfer from the ICU	490
Key Points	490
Annotated References	490
Chapter 70: Burns and Inhalation Injury	491
? Classification of Injury	491
? Initial Inhalation Insult	491
? Environmental Variables That Determine Severity	491
? Pathology	491
? Damage From Asphyxiants	492
? Features of Specific Irritants	492
? Role of a Cutaneous Thermal Injury	493
? Postinhalation Pulmonary Complications	493
? Ongoing Pulmonary Damage After Inhalation Injury	494
? Treatment	495
? Future Directions	496
Key Points	496
Annotated References	496
Chapter 71: Drowning	498
? A New Definition	498
? Pathophysiology	498
? Chain of Survival, Prevention to Hospital	499
? Outcome and Scoring Systems	502
Annotated References	503
Chapter 72: Acute Parenchymal Disease in Pediatric Patients	504
? Diseases of the Airways	504
? Diseases of the Alveoli	508
? Diseases of the Interstitium	510
? Complex Parenchymal Diseases	512
? Weaning the Pediatric Patient from Mechanical Ventilation	514
? Summary	515
Annotated References	515
Chapter 73: Pulmonary Edema	516
? Definition	516
? Pulmonary Fluid Homeostasis	516
? Diagnosis and Assessment	516
? Noncardiogenic Pulmonary Edema	519
? Cardiogenic Pulmonary Edema	522
Annotated References	530
Part 4: Cardiovascular	531
Chapter 74: Hemodynamic Monitoring	533
? Arterial Pressure Monitoring	533
? Central Venous Pressure	533
? Pulmonary Artery Catheter	534
? Pulse Contour Analysis	535
? Esophageal Doppler	536
? Electrical Impedance Cardiography Technology	537
? Conclusion	537
Key Points	537
Annotated References	537
Chapter 75: Acute Myocardial Infarction	538
? Epidemiology	538
? Pathophysiology	538
? Clinical Features	539
? Diagnostic Strategies	540
Annotated References	547
Chapter 76: Acute Coronary Syndromes:	548
? Definition and Clinical Manifestations	548
? Pathophysiology of Acute Coronary Syndromes	548
? ST-Segment Elevation Myocardial Infarction	548
? Non–ST-Segment Elevation Myocardial Infarction	553
? Complications of Acute Myocardial Infarction	555
Annotated References	558
Chapter 77: Invasive Cardiac Procedures	559
? Percutaneous Transluminal Coronary Angioplasty	559
? Other Coronary Interventions	562
? Comparison of Clinical Applications	562
? Mitral Valvuloplasty	563
? Aortic Valvuloplasty	563
? Conclusion	563
Key Points	564
Annotated References	564
Chapter 78: Supraventricular Arrhythmias	565
? Classification and Epidemiology	565
? Clinical Presentation	565
? Electrocardiography	565
? Atrioventricular Nodal Reentry Tachycardia	566
? Atrioventricular Reentry Tachycardia	567
? Accelerated Atrioventricular Rhythm	570
? Atrial Fibrillation and Atrial Flutter	570
? Atrial Tachycardia	573
? Inappropriate Sinus Tachycardia	573
Key Points	574
Annotated References	574
Chapter 79: Ventricular Arrhythmias	575
? Normal Electrophysiology	575
? Mechanisms of Ventricular Tachyarrhythmias	576
? Conditions Predisposing to Ventricular Arrhythmias	578
? Clinical Diagnosis	582
? Acute Management	584
? Conclusion	586
Key Points	586
Chapter 80: Conduction Disturbances and Cardiac Pacemakers	587
? Conduction Disturbances	587
? Pacemakers	590
? Temporary Pacing	592
Annotated References	593
Chapter 81: Sudden Cardiac Death:	594
? Epidemiology of Sudden Cardiac Death	594
? Prevention of Tachyarrhythmic Sudden Cardiac Death: Non-Device Therapy	594
? Implantable Cardioverter-Defibrillator Therapy	595
? Clinical Trials	598
? Device-Related Issues Among Patients in Intensive Care	598
Annotated References	603
Chapter 82: Severe Heart Failure	604
? Etiology	604
? Presentations of Severe Heart Failure	605
? Investigations	606
? Treatment	607
? Further Management: Specialist Heart Failure Clinic	611
? Prognosis	611
? Summary	611
Key Points	611
Annotated References	612
Chapter 83: Myocarditis and Acute Myopathies	613
? Myocarditis in the Intensive Care Unit	613
? Pathogenesis	613
? Clinical Presentation and Diagnosis	613
? Endomyocardial Biopsy	615
? Clinical Course and Prognosis	616
? Therapy	618
? Transient Apical Ballooning Syndrome	622
? Tachycardia-Induced Cardiomyopathy	623
Key Points	624
Annotated References	624
Chapter 84: Acquired and Congenital Heart Disease in Children	625
? Physiology	625
? Circulatory Support in Children	626
? Cardiomyopathies	630
? Congenital Heart Disease	631
? Specific Issues for the Intensivist	638
Chapter 85: Pericardial Diseases	639
? Etiology and Classification of Pericardial Disease	639
? Pericardial Syndromes	639
? Specific Forms of Pericarditis	641
? Rare Forms of Pericardial Disease	645
Key Points	645
Annotated References	646
Chapter 86: Emergent Valvular Disorders	647
? Mitral Regurgitation	647
? Aortic Regurgitation	649
? Mitral Stenosis	650
? Aortic Stenosis	651
? Right-Sided Valve Disease	653
? Prosthetic Valves	653
Annotated References	654
Chapter 87: Infectious Endocarditis	655
? Pathophysiology	655
? Incidence and Classification	655
? Demographics and Etiologic Profiles	655
? Clinical Characteristics and Diagnosis	657
? Complications	658
? Medical and Surgical Treatment	659
? Outcome and Prognostic Factors	660
? Conclusion	661
Annotated References	661
Chapter 88: Hypertensive Crisis:	662
? Pathophysiology of Hypertensive Crisis	662
? Diagnosis of Hypertensive Emergencies	662
? Treatment of Hypertensive Emergency	663
? Specific Treatment Recommendations for Hypertensive Crisis Based on Etiology	664
? Hypertensive Urgency	669
Annotated References	670
Chapter 89: Cardiac Surgery:	671
? Surgical Indications for Coronary Artery Diseases	671
? Surgical Indications for Aortic Valve Surgery	671
? Surgical Indications for Mitral Valve Surgery	672
? Complications After Cardiac Surgery	672
Annotated References	676
Chapter 90: Pathophysiology and Classification of Shock States	677
? Pathophysiology of Shock	677
? Classification of Shock	678
? Clinical Aspects of Shock	681
Annotated References	683
Chapter 91: Resuscitation from Circulatory Shock	684
? Understanding Underlying Pathophysiology of Global Flow and Oxygen Delivery	684
? Deciding Diagnostic and Treatment Strategy	686
? Therapeutic Principles: Symptomatic and Etiologic Treatments	687
? Prognosis	688
Key Points	688
Annotated References	688
Chapter 92: Inotropic Therapy	689
? Rationale for Using Inotropic Therapy in the Critically Ill	689
? Pharmacologic Properties of Inotropic Agents	690
? Hemodynamic Effects of Inotropic Agents in Critically Ill Patients	692
? Main Indications for Inotropic Therapy in Patients with Circulatory Failure	694
Annotated References	695
Chapter 93: Mechanical Support in Cardiogenic Shock	696
? Historical Background	696
? Current Mechanical Support Devices	697
? Treatment of Cardiogenic Shock: Algorithm for Mechanical Support	704
? Conclusion	707
Key Points	707
Annotated References	708
Part 5: Gastrointestinal	709
Chapter 94: Critical Care Nutrition	711
? Gut Use and Differential Response to Feeding and Starvation	711
? Impact of Enteral Nutrition on Outcome	712
? Assessment of the Critically Ill Patient	715
? Practical Considerations	715
? Immunonutrition	716
? Appropriate Use of Total Parenteral Nutrition in the Intensive Care Unit	718
? Future Considerations	720
Key Points	721
Annotated References	721
Chapter 95: Nutrition Issues in Critically Ill Children	722
? Role of Nutritional Support for Critically Ill Children	722
? Impact of Physiologic Stress on Children	722
? Nutrition Assessment	723
? Energy Expenditure	725
? Nutritional Support for the Critically Ill Child	725
? Assessment of Response to Nutritional Support	728
? Summary	728
Key Points	729
Annotated References	729
Chapter 96: Portal Hypertension	730
? Anatomy and Physiology of the Portal System	730
? Pathophysiology	730
? Diagnosis of Portal Hypertension	731
? Complications of Portal Hypertension	731
? Treatment	732
? Failure of Therapy/Salvage	733
? Prognosis	734
? Complications	735
? Other Complications of Portal Hypertension Syndrome	736
Annotated References	737
Chapter 97: Ascites	738
? Definition and Diagnosis	738
? Pathophysiology	738
? Etiology	741
? Management	741
? Complications	743
? Prognosis and Outcomes	744
Key Points	745
Annotated References	745
Chapter 98: Gastrointestinal Hemorrhage	746
? Definitions	746
? Epidemiology	746
? Initial Assessment and Management	746
? Upper GI Hemorrhage	747
? Small-Bowel Bleeding	749
? Lower GI Hemorrhage	750
? Conclusion	751
Key Points	751
Annotated References	751
Chapter 99: Hepatorenal Syndrome	752
? Mechanisms of Renal Dysfunction in Cirrhosis	752
? Pathogenesis	752
? Diagnosis	752
? Treatment	754
? Prevention	755
? Conclusion	755
Key Points	756
Annotated References	756
Chapter 100: Hepatopulmonary Syndrome	757
? Definition	757
? Clinical Features	757
? Pathophysiology	757
? Diagnosis	757
? Prevalence	758
? Prognosis	758
? Therapy	758
Key Points	758
Annotated References	758
Chapter 101: Hepatic Encephalopathy	760
? General Principals	760
? Encephalopathy in the Setting of Acute Hepatic Failure	763
? Use of Intracranial Pressure Monitoring	764
? Management of Encephalopathy and Intracranial Hypertension	765
? Encephalopathy in the Setting of Chronic Liver Disease	767
? Summary	770
Annotated References	770
Chapter 102: Fulminant Hepatic Failure	771
? Definitions	771
? Etiology	771
? Prognostic Scoring Systems	772
? Role of Liver Biopsy	773
? Pathogenesis and Clinical Features of Acute Liver Failure	774
? Management	775
? Conclusion	778
Key Points	778
Annotated References	779
Chapter 103: Calculous and Acalculous Cholecystitis	780
? Risk Factors and Pathophysiology	780
? Incidence	780
? Clinical Presentation	781
? Imaging Studies	781
? Management	782
? Complications and Outcome	783
? Prevention	784
? Summary	784
Key Points	784
Annotated References	784
Chapter 104: Acute Pancreatitis	785
? Etiology and Epidemiology	785
? Pathogenesis and Genetic Susceptibility	785
? Diagnosis	786
? Severity and Scoring	786
? Imaging	787
? Management	789
? Pathogenesis of Pancreatic Infection and Antibiotic Prophylaxis	790
? Management of Pancreatic Necrosis and Abscess	792
? Outcome	793
? Summary	794
Key Points	794
Annotated References	794
Chapter 105: Peritonitis and Intraabdominal Infection	795
? Pathogenesis	795
? At-Risk Patient	796
? Spectrum of Disease Causing Critical Illness	797
? Diagnosis	801
? Principles of Management	801
? Complications	803
? Mortality	803
Key Points	804
Annotated References	804
Chapter 106: Ileus and Mechanical Bowel Obstruction	806
? Definition	806
? Pathophysiology	806
? Clinical Consequences of Ileus	806
? Diagnosis	806
? Treatment	806
? Conclusions	807
Annotated References	807
References	807
Chapter 107: Toxic Megacolon and Ogilvie’s Syndrome	808
? Clinical Features	808
? Pathogenesis of Megacolon	808
? Predisposing Factors	809
? Diagnosis and Differential Diagnosis of Acute Megacolon	810
? Management	811
? Outcome	812
? Strategies to Prevent Megacolon in the Critically Ill	812
Key Points	813
Annotated References	813
Part 6: Renal	815
Chapter 108: Clinical Assessment of Renal Function	817
? Renal Blood Flow	817
? Glomerular Filtration Rate	818
? Creatinine Clearance and Serum Creatinine	818
? Sodium Balance and Extracellular Fluid Volume	821
Key Points	821
Annotated References	822
Chapter 109: Metabolic Acidosis and Alkalosis	823
? Acid-Base Disorders	823
? Diagnosis of Types of Disturbances	824
? Metabolic Acidosis	827
? High–Anion Gap Acidosis	827
? Non–Anion Gap (Hyperchloremic) Metabolic Acidoses	833
? Metabolic Alkalosis	835
? Symptoms of Metabolic Alkalosis	838
? Treatment of Metabolic Alkalosis	838
Key Points	838
Annotated References	840
Chapter 110: Disorders of Water Balance	841
? Control of Serum Sodium Concentration	841
? Hypernatremia	841
? Hyponatremia	845
Annotated References	849
Chapter 111: Disorders of Plasma Potassium Concentration	850
? Potassium Channels	850
? Driving Forces	850
? Regulation of Potassium Homeostasis	850
? Long-Term Regulation of Potassium Homeostasis	851
? Tools to Assess Control of Renal Excretion of Potassium	853
HYPERKALEMIA	854
? Therapy of Hyperkalemia	854
? Clinical Approach	854
? Specific Causes of Hyperkalemia	856
HYPOKALEMIA	858
? Clinical Approach	858
? Specific Causes of Hypokalemia	860
? Therapy of Hypokalemia	863
Annotated References	864
Chapter 112: Disorders of Calcium and Magnesium Metabolism	865
? Serum Calcium Concentration	865
? Hypocalcemia	865
? Hypercalcemia	868
? Disorders of Magnesium Metabolism	872
? Hypomagnesemia and Magnesium Depletion	872
? Hypermagnesemia	874
Annotated References	875
Chapter 113: Fluids and Electrolytes in Children	876
? Body Water Distribution in Children	876
? Fluid Homeostasis in Children	876
? Perioperative Fluid Management	877
? Disorders of Sodium Homeostasis	877
? Management of Acute Water and Sodium Deficits in Children	878
? Chloride	880
? Potassium	881
? Calcium	881
Annotated References	881
Chapter 114: Acute Kidney Injury	883
? Prerenal Causes	883
? Postrenal Causes	883
? Intrarenal Causes	883
? Epidemiology	884
? Definition	885
? Treatment	886
? Hemodynamic Management	887
? Nutritional Support	888
? Indications for Nephrology Consultation	889
? Renal Replacement Therapy	889
? Conclusion	892
Key Points	892
Annotated References	893
Chapter 115: Renal Replacement Therapy	894
? Principles of Renal Replacement Therapy	894
? Indications for Renal Replacement Therapy	894
? Mode of Renal Replacement Therapy	895
? Continuous Renal Replacement Therapy	895
? Intermittent Hemodialysis	899
? Peritoneal Dialysis	899
? Drug Prescription During Dialysis Therapy	899
? Controversies in Renal Replacement Therapy	899
? Summary	900
Key Points	900
Annotated References	901
Chapter 116: Urinary Tract Obstruction	902
? Epidemiology	902
? Etiology	902
? Clinical Presentation	903
? Imaging in Urinary Tract Obstruction	904
? Pathophysiology of Obstruction	905
? Treatment	906
? Recovery of Kidney Function	907
Key Points	907
Annotated References	907
Chapter 117: Contrast-Induced Nephropathy	909
? Epidemiology	909
? Risk Factors	909
? Pathogenesis	909
? Clinical Features and Diagnosis	910
? Prognosis	910
? Preventive Interventions	910
? Management and Outcome	911
? Conclusion	912
Key Points	912
Annotated References	912
Chapter 118: Glomerulonephritis and Interstitial Nephritis	913
? Glomerulonephritis	913
? Interstitial Nephritis	916
Key Points	917
Annotated References	917
Part 7: Infectious Diseases	919
Chapter 119: Antimicrobials in Chemotherapy Strategy	921
? Antimicrobial Resistance in the ICU	921
? Strategies to Reduce Antimicrobial Resistance	922
? Principles of Appropriate Antimicrobial Use	923
? Protocols and Guidelines for Use of Antimicrobials	928
Key Points	928
Annotated References	929
Chapter 120: Beta-Lactam Drugs	930
? Mechanism of Action	930
? Mechanisms of Resistance	930
? Penicillins	932
? Cephalosporins	934
? Carbapenems and Monobactams	936
Key Points	936
Annotated References	937
Chapter 121: Aminoglycosides	938
? Mechanism of Action	938
? Spectrum of Activity	938
? Mechanisms of Resistance	939
? Pharmacokinetics	939
? Pharmacodynamics	939
? Adverse Events	940
? Drug Interaction	940
? Extended-Interval Dosing Versus Multiple Daily Dosing	940
? Serum Concentration Monitoring	941
Key Points	941
Annotated References	942
Chapter 122: Fluoroquinolones	943
? Mechanism of Action	943
? Antimicrobial Spectrum of Activity	943
? Mechanisms of Fluoroquinolone Resistance	944
? Pharmacokinetics	945
? Pharmacodynamic Considerations	945
? Adverse Effects	946
? Drug-Drug Interactions	946
? Dosing	947
Key Points	947
Annotated References	947
Chapter 123: Macrolides	949
? Mechanism of Action	949
? Mechanisms of Resistance	949
? Antimicrobial Spectrum of Activity	949
? Pharmacokinetics	949
? Pharmacodynamics	951
? Immune Modulation	951
? Adverse Effects	951
? Prokinetic Activity	951
? Drug-Drug Interactions	951
Key Points	951
Annotated References	952
Chapter 124: Agents with Primary Activity Against Gram-Positive Bacteria	953
? Vancomycin	953
? Teicoplanin	956
? Daptomycin	956
? Quinupristin/Dalfopristin	957
? Linezolid	958
? Telavancin	958
Annotated References	960
Chapter 125: Metronidazole and Other Antibiotics for Anaerobic Infections	961
? Metronidazole	961
? Other Agents Effective Against Obligate Anaerobes	962
Annotated References	965
Chapter 126: Prevention and Control of Nosocomial Pneumonia	966
? Pathogenesis	966
Annotated References	971
Chapter 127: Selective Decontamination of the Digestive Tract	972
? Background	972
? Clinical Results	972
? Microbiological Effects of Selective Decontamination	974
Annotated References	975
Chapter 128: Vascular Catheter–Related Infections	976
? Definitions	976
? Pathogenesis	977
? Risk Factors	977
? Diagnostic Techniques	978
? Catheter and Site Maintenance	978
? Infection Risks of Specific Catheters	980
? Adjuncts To Prevent CRBSI	980
? Recommendations	981
Key Points	982
Annotated References	982
Chapter 129: Pathophysiology of Sepsis and Multiple Organ Dysfunction	983
? Pathophysiology of Sepsis	983
? Pathophysiology of Multiorgan Dysfunction	988
Annotated References	991
Chapter 130: Septic Shock	992
? Incidence	992
? Etiology of Septic Shock	992
? Pathophysiology of Septic Shock	992
? Classification	992
? Clinical Presentation	993
? Hemodynamic Changes	993
? Monitoring	994
? Management	994
? Conclusion	997
Key Points	997
Annotated References	997
Chapter 131: Sepsis and Multiple Organ System Failure in Children	998
? Definitions of Sepsis, Severe Sepsis, Septic Shock, and Multiple Organ Failure	998
? Changing Outcomes and Epidemiology	998
? Pathophysiology and Developmental Effects	998
? Predisposing Factors and Prevention Strategies	1000
? Diagnostic Approach and Scoring Systems	1000
? Therapy	1000
? Multicenter Randomized Controlled Trials for Pediatric Septic Shock	1003
Key Points	1003
Annotated References	1003
Chapter 132: Acute Bloodstream Infection	1004
? Definitions	1004
? Epidemiology	1004
? Microbiology	1004
? Impact	1004
? General Principles of Management	1007
? Prevention	1007
Key Points	1009
Annotated References	1009
Chapter 133: Infections of the Urogenital Tract	1010
? Definition	1010
? Etiology	1010
? Epidemiology	1010
? Pathophysiology	1011
? Diagnosis	1012
? Therapy	1012
? Special Clinical Issues	1014
Annotated References	1015
Chapter 134: Central Nervous System Infections	1017
? Bacterial Meningitis	1017
? Brain Abscess	1023
? Viral Infections of the Central Nervous System	1024
? Central Nervous System Infection and the AIDS Patient	1025
? Paradural Abscess	1025
? Sepsis Syndrome with Central Nervous System Involvement	1025
? Conclusions	1027
Key Points	1027
Annotated References	1027
Chapter 135: Infections of Skin, Muscle, and Soft Tissue	1028
? Necrotizing Soft-Tissue Infections	1028
? Important Soft-Tissue Infections of the Head and Neck	1030
? Infections of Bite Wounds	1031
? Infections of Burn Wounds	1032
? Infections of Pressure Ulcers	1033
Annotated References	1034
Chapter 136: Head and Neck Infections	1036
? Normal Head and Neck Flora	1036
? Sites of Deep Head and Neck Infection	1036
? Clinical Syndromes	1036
? Conclusions	1039
Annotated References	1039
Chapter 137: Infections in the Immunocompromised Patient	1040
? Commonly Encountered Immunocompromising Conditions	1040
? General Diagnostic Approach to Immunocompromised Patients with Severe Infections	1042
? Major Manifestations of Infection in Immunocompromised Patients	1043
? Therapeutic Difficulties in Immunocompromised Patients	1045
? Conclusion	1045
Key Points	1046
Annotated References	1046
Chapter 138: Infectious Endocarditis	1047
? Healthcare-Associated Native Valve Endocarditis	1047
? Healthcare-Associated Prosthetic Valve Endocarditis	1048
? Infective Endocarditis in the ICU	1048
Key Points	1049
Annotated References	1049
Chapter 139: Fungal Infections	1050
? Fungal Infections in the Critically Ill	1050
? Systemic Antifungal Agents	1053
? In Vitro Susceptibility Testing of Systemic Antifungal Agents	1056
? Treatment of Fungal Infections in the Critically Ill	1056
? Conclusions	1059
Key Points	1059
Annotated References	1060
Chapter 140: Influenza	1061
? Pathogenicity of Influenza Viruses	1061
? Clinical Manifestations and Complications of Influenza	1062
? Influenza A 2009 H1N1-Related Epidemiology and Clinical Manifestations	1062
? Clinical and Laboratory Diagnosis	1064
? Supportive Care	1065
? Antiviral Therapy	1065
? Adjunctive Pharmacologic Therapy	1065
? Secondary Bacterial Pneumonia	1065
? Infection Control in the ICU	1066
? Global Critical Care Collaboration	1066
Annotated References	1066
Chapter 141: Human Immunodeficiency Virus Infection	1067
? Intensive Care Trends Among HIV-Infected Patients	1067
? Intensive Care Trends in Pneumocystis Pneumonia	1068
? Combination Antiretroviral Therapy and the ICU	1070
? Metabolic Abnormalities in the ICU	1071
? Conclusion	1071
Key Points	1071
Annotated References	1072
Chapter 142: Tuberculosis	1073
? Epidemiology	1073
? The Serious Problem of Highly Drug-Resistant Tuberculosis	1073
? Tuberculosis in the Intensive Care Unit	1073
? Pulmonary Tuberculosis	1073
? Disseminated Tuberculosis	1074
? Neurologic Tuberculosis	1075
? Cardiovascular Tuberculosis	1076
? Tuberculosis in HIV-Positive Patients	1077
? Tuberculosis and Immunomodulatory Therapies	1077
? Diagnosis of Tuberculosis	1078
? Treatment of Tuberculosis	1078
? Risk to Healthcare Workers	1079
Annotated References	1079
Chapter 143: Malaria and Other Tropical Infections in the Intensive Care Unit	1080
? Epidemiology	1080
? Pathophysiology	1080
? Clinical Presentation	1086
? Diagnosis	1088
? Clinical Management	1089
? Prognosis	1091
Acknowledgments	1091
Key Points	1091
Annotated References	1092
Chapter 144: Rickettsial Diseases	1093
? Rickettsial Diseases	1093
? Ehrlichioses	1096
? Q Fever	1097
Annotated References	1098
Chapter 145: Acute Viral Syndromes	1099
? Vesicular Rash	1099
? Fever in Immunocompromised Patients	1101
? Viral Hemorrhagic Fevers	1102
? 2009 Pandemic Influenza A and Avian Influenza A	1102
? Hendra and Nipah Viruses	1103
? Other Acute Viral Syndromes	1103
? Antiviral Drugs	1103
Annotated References	1104
Chapter 146: Clostridium difficile Colitis	1105
? Etiology	1105
? Pathophysiology	1105
? Clinical Signs and Symptoms	1105
? Diagnosis	1105
? Treatment	1105
? Prevention	1106
? Complications	1106
? Conclusion	1106
Key Points	1106
Annotated References	1107
Chapter 147: Tetanus	1108
? Epidemiology	1108
? Pathophysiology	1108
? Clinical Features	1108
? Diagnosis	1108
? Management	1110
? Outcome	1110
Key Points	1110
Annotated References	1111
Chapter 148: Botulism	1112
? Toxin Characteristics	1112
? Forms of Human Botulism	1112
? Diagnosis	1114
? Management	1115
Annotated References	1116
Chapter 149: Dengue	1117
? Epidemiology	1117
? Pathophysiology	1117
? Clinical Features	1117
? Diagnosis	1118
? Management	1118
? Conclusion	1122
Key Points	1123
Annotated References	1123
Part 8: Hematology/Oncology	1125
Chapter 150: Anemia and Red Blood Cell Transfusion in Critically Ill Patients	1127
? Natural History of Uncorrected Anemia	1127
? Anemia in High-Risk Groups	1127
? Risks and Benefits of Transfusion	1128
? Alternatives to Transfusion	1131
? Conclusions	1131
? Recommendations	1132
Key Points	1132
Annotated References	1132
Chapter 151: Blood Component Therapies	1133
? Guidelines for Blood Component Therapy	1133
? Transfusion Management of Massive Acute Hemorrhage	1135
? Hazards of Allogeneic Transfusion	1135
? Basic Immunohematology	1139
Annotated References	1140
Chapter 152: Management of Neutropenic Cancer Patients	1141
? Management of Neutropenic Cancer Patients in the Intensive Care Unit	1141
? Hematopoietic Growth Factors	1142
? Specific Organ Failures	1143
? Conclusion	1144
Key Points	1144
Annotated References	1144
Chapter 153: Venous Thromboembolism in Medical-Surgical Critically Ill Patients	1145
? Risk Factors for Venous Thromboembolism in Medical-Surgical ICU Patients	1145
? Prevalence and Incidence	1147
? Diagnosis	1147
? Thromboprophylaxis	1148
? Thromboprophylaxis Compliance	1149
Annotated References	1149
Chapter 154: Hematologic Malignancies in the Intensive Care Unit	1150
? Emergency Management of Hematologic Malignancies in the Intensive Care Unit	1150
? Emergency Chemotherapy in Leukemias	1151
? Emergency Treatment of Non-Hodgkin’s Lymphomas	1151
? Emergency Treatment of Hodgkin’s Disease	1152
? Blastic Meningitis	1152
? Organ Failures Related To Hemophagocytic Syndrome	1152
? Management of Disseminated Intravascular Coagulation	1153
? Multiple Myeloma and Other Causes of Hyperviscosity Syndromes	1153
Key Points	1154
Annotated References	1154
Chapter 155: Hematopoietic Stem Cell Transplantation Patient	1155
? Pulmonary Infections	1155
? Noninfectious Pulmonary Disease	1156
? Bronchoscopy	1157
? Sepsis	1157
? Hepatic Veno-Occlusive Disease	1157
? Supportive Care	1158
? Outcomes, Prognostication, and Triage	1158
? The Future	1158
Key Points	1159
Annotated References	1159
Chapter 156: Organ Toxicity of Cancer Chemotherapy	1160
? Pulmonary Toxicity	1160
? Cardiac Toxicity	1161
? Hematologic Toxicity	1162
? Neurologic Toxicity	1163
? Urologic and Renal Toxicity	1165
? Digestive Toxicity	1166
? Metabolic Toxicity	1166
Key Points	1166
Annotated References	1167
Chapter 157: Hematology and Oncology in Children	1168
? Hematology	1168
? Oncology	1169
Annotated References	1171
Part 9: Obstetrics	1173
Chapter 158: Cardiovascular and Endocrinologic Changes Associated with Pregnancy	1175
? Cardiovascular Changes in Pregnancy	1175
? Endocrine and Metabolic Changes in Pregnancy	1178
Annotated References	1179
Chapter 159: Hypertensive Disorders in Pregnancy	1181
? Blood Pressure Measurements in Pregnancy	1181
? Physiologic Changes in Pregnancy	1181
? Causes of Hypertension in Pregnancy	1181
? Pathology of Preeclampsia	1182
? Clinical Presentation of Preeclampsia	1183
? Other Causes of Hypertension in Pregnancy	1183
? General Treatment Principles	1183
? Antihypertensive Drug Therapy	1184
? Management of Hypertension During Labor and Delivery	1185
Key Points	1185
Annotated References	1186
Chapter 160: Acute Pulmonary Complications in Pregnancy	1187
? Pulmonary Physiology in Pregnancy	1187
? Asthma	1187
? Pulmonary Edema	1189
? Acute Respiratory Distress Syndrome	1189
? Embolism	1190
? Pneumonia	1191
? Conclusion	1191
Key Points	1191
Annotated References	1191
Chapter 161: Postpartum Hemorrhage	1192
? Definition	1192
? Incidence and Mortality	1192
? Pathophysiology	1192
? Presentation	1192
? Causes of Postpartum Hemorrhage	1192
? Diagnostic Studies	1193
? Prevention	1194
? General Treatment Measures	1194
? Specific Treatment Measures	1195
? Surgical Therapy	1195
? Complications	1196
? Prognosis	1196
Key Points	1196
Annotated References	1196
Chapter 162: Trauma in the Gravid Patient	1198
? Fetal Physiology	1198
? Anatomic and Physiologic Changes Associated with Pregnancy	1198
? Initial Assessment and Resuscitation	1199
? Specific Complications of Pregnancy	1201
? Prevention	1201
? Summary	1202
Key Points	1202
Annotated References	1202
Part 10: Endocrine	1203
Chapter 163: Hyperglycemic Comas	1205
? Hyperglycemic Syndromes	1205
? Neurologic Sequelae of the Hyperglycemic Syndromes	1206
? Clinical Approach to the Obtunded Hyperglycemic Patient in the Intensive Care Unit	1208
Annotated References	1209
Chapter 164: Hyperglycemia and Blood Glucose Control	1210
? Altered Glucose Regulation in Stress	1210
? Hyperglycemia in Critically Ill Patients	1210
? Maintenance of Normoglycemia in the Intensive Care Unit	1210
? Critical Appraisal of the Evidence for Tight Glycemic Control in the ICU	1212
? Biological Rationale for Tight Glycemic Control	1213
? Conclusion	1214
Key Points	1214
Annotated References	1214
Chapter 165: Adrenal Insufficiency	1215
? Historical Review	1215
? Anatomy of the Adrenal Gland	1215
? Physiology of the Hypothalamic-Pituitary-Adrenal Axis	1216
? Cellular Response to Adrenocortical Hormones and Related Drugs	1216
? Definitions of Adrenal Insufficiency	1217
? Relative Adrenal Insufficiency	1218
? Evaluation of Adrenal Insufficiency	1218
? Clinical Symptoms	1220
? Therapeutic Strategies	1221
? Glucocorticoid Replacement in Patients with Septic Shock	1221
? Further Implications for Anesthesia and Critical Care	1223
? Conclusions	1223
Key Points	1224
Annotated References	1224
Chapter 166: Thyroid Gland Disorders	1225
? Normal Thyroid Hormone Economy	1225
? Thyroid Hormone Economy in Critical Illness	1225
? Evaluation of Thyroid Function in the Critically Ill Patient	1227
? Sick Euthyroid Syndrome	1228
? Thyroid Storm	1229
? Myxedema Coma	1231
? Summary	1232
Annotated References	1233
Chapter 167: Diabetes Insipidus	1234
? Central Diabetes Insipidus	1234
? Clinical Picture	1234
? Differential Diagnosis	1234
? Treatment	1234
? Nephrogenic Diabetes Insipidus	1235
Key Points	1235
Annotated References	1236
Chapter 168: Endocrine and Metabolic Crises in the Pediatric Intensive Care Unit	1237
? Endocrine Crises	1237
? Metabolic Crises	1244
Annotated References	1250
Part 11: Pharmacology/Toxicology	1251
Chapter 169: General Principles of Pharmacokinetics and Pharmacodynamics	1253
? General Principles of Pharmacokinetics	1253
? Pharmacodynamics	1258
? Nonlinear Pharmacokinetics	1261
? Alterations in the Elderly	1262
? Pharmacogenomics	1262
Key Points	1264
Annotated References	1264
Chapter 170: Poisoning:	1265
? Gastrointestinal Decontamination	1265
? Enhanced Elimination	1266
? Selected Antidotes	1266
? Hypotension in the Poisoned Patient	1267
? Cardiac Arrhythmias	1268
? Acute Renal Failure	1268
? Seizures	1268
? Mechanical Ventilation and Extubation	1268
? Toxicology Laboratory	1268
Key Points	1268
Annotated References	1268
Chapter 171: Ethanol, Methanol, and Ethylene Glycol	1270
? Ethanol Intoxication	1270
? Alcoholic Ketoacidosis	1272
? Ethanol Withdrawal	1273
? Methanol Intoxication	1275
? Ethylene Glycol Intoxication	1279
Annotated References	1281
Chapter 172: Anticonvulsants	1282
? Anticonvulsants: General ICU Concerns	1282
? Specific Anticonvulsant Properties by Class	1284
Annotated References	1290
Chapter 173: Calcium Channel Blocker Toxicity	1291
? Pharmacology	1291
? Clinical Manifestations of Toxicity	1291
? Differential Diagnosis	1291
? Diagnostic Testing	1291
? Treatment	1292
? Patient Monitoring and Disposition	1293
? Conclusions	1293
Key Points	1293
Annotated References	1293
Chapter 174: Drug Therapy in Renal Failure	1294
? Quantitation of Renal Function	1294
? Altered Drug Disposition in Critically Ill Patients with Renal Insufficiency	1294
? Strategies for Drug Therapy Individualization	1295
? Summary	1299
Key Points	1299
Annotated References	1302
Chapter 175: Antidepressant Drug Overdose	1303
? Classification	1303
? Pharmacology	1303
? Toxicology	1304
Annotated References	1307
Chapter 176: Clinical Use of Immunosuppressants	1308
? Basic Principles of Immunosuppression	1308
? Overview of Transplantation Immunobiology	1308
? Specific Agents	1309
Annotated References	1316
Chapter 177: Digitalis	1317
? Therapeutic Indications	1317
? Mechanism of Action	1317
? Pharmacokinetics	1317
? Dosing Recommendations	1317
? Special Populations	1318
? Therapeutic Monitoring	1319
? Contraindications	1319
? Drug-Drug and Drug-Assay Interactions	1319
? Adverse Effects	1320
? Treatment of Digoxin Toxicity	1320
Annotated References	1321
Chapter 178: Heavy Metals	1322
? Arsenic	1322
? Mercury	1324
? Lead	1325
? Thallium	1327
Annotated References	1329
Chapter 179: Hydrocarbons	1330
? Chemistry	1330
? Epidemiology	1330
? General Management	1330
? Nonspecific Symptoms of Aspiration	1330
? Pulmonary Toxicity	1331
? Nervous System Toxicity	1332
? Cardiac Toxicity	1332
? Hepatotoxicity	1332
? Renal Effects	1333
? Hematologic Effects	1333
? Dermatologic Effects	1333
? Carcinogenicity	1333
? Conclusion	1333
Key Points	1333
Annotated References	1334
Chapter 180: Lithium	1335
? Pharmacology	1335
? Lithium Toxicity	1335
Annotated References	1338
Chapter 181: Theophylline and Other Methylxanthines	1339
? Pharmacology	1339
? Clinical Utility	1340
? Adverse Events	1341
? Management of Acute Toxicity	1341
? Summary	1341
Key Points	1341
Annotated References	1341
Chapter 182: Antipsychotics	1342
? Pharmacology of Antipsychotics	1342
? Use of Antipsychotics in the Intensive Care Unit	1343
? Management of Antipsychotic Overdose	1344
Key Points	1345
Annotated References	1345
Chapter 183: Nonsteroidal Antiinflammatory Agents	1346
? NSAID Pharmacodynamics	1346
? Clinical Implications and Uses of NSAIDs in Critically Ill Patients	1348
? Toxicity of NSAIDs	1349
? Overdose	1351
? Summary	1353
Key Points	1353
Annotated References	1353
Chapter 184: Opioids	1354
? History	1354
? Nomenclature	1354
? Pharmacology and Receptor Physiology	1354
? Pharmacokinetics	1354
? Clinically Important Effects in the Intensive Care Unit	1354
? Specific Agents	1356
? Special Clinical Situations	1359
? Summary	1360
Key Points	1360
Annotated References	1361
Chapter 185: Pesticides and Herbicides	1362
? General Principles of Management	1362
? Specific Agents	1362
Annotated References	1365
Chapter 186: Sedatives and Hypnotics	1366
? Rationale for Sedative Use in the Intensive Care Unit	1366
? Goals of Sedation for Patients in Intensive Care Units	1366
? Epidemiology of Sedative Use in the Intensive Care Unit	1366
? Pharmacology and Clinical Use of Sedatives Commonly Administered in the Intensive Care Unit	1368
? Optimizing Sedation at the Bedside	1371
? Pharmacoeconomics of Sedatives Used in the Intensive Care Unit	1372
? Toxic Ingestion of Sedative-Hypnotics	1373
Key Points	1373
Annotated References	1373
Chapter 187: Toxic Inhalants	1374
? Pulmonary Irritants	1374
? Specific Examples	1375
? Conclusion	1378
Key Points	1378
Annotated References	1378
Chapter 188: Cocaine	1379
? Mechanism of Action	1379
? Toxicities	1379
? Other Complications	1380
? Drug Transporters	1381
? Cocaine Withdrawal	1381
Annotated References	1381
Chapter 189: Methamphetamine, Ecstasy, and Other Street Drugs	1382
? History	1382
? Pharmacology and Metabolism	1382
? Acute Effects	1382
? Clinical Management	1383
? Amphetamine Derivatives	1385
Annotated References	1386
Chapter 190: Pharmacoeconomics	1387
? Economics of Health Care in the Intensive Care Unit	1387
? Economic Evaluations in Critical Care Medicine	1387
? Determining Costs in the Intensive Care Unit	1388
? Cost of Intensive Care Unit–Related Conditions	1388
? Cost of Pharmacotherapy in Critical Care	1390
? Cost of Adverse Drug Events	1391
? Economic Impact of Critical Care Pharmacists	1392
? Conclusion	1392
Key Points	1392
Annotated References	1392
Part 12: Surgery/Trauma	1393
Chapter 191: Resuscitation of Hypovolemic Shock	1395
? Epidemiology of Severe Hemorrhagic Shock	1395
? Current State of Knowledge About Inadequate or Incomplete Resuscitation in Hemorrhagic and Hypovolemic Shock	1395
? Resuscitative Strategies in Hemorrhagic Shock	1397
Annotated References	1398
Chapter 192: Mediastinitis	1399
? Acute Anterior Mediastinitis	1399
? Posterior Mediastinitis	1401
? Migratory and Chronic Mediastinal Inflammation	1401
Annotated References	1402
Chapter 193: Epistaxis	1403
? Anatomy and Physiology	1403
? Healthcare Personnel Safety	1403
? Location of Bleeding	1403
? Diagnosis	1403
? Treatment	1403
? Specific Intensive Care Unit Situations	1405
? Conclusion	1405
Key Points	1405
Annotated References	1405
Chapter 194: Management of the Postoperative Cardiac Surgical Patient	1406
? The Cardiac Surgery Patient in the Intensive Care Unit	1406
? Separation from Cardiopulmonary Bypass and the End of Surgery	1407
? Monitoring the Postoperative Cardiac Surgery Patient	1409
? Clinical Manifestations of the Postbypass Period	1410
? Management of Common Postoperative Problems	1413
? Outcomes of Cardiac Surgery	1415
? Summary	1415
Key Points	1416
Annotated References	1416
Chapter 195: Management of Patients After Heart, Heart-Lung, or Lung Transplantation	1417
? Lung Transplantation	1417
? Heart Transplantation	1420
Annotated References	1421
Chapter 196: Management of Patients after Kidney, Kidney-Pancreas, or Pancreas Transplantation	1422
? Background	1422
? Ethical Issues	1422
? Current Immunosuppressive Agents/Regimens	1423
? Common Related Diseases and Conditions	1423
? Routine Perioperative Care: Kidney or Kidney/Pancreas Transplant	1424
? Posttransplant Complications	1424
? Pancreas Transplant	1430
Key Points	1430
Annotated References	1430
Chapter 197: Liver Transplantation	1431
? Candidate Selection	1431
? Donor Selection and Operation	1432
? Recipient Operation	1432
? Postoperative Management	1435
? Hemodynamic Changes	1437
? Pulmonary Considerations	1437
? Renal Considerations	1439
? Gastrointestinal Considerations	1439
? Neurologic Considerations	1439
? Infectious Complications	1440
? Endocrine Considerations	1441
? Conclusion	1441
Key Points	1441
Annotated References	1442
Chapter 198: Intestinal and Multivisceral Transplantation	1443
? Management of Intestinal Failure	1443
? Transplantation Procedures	1445
? Immunosuppression	1446
? Postoperative Management	1447
? Management of Allograft Rejection	1448
? Management of Complications	1450
? Outcomes	1452
? Conclusions	1453
Annotated References	1453
Chapter 199: Aortic Dissection	1454
? Classification	1454
? Clinical Findings	1454
? Pathologic Findings	1455
? Presentation	1456
? Diagnosis	1456
? Treatment	1456
? Long-Term Follow-Up	1458
Key Points	1458
Annotated References	1459
Chapter 200: Splanchnic Ischemia	1460
? Anatomy, Physiology, and Pathophysiology	1460
? Diagnostic Methods	1461
? Clinical Presentations of Splanchnic Ischemia	1463
? Treatment	1465
? Postoperative Care	1467
Annotated References	1468
Chapter 201: Abdominal Compartment Syndrome	1469
? Definitions	1469
? Damage Control	1469
? Historical Perspective	1469
? Intraabdominal Pressure Measurement	1469
? Pathophysiology	1470
? Pathophysiologic Response of Specific Organs	1470
? Classification	1471
? Epidemiology	1471
? Prediction and Diagnosis	1472
? Treatment	1472
? Management of the Open Abdomen	1473
? Prevention, Surveillance, and Future Directions	1473
Key Points	1474
Annotated References	1474
Chapter 202: Thrombolytics	1475
? Drugs	1475
? Clinical Indications	1475
? Management/Laboratories	1481
? Conclusion	1481
Key Points	1481
Annotated References	1481
Chapter 203: Atheroembolization	1483
? Pathophysiology	1483
? Clinical Consequences of Atheromatous Embolization	1483
? Diagnosis and Screening	1484
? Vascular Manipulation and Embolic Events	1485
? Prevention and Management	1486
? Summary	1487
Key Points	1487
Annotated References	1487
Chapter 204: Pressure Ulcers	1489
? Epidemiology	1489
? Risk Factors	1489
? Pathophysiology	1489
? Classification	1489
? Prevention	1489
? Treatment	1490
? Conclusion	1491
Annotated References	1491
Chapter 205: Management of Pain, Anxiety, and Delirium	1492
? General Principles	1492
? Pain	1492
? Anxiety, Agitation, and Sedation	1493
? Delirium	1495
? Conclusion	1497
Key Points	1498
Annotated References	1498
Chapter 206: Burns	1499
? Phases of Burn Care	1499
? Physiology of Burn Injury	1499
? Initial Evaluation and Burn-Specific Secondary Survey	1499
? Fluid Resuscitation	1502
? Burn Critical Care Issues	1502
? Rehabilitation Therapy in the Burn Intensive Care Setting	1504
? Special Injury Considerations	1506
? Conclusion	1507
Key Points	1507
Annotated References	1507
Chapter 207: Thoracic Trauma	1509
? Initial Assessment	1509
? Pleural Space	1509
? Chest Wall Injury	1511
? Lung Injury	1511
? Pneumomediastinum	1511
? Tracheobronchial Injury	1512
? Esophageal Injury	1512
? Blunt Cardiac Injury	1512
? Penetrating Cardiac Injury	1513
? Transmediastinal Penetrating Trauma	1514
? Thoracic Great Vessel Injury	1514
Annotated References	1517
Chapter 208: Abdominal Trauma	1518
? Initial Assessment of the Trauma Patient	1518
? Blunt Abdominal Injury	1518
? Penetrating Abdominal Injury	1519
? Solid-Organ Injury	1519
? Damage Control	1521
Annotated References	1522
Chapter 209: Pelvic and Major Long Bone Fractures	1523
? Pelvic Fracture	1523
? Long Bone Fracture	1523
? Local Complications	1524
Annotated References	1528
Chapter 210: Pediatric Trauma	1529
? Trauma Systems and Trauma Centers	1529
? Trauma Teams	1529
? Role of Pediatric Critical Care Physicians	1529
? Initial Resuscitation	1530
? Specific Injuries and Critical Care Management	1530
? Organ Failure	1535
? Special Considerations	1537
? Infectious Disease and Immunology	1538
? Coagulopathies	1539
? Nutrition	1539
? Sedation and Pain	1540
? Inflicted Trauma	1540
? Rehabilitation	1541
? Brain Death and Organ Donation	1541
? Burnout	1542
Key Points	1542
Annotated References	1542
Chapter 211: Management of the Brain Dead Organ Donor	1543
? Declaration of Brain Death	1543
? Physiology of Brain Death	1543
? Initial Donor Resuscitation	1543
? Specific Considerations and Controversies	1543
? Other Treatment	1547
? Conclusion	1547
Annotated References	1547
Chapter 212: Organ Donation After Cardiac Death	1549
? Historical Perspective	1549
? Current Status of DCD Donation	1549
? Identification and Categorization of the Potential DCD Donor	1551
? Principles of DCD Donor Management	1551
? DCD Procurement: an Opportunity for Standardization	1554
? Future Directions	1555
? Conclusion	1556
Key Points	1556
Annotated References	1556
Part 13: Ethical and End-of-Life Issues	1557
Chapter 213: Beyond Technology:	1559
? The Patient—When the Outcome Is Poor	1559
? The Family—Difficult Decisions, Autonomy, and Paternalism	1560
? The ICU—Restricted Space, Many Patients, Limited Finances	1561
? Patient Satisfaction	1561
? Family Satisfaction	1562
Key Points	1562
Annotated References	1562
Chapter 214: Conversations with Families of Critically Ill Patients	1563
? Medical Decision Making	1563
? Family Conferences in the ICU	1564
? Summary	1566
Annotated References	1567
Chapter 215: Resource Allocation in the Intensive Care Unit	1568
? Allocation Versus Evidence-Based Medicine	1568
? Allocation Strategies	1569
? Illusory Cost Savings	1570
? Strategies for Bedside Allocation of Resources in the Intensive Care Unit	1570
? Conclusion	1571
Key Points	1572
Annotated References	1572
Chapter 216: Basic Ethical Principles in Critical Care	1573
? Foundations of Ethics in Critical Care	1573
? Goals of Care and Medical Decision Making	1573
Annotated References	1575
Chapter 217: Ethical Controversies in Pediatric Critical Care	1576
? Decision Making in the Pediatric Intensive Care Unit	1576
? Issues in End-of-Life Care	1577
? Family Presence at Resuscitation Attempts	1578
? Ethical Concerns After Death	1578
Annotated References	1579
Chapter 218: End-of-Life Issues in the Intensive Care Unit	1580
? How Are Critically Ill Patients Dying?	1580
? What Accounts for Variability in Practice?	1580
? Predicting Outcomes	1580
? Caring for Families in the Intensive Care Unit	1581
? Who Decides?	1581
? Conclusion	1583
Key Points	1583
Annotated References	1583
Chapter 219: Determination of Brain Death	1585
? Prerequisites	1585
? Unresponsiveness	1585
? Absence of Brainstem Reflexes	1585
? Confirmatory Testing	1586
? Children	1586
? Regional Rules and Laws	1586
Key Points	1586
Annotated Reference	1586
Part 14: Organization and Management of Critical Care	1587
Chapter 220: Building Teamwork to Improve Outcomes	1589
? Current Climate of Teamwork in Critical Care	1589
? Components of Effective Teamwork	1589
? Impact of Teamwork on Outcomes	1590
? Strategies to Establish Better Teamwork	1591
? Examples of Teamwork in Critical Care	1593
? Conclusion	1593
Key Points	1594
Annotated References	1594
Chapter 221: Pursuit of Performance Excellence	1595
? Background and Overview	1595
? The Baldrige Intensive Care Unit	1596
? Conclusion	1602
Key Points	1602
Annotated References	1603
Chapter 222: Severity-of-Illness Indices and Outcome Prediction:	1604
? Background	1604
? Outcome of Interest	1604
? Databases and Definitions	1604
? Model Development	1604
? Validation and Testing Model Performance	1606
? Standardized Mortality Ratio	1607
? Models Based on Physiologic Derangement	1607
? Comparisons Between Models	1610
? Uses For Severity-of-Illness Indices	1611
? Quality Improvement and Benchmarking	1611
? Predicting and Planning Resource Utilization	1612
? Use of Severity Indices in Clinical Research	1612
? Uses of Severity Adjustment for Individual Predictions	1612
? Pitfalls in the Application of Severity-of-Illness Indices	1613
? Conclusion	1614
Key Points	1614
Annotated References	1614
Chapter 223: Evaluating Pediatric Critical Care Practices	1615
? A Historical Perspective on Quality	1615
? Systems of Care	1615
? Designing for Evaluation	1615
? Evaluation Domains at the Unit Level	1616
? Evaluation Domains at the Provider Level	1619
? Conclusions	1621
Annotated References	1621
Chapter 224: Key Issues in Critical Care Nursing	1622
? Critical Care Nursing Knowledge and Skill Development	1622
? Clinical Topics	1622
? Conclusion	1626
Key Points	1626
Annotated References	1626
Chapter 225: Transport Medicine	1627
? Risks of Transport	1627
? Rapid Transfer, Goal-Directed Therapy, and the Golden Hour	1627
? Regionalization of Critical Care	1628
? Out-of-Hospital Transport	1628
? Structure of Regional and Specialty Retrieval Systems	1629
? Responsibilities of the Referring Hospital	1630
? Unique Aspects of Pediatric Transport	1630
? In-Hospital Transport	1631
? Conclusion	1632
Key Points	1632
Annotated References	1632
Chapter 226: Mass Critical Care	1633
? Background	1633
? Terminology	1633
? Classification of Disasters	1634
? Natural Disasters	1634
? Manmade Disasters	1637
? Medical Disaster Syndromes	1640
? Disaster Preparedness	1642
? Issues Unique to the Intensive Care Unit	1643
? Critical Care in Unconventional Situations	1644
? Critical Care Transport	1644
? Conclusion	1644
Key Points	1644
Annotated References	1645
Chapter 227: Evidence-Based Critical Care	1646
? Asking a Question	1646
? Types of Evidence	1646
? Appraising Evidence	1649
? Applying Evidence	1649
? Problems with Evidence-Based Medicine in Critical Care	1650
? Conclusion	1651
Key Points	1651
Annotated References	1652
Chapter 228: Teaching Critical Care	1653
? Creating Educational Objectives	1653
? Motivating Students to Learn	1653
? Learning Experiences	1654
? Evaluation	1655
? Providing Effective Feedback	1657
Key Points	1657
Annotated References	1657
Index	1659
IBC	1703

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