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Key Clinical Topics in Critical Care
Sara-Catrin Cook, Matt Thomas, Jerry Nolan, Michael Parr
Abdominal compartment syndrome
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Acute coronary syndrome
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Immediate management
Revascularisation
STEMI
Thrombolytic therapy
NSTE-ACS
Antiplatelet therapy
Anticoagulants
Beta-blockade
ACE inhibitor/ARB
Spironolactone
Statins
Glycaemic control
Rehabilitation
Complications
Related topics of interest
Acute respiratory distress syndrome (ARDS) – diagnosis
Key points
Diagnosis
Epidemiology
Pathophysiology
Clinical features
Investigations
Related topics of interest
Acute respiratory distress syndrome (ARDS) – treatment
Key points
Treatment
Prevention of complications
Ventilation and lung protective strategies
Paralysis
Fluid management
Steroids
Alternative ventilatory strategies
Alternative strategies for refractive hypoxia
Related topics of interest
Adrenal disease
Key points
Adrenal gland function
Control of medullary catecholamine release
Control of mineralocorticoid release
Control of glucocorticoid activity – the hypothalamic-pituitary-adrenal axis
Adrenocortical excess
Cushing's syndrome
Features of Cushing's syndrome
Conn's syndrome
Adrenal insufficiency
Diagnosis of adrenal insufficiency
Effects of glucocorticoid deficiency
Critical illness-related corticosteroid insufficiency
Steroids in sepsis
Catecholamine excess – phaeochromocytoma
Related topics of interest
Airway complications on the intensive care unit
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Treatment
Complications
Related topics of interest
Airway management in an emergency
Key points
Basic airway management
Indications for definitive airway
Adverse outcomes in emergency airway management
Related topics of interest
Airway obstruction – upper and lower
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Analgesia in critical care – advanced
Key points
Pain scoring and assessment
Simple analgesia
Opioid drugs
Specific opioids
Epidural analgesia
Mode of action
Benefits and complications
Monitoring an epidural block
Epidural removal
Nerve blocks and infusions
Procedural analgesia on the ICU
The difficult pain patient on the ICU
Related topics of interest
Anaphylaxis
Key points
Epidemiology
Key figures
Pathophysiology
Classical pathway
Other immunological mechanisms
Other non-immunological mechanisms
Common end pathway
Triggers
Clinical features
Diagnosis
Treatment
Immediate management
Subsequent management
Investigations
Related topics of interest
Antibiotics, antivirals and antifungals
Key points
Antibiotic resistance
Pharmacokinetics and pharmacodynamics of antibiotics in critically ill patients
Anti-viral drugs
Anti-fungals
Related topics of interest
Arterial blood gases – acid–base physiology
Key points
Dilution
Buffers
Respiratory compensation
Renal control
Tubular secretion of hydrogen ions
Interaction of bicarbonate and hydrogen ions in the tubules
The liver
Bone
The Stewart approach to acid–base balance
Saline administration
Related topics of interest
Arterial blood gases – analysis
Key points
Pao2 – partial pressure of oxygen in arterial blood
Paco2 – partial pressure of carbon dioxide in arterial blood
pH
Standard bicarbonate
Actual bicarbonate
Base excess and base deficit
Interpretation of blood gas data
Lactate
Alpha-stat versus pH stat
Related topics of interest
Arterial cannulation
Key points
Introduction
Indications
Contraindications
Technique
Alternatives to radial artery cannulation
Ulnar artery
Brachial artery
Dorsalis pedis
Femoral artery
Sources of error
Estimating cardiac output and fluid responsiveness from an arterial catheter
Complications
Related topics of interest
Asthma
Key points
Epidemiology
Clinical features
Pathophysiology
Clinical features
Investigations
Treatment
Treatment – immediate
Fluid therapy in severe asthma
Heliox
Anaesthetics
Extracorporeal life support
Prognosis
Related topics of interest
Blood and blood products
Key points
Screening
Collection and storage
Leucodepletion, washing, irradiation and pathogen inactivation
Blood components
Whole blood
Red cells
Platelets
Fresh frozen plasma
Cryoprecipitate
Other plasma products
Alternatives to homologous blood
Autologous donation
Perioperative red cell salvage
Red cell substitutes
Related topics of interest
Blood coagulopathies
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Coagulation tests
Specific problems
Haemophilias
Von Willebrand's disease
Haemostatic failure associated with liver disease
Oral anticoagulant agents
Heparin
Anti-platelet agents
Disseminated intravascular coagulopathy
Thrombocytopenia
Bleeding related to thrombolysis
Tranexamic acid
Recombinant factor VIIa (rFVIIa)
General management principles for abnormal bleeding
Related topics of interest
Blood transfusion and complications
Key points
Anaemia in the critically ill
Blood transfusion triggers
Haemorrhage and massive transfusion
Compatibility testing
Complications of blood transfusions
Related topics of interest
Brain death and organ donation
Key points
Determination of death
Cardiorespiratory criteria
Neurological criteria
Diagnosis of death by neurological criteria
Preconditions
Exclusion of reversible causes
Medications
Cardiorespiratory parameters
Temperature
Biochemistry
Other causes of apnoea
Testing
Brainstem reflexes
Apnoea testing
Other tests
Organ donation and transplantation
Donor identification
Consent
Donation after circulatory death
Donation after brain death
Related topics of interest
Burns
Key points
Epidemiology
Pathophysiology
Systemic changes
Metabolic
Pulmonary
Immune system
Clinical features
Investigations
Diagnosis
Treatment
Airway and inhalational injury
Fluid resuscitation
Ventilation
Analgesia
Nutrition and metabolism
Infection
Surgical management
Complications
Related topics of interest
Calcium, magnesium and phosphate
Key points
Calcium
Hypocalcaemia
Clinical features
Treatment
Calcium management following parathyroidectomy
Calcium infusion after parathyroidectomy
Hypercalcaemia
Clinical features
Treatment
Magnesium
Hypomagnesaemia
Clinical features
Treatment
Hypermagnesaemia
Clinical features
Treatment
Phosphate
Hypophosphataemia
Clinical features
Treatment
Hyperphosphataemia
Clinical features
Treatment
Related topics of interest
Cancer patients andcritical care
Key points
Introduction
Oncological and haematological emergencies
Direct tumour involvement
Superior vena cava syndrome
Neurological complications
Malignant pericardial effusion
Metabolic complications
Malignant hypercalcaemia
Syndrome of inappropriate secretion of anti-diuretic hormone
Complications of treatment
Respiratory complications
Febrile neutropaenia
Gastrointestinal toxicities
Cardiac toxicities
Neurological complications
Tumour lysis syndrome
Graft versus host disease
Toxicities of targeted therapies
The dilemma of admission
Related topics of interest
Cardiac arrhythmias
wKey points
Epidemiology
Pathophysiology
Assessment
Treatment options
Related topics of interest
Cardiac failure – acute
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Related topics of interest
Cardiac output measurement
Key points
Introduction
Clinical features
Pulmonary artery floatation catheter
Oesophageal Doppler
LiDCO plus and LiDCO rapid systems
FloTrac/Vigileo system
PiCCOPlus System
Echocardiography
Bioimpedance and bioreactance
Haemodynamic optimisation
Related topics of interest
Cardiac pacing
Key points
Introduction
Permanent pacemakers
Temporary pacemakers
Pacemaker problems
Implantable cardioverter-defibrillators
Related topics of interest
Cardiac surgery – postoperative care
Key points
Cardiovascular issues
Heart rate
Pacing
Pre-load
Contractility
Afterload
Right ventricular dysfunction
Tamponade
Cardiac arrest after cardiac surgery
Mechanical support
Intra-aortic balloon pump
Left ventricular assist devices
Respiratory issues
Ventilation
Post-operative pulmonary function
Renal issues
Gastrointestinal issues
Pancreatitis
Cholecystitis
Hepatic dysfunction
Feeding
Neurological issues
Haematological issues
Infective issues
Re-introduction of medicines
Cardiovascular
Diabetes
Central nervous system
Long-term steroids
Related topics of interest
Cardiac valve disease
Key points
Epidemiology
Aortic stenosis
Investigations
Management
Aortic regurgitation
Investigations
Management
Mitral regurgitation
Investigations
Management
Mitral stenosis
Investigations
Management
Related topics of interest
Cardiopulmonary resuscitation
Key points
Epidemiology
Pathophysiology
Resuscitation decisions
Basic life support
Feedback systems
Advanced life support
Mechanical devices
Airway management
Vascular access
Use of ultrasound during advanced life support
Extracorporeal life support
Related topics of interest
Care bundles
Key points
Background
Ventilator care bundle
Central line care bundle
Sepsis care bundle
Related topics of interest
Central venous cannulation
Key points
Central venous cannulation
Complications of CVCs
Insertion sites
Internal jugular vein
Subclavian vein
Basilic vein
Femoral vein
Insertion guidelines
Central venous pressure measurement
Related topics of interest
Chest tube thoracostomy
Key points
Indications
Equipment
Technique
Bronchopleural fistulae
Complications
Removal of chest drains
Related topics of interest
Chronic obstructive pulmonary disease
Key points
Epidemiology
Pathophysiology
Clinical features and diagnosis of COPD
Investigations
Treatment of COPD
Non-pharmacological therapy
Pharmacological therapy
Treatment of exacerbation of COPD
Outcome
Related topics of interest
Coma
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Treatment
Neurosurgical emergencies
Extradural haemorrhage
Subdural haemorrhage
Intracerebral haemorrhage
Intracerebral infarction
Brain death
Vegetative state
Locked-in syndrome
Pseudo-coma/psychogenic coma
Global ischaemia
Related topics of interest
Consent
Key points
Consent
Definition of consent
Role of consent
Principles of consent
Consent and age
Capacity
Treatment in those who lack capacity
Proxy decision-making
Best interests
Advance decisions
Independent mental capacity advocates
Research
Critical illness polyneuromyopathy
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Differential diagnosis
Treatment
Complications
Related topics of interest
Delirium
Key points
Epidemiology
Pathophysiology
Clinical features
Hyperactive delirium
Hypoactive delirium
Mixed delirium
Investigations
Biochemical tests
Electrophysiology studies
Radiology
Diagnosis
Intensive care delirium screening checklist
Confusion assessment method – ICU (CAM-ICU)
Treatment
Complications
Related topics of interest
Diabetes mellitus
Key points
Epidemiology
Pathophysiology
Specific diabetic emergencies
Diabetic ketoacidosis (DKA)
Pathophysiology
Clinical features
Investigations
Treatment
Other supportive treatment
Complications
Hyperglycaemic hyperosmolar state
Pathophysiology
Clinical features
Investigation
Treatment
Hypoglycaemia
Management
Intensive insulin treatment in critically ill patients
Related topics of interest
Diarrhoea
Key points
Epidemiology
Pathophysiology
Clostridium difficile and antibiotic-associated diarrhoea
Investigations
Prevention
Treatment
Non-infective diarrhoea
Complications
Related topics of interest
Drug overdose and poisons
Key points
Epidemiology
Resuscitation
Substance identification
Investigations
Treatment
Drug elimination
Specific treatments
Tricyclic antidepressants
Selective serotonin reuptake inhibitors
Quetiapine
Paracetamol
Aspirin
Anticholinergic drugs
Amphetamines and ecstasy
Benzodiazepines
Beta-blockers
Calcium channel blockers
Digoxin
Ethanol
Methanol
Ethylene glycol
Opioids
Lithium
Organophosphates and carbonates
Related topics of interest
Echocardiography for critical care
Key points
Assessments
Left ventricular function
Preload
Regional wall motion abnormality (see Table 19)
Right ventricular function
Valvular dysfunction (see Table 20)
Cardiac output
Clinical conditions
Related topics of interest
Extracorporeal membrane oxygenation
Key points
Definition and description
Modes of ECMO
The ECMO Circuit
Practicalities
Indications
Contraindications
Complications
Evidence supporting the use of ECMO
Extracorporeal carbon dioxide removal
Related topics of interest
Endocarditis
Key points
Epidemiology
Causative organisms
Native valve endocarditis
Prosthetic valve endocarditis
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Prophylaxis
Related topics of interest
End-of-life care
Key points
Decision making
Patient autonomy versus paternalism
Communication
Family support
Cultural and spiritual differences
Withdrawing life support
Symptom control
Pain
Dyspnoea
Delirium
Death rattles
Terminal care
Related topics of interest
Ethics
Key points
Basic principles
Withholding and withdrawing treatment
Rationing
Organ donation
Informed consent for research
Dealing with difficult decisions
Related topics of interest
Fibreoptic bronchoscopy
Key points
Diagnostic uses
Diagnostic indications
Therapeutic indications
Airway management
Complications
Related topics of interests
Fluid therapy
Key points
Physiology
Crystalloids
Colloids
Blood
Albumin
Gelatins
Hydroxyethyl starch
Artificial oxygen carriers
Haemoglobin-based oxygen carriers (HBOCs)
Perfluorocarbon emulsions
How much is enough?
Related topics of interest
Guillain–Barré syndrome
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Haematological disorders
Key points
Epidemiology
Pathophysiology
Leukaemia
Lymphoma
Myeloma
Clinical features
Acute leukaemias
Chronic leukaemias
Lymphomas
Myeloma
Investigations
Diagnosis
Treatment
General supportive care
Disease specific
Complications
ARDS
Bone marrow failure
Renal failure
Metabolic derangement
Related topics of interest
HIV and critical care
Key points
Epidemiology
Pathophysiology
Diagnosis
HIV testing in critical care
Presentation
Treatment
Prognosis
Pneumocystis jiroveci pneumonia
Presentation
Investigations
Complications
Treatment
Related topics of interest
Hypertension
Key points
Epidemiology
Pathophysiology
Causes of hypertension
Essential hypertension
Secondary hypertension
Clinical features
Investigations
Diagnosis
Treatment
Malignant hypertension
Complications
Related topics of interest
Hyperthermia
Key points
Pathophysiology
Clinical features
Treatment
3,4-methylenedioxymetha-mphetamine (MDMA, Ecstasy) poisoning
Serotonin syndrome
Neuroleptic malignant syndrome
Malignant hyperthermia
Related topics of interest
Hypothermia
Key points
Epidemiology
Pathophysiology
Drowning
Clinical features
Cardiovascular
Respiratory
Central nervous system
Metabolic
Renal
Haematological
Endocrine
Infection and immunity
Gastrointestinal
Investigations
Diagnosis
Treatment
Therapeutic hypothermia
Related topics of interest
ICP monitoring
Key points
Introduction
ICP physiology and pathophysiology
ICP-guided management of traumatic brain injury
Cerebrovascular pressure reactivity
Related topics of interest
Infection acquired in hospital
Key points
Epidemiology
Pathophysiology
Diagnosis
Treatment
Treatment of focus
Antibiotic choice
Pathogens of particular importance
Coagulase negative staphylococci
Staphylococcus aureus
Enterobacteriaceae
Pseudomonas aeruginosa
Acinetobacter spp. and Stenotrophomonas maltophilia
Clostridium difficile
Enterococci
Candida
Foci of infection
Respiratory tract infections
Epiglottitis
Urinary tract infection
Bloodstream infection
Catheter-associated bloodstream infection
Central nervous system infection
Abdominal sepsis including C. difficile
Wound infection
Related topics of interest
Infection prevention and control
Key points
Introduction
Alert organisms
Surveillance
Risk factors for acquiring an infection
Policies and procedures
Hygiene
Environmental
Hand washing
Personal protective equipment
Isolation
Antibiotic stewardship
Related Topics of Interest
Inotropes and vasopressors
Key points
Introduction
Sympathomimetic amines
Noradrenaline (norepinephrine)
Adrenaline (epinephrine)
Dopamine
Isoprenaline
Dobutamine
Dopexamine
Administration
Cardiac glycosides
Digoxin
Phosphodiesterase inhibitors
Amrinone, milrinone and enoximone
Calcium sensitisation
Levosimendan
Vasopressors
Metaraminol, phenylephrine and ephedrine
Vasopressin (anti-diuretic hormone)
Related topics of interest
Liver failure – acute
Key points
Definition
Epidemiology
Pathophysiology
Causes of ALF
Clinical features
Investigation and diagnosis
Treatment
Management of hepatic encephalopathy and cerebral oedema
Management of intracranial hypertension
Controlling ammonia levels
Intubation and mechanical ventilation
Haemodynamic management
Renal dysfunction
Coagulopathy
Infection
Acetylcysteine
Liver transplantation
Outcome
Related topics of interest
Liver failure – chronic
Key points
Epidemiology and Pathophysiology
Clinical features
Cardiovascular
Nutrition and gastrointestinal function
Infection
Ascites
Electrolytes and renal function
Alcohol withdrawal
Common clinical scenarios in patients with CLD presenting to ITU
Massive upper GI bleeding secondary to varices
Severe sepsis
Hepatic encephalopathy and low GCS
Hepatopulmonary syndrome
Alcoholic hepatitis
Acute kidney injury
Investigations
Prognosis
Related topics of interest
Major haemorrhage
Key points
Definition
Epidemiology
Pathophysiology
Clinical features
Investigations
Treatment
Complications
Related topics of interest
Meningitis and encephalitis
Key points
Epidemiology
Pathology
Clinical features
Investigation
Treatment
Complications
Seizures
Raised ICP
Neurological deficits
Prophylaxis
Prognosis
Related topics of interest
Meningococcal sepsis
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Myasthenia gravis
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Myasthenic crisis
Cholinergic crisis
Related topics of interest
Neurological diseases
Key points
Duchene muscular dystrophy and Becker's muscular dystrophy
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Multiple sclerosis
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Motor neurone disease
Epidemiology
Pathophysiology
Clinical features
Investigations
Treatment
Complications
Related topics of interest
Nutrition
Key points
Recognition of malnutrition
Nutritional requirements
Timing and route of nutrition provision
Immunonutrition
Recent studies in critical care nutrition
Related topics of interest
Obstetric emergencies – haemorrhage
Key points
Epidemiology
Principles of management of obstetric haemorrhage
Antepartum haemorrhage
Placental abruption
Placenta praevia
Primary postpartum haemorrhage
Uterine atony
Retained products of conception
Trauma
Coagulation defect
Principles of management of PPH
Secondary PPH
Related topics of interest
Obstetric emergencies – medical
Key points
Maternal sepsis
Pre-eclampsia and eclampsia
Pre-eclempsia
Eclampsia
HELLP Syndrome
Management of pre-eclampsia
Thromboembolism
Amniotic fluid embolism
Pathophysiology
Clinical features
Cardiac disease in pregnancy
Cardiac arrest in pregnancy
Local anaesthetic toxicity
Related topics of interest
Oscillation and high-frequency ventilation
Key points
Introduction
Definition
Mechanism of action
Clinical application of HFOV
Initiating HFOV
Initial setting on HFOV
Oxygenation protocol
Ventilation protocol
Maintenance
Weaning and switching from HFOV to CMV
Evidence for efficacy
Related topics of interest
Pancreatitis – acute severe
Key points
Epidemiology
Causes
Pathophysiology
Clinical features
Investigations
Amylase
Lipase
Chest X-ray
Ultrasound scan
Computerised tomography
Magnetic resonance imaging
Endoscopic ultrasound
Diagnosis
Severity assessment
Treatment
Nutrition
Prophylactic antibiotics
Endoscopic retrograde cholangiopancreatography
Surgery
Complications
Pancreatic necrosis
Pseudocyst
Related topics of interest
Pandemic influenza
Key points
Introduction
Pandemics over the past 100 years and antigen shifts
Case definitions
Definitions of illness severity
Predictors of outcome
Diagnostic assays
Treatment
ICU management and referral guidelines for severe hypoxic respiratory failure
Hypoxic respiratory failure fulfilling ARDS criteria:
Non-ventilatory management
Ventilatory management
0–48 h
Day 3 onwards
Related topics of interest
Patient safety
Key points
Quality, safety and error
Quality of care
Risk factors
Quality improvement
Care bundles
Matching Michigan
Critical care bundles
Promoting the safer ICU
Related topics of interest
Pituitary disease
Key points
Anatomy and physiology
The pituitary in intensive care patients
Traumatic brain injury and subarachnoid haemorrhage
Panhypopituitarism
Pituitary tumours
Multiple endocrine neoplasia
Related topics of interest
Pleural disease
Key points
Epidemiology
Pneumothorax
Pleural effusion
Empyema
Clinical features
Pneumothorax
Pleural effusions
Empyema
Haemothorax
Investigations
Chest radiograph
Ultrasound
Computed tomography
Pleural aspiration
Treatment
Pneumothorax
Effusions
Empyema
Size of chest drain
Complications
Related topics of interest
Pneumonia – community acquired
Key points
Epidemiology
Clinical features and initial management
CURB-65
Investigations and diagnosis
Treatment
Antibiotics
Ventilation
Circulation
Complications
Related topics of interest
Pneumonia – hospital acquired
Key points
Epidemiology
Pathophysiology
Diagnosis
Treatment
Prevention of ventilator-associated pneumonia
Related topics of interest
Post-resuscitation care
Key points
Epidemiology
Pathophysiology – the post cardiac arrest syndrome
Airway and breathing with controlled reoxygenation
Circulation
Brain (disability)
Targeted temperature management
Indications for post-arrest cooling
Cooling techniques
Sedation
Cerebral perfusion
Control of seizures
Glucose control
Prognostication
Organ donation
Cardiac-arrest centres
Related topics of interest
Potassium
Key points
Introduction
Homeostasis
Hypokalaemia
Causes
Clinical features
Management
Hyperkalaemia
Causes
Impaired renal excretion
Potassium shift from cells
Other
Clinical features
Management
Related topics of interest
Pre-hospital care
Key points
Introduction
Advanced pre-hospital interventions
Sedation, analgesia and anaesthesia
Airway management
Circulatory control
Surgical procedures
Delivering the right resources to the patient
Delivering the patient to the right resources
The future of pre-hospital care
Related topics of interest
Pulmonary function tests
Key points
Indications
Pre-operative assessment
Monitoring disease progression or response to treatment during critical care admission
Spirometry and diffusing capacity
Flow-volume loops
Cardiopulmonary exercise testing
Other investigations
Related topics of interest
Quality indicators
Key points
Background
Structural-based quality indicators
Process-based quality indicators
Outcome-based quality indicators
Related topics of interest
Quality of life after ICU
Key points
Introduction
Measuring quality of life
Care requirement
Chronic pain
Mobility
Tracheostomy
Appetite
Sleep
Anxiety/depression/post-traumatic stress disorder
National Institute of Health and Care Excellence Guidance
Follow-up clinics
Related topics of interest
Radiology for critical care
Key points
Imaging for critically ill patients
Plain films
Ultrasonography
Cross-sectional imaging
Related topics of interest
Rapid response systems
Key points
Related topics of interest
Refractory hypoxaemia
Key points
Definition
Epidemiology
Identifying patients at risk of developing refractory respiratory failure
Management
Diagnosis and appropriate treatment
Good supportive management
Management of respiratory failure
Ventilatory management
Non-ventilatory strategy
Related topics of interest
Renal – acute kidney injury
Key points
Definition
Epidemiology
Pathophysiology
Investigations
Assessment of renal function
Diagnosis
Prevention
Related topics of interest
Renal – treatment of established acute kidney injury
Key points
Preparation for renal-replacement therapy
Indications for renal-replacement therapy
Principles of dialysis and filtration
Renal-replacement-therapy techniques
Intermittent haemodialysis
Continuous renal replacement therapies
Replacement fluid
Anticoagulation
Nutrition
Diuretic phase
Related topics of interest
Respiratory support – invasive
Key points
Definitions
Indications for invasive mechanical ventilation
Complications
Ventilator settings
Alternative modes and therapies
Reverse I:E ratio
Nitric oxide
Tracheal gas insufflation
Prone ventilation
Extracorporeal CO2 removal
Extracorporeal membrane oxygenation
High-frequency oscillatory ventilation
Related topics of interest
Respiratory support – non-invasive techniques
Key points
Acute hypoxaemic (Type I) respiratory failure
Ventilatory (Type II) respiratory failure
Assessment
Simple measures to improve respiratory function
Oxygen therapy
Variable performance devices
Fixed-performance devices
Continuous positive airway pressure
Non-invasive ventilation
Related topics of interest
Scoring systems
Key points
Background
Acute physiology and chronic health evaluation (APACHE)
Simplified acute physiology score (SAPS)
Mortality prediction model (MPM)
Multiple organ dysfunction score (MODS)
Sequential organ failure assessment (SOFA)
Intensive Care National Audit and Research Centre (ICNARC)
Summary
Related topics of interest
Sedation
Key points
General principles
The ideal sedative
Drug administration
Drugs
Sedative drugs
Analgesic drugs
Assessment of sedation
Related topics of interest
Seizures – status epilepticus
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations and diagnosis
Treatment
Choice of anticonvulsant
Non-convulsive status
Non-epileptic status
Related topics of interest
Selective oropharyngeal and digestive tract decontamination
Key points
Introduction
Rationale
Method
Evidence
Related topics of interest
Sepsis – management
Key points
Resuscitation
Airway and breathing
Circulation
Fluid therapy
Vasoactive drugs
Diagnosis
Antibiotics
Source control
General supportive measures
The role of corticosteroids
Other therapies
Related topics of interest
Sepsis – pathophysiology
Key points
Introduction
Trigger
Recognition
Mediator release
The compensatory anti-inflammatory response syndrome
Cellular hypoxia
Organ dysfunction
Related topics of interest
Sepsis and SIRS
Key points
Introduction
Incidence and outcome
Definitions
Causes of SIRS
Related topics of interest
Sickle cell disease
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Skin and soft tissue infections
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Sodium
Key points
Hyponatraemia
Pathophysiology
Clinical features of hyponatraemia
Diagnosis
Treatment
Hypernatraemia
Pathophysiology
Diabetes insipidus
Causes of cranial DI
Causes of nephrogenic DI
Diagnosis
Clinical features
Treatment
Related topics of interest
Spinal injuries
Key points
Epidemiology
Pathophysiology
Clinical features of acute injury
Complete cord injury
Airway
Breathing
Circulation
Neurology
Temperature
Gastrointestinal tract
Genitourinary
Biochemical and endocrine
Thromboembolism
Incomplete cord injury
Investigations
Diagnosis
Treatment
Airway with cervical spine control
Breathing
Circulation
Neurology
Gastrointestinal tract
Genitourinary
Musculoskeletal
Skin
Thromboembolism
Psychological
Spinal injuries in children
SCIWORA
Related topics of interest
Stress ulceration prophylaxis
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Risk factors
Treatment
Nutrition
Antacids
H2-receptor antagonists
Sucralfate
Proton pump inhibitors
Misoprostol
Complications
Complications of management
Related topics of interest
Stroke
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Subarachnoid haemorrhage
Key points
Epidemiology
Aneurysmal sub-arachnoid haemorrhage
Idiopathic sub-arachnoid haemorrhage
Ruptured cerebral arteriovenous malformation
Pathophysiology
Clinical features
Investigations and diagnosis
Detection of sub-arachnoid blood
Location of aneurysm
Treatment
Prevention of re-bleeding
Treatment of hydrocephalus
Prevention and treatment of cerebral artery vasospasm
Seizures
Complications
Medical complications
Outcome after aneurysmal subarachnoid haemorrhage
Related topics of interest
Tetanus
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Thyroid gland disorders
Key points
Thyroid crisis
Epidemiology
Pathophysiology
Clinical features
Investigation
Treatment
Complications
Myxoedema coma
Epidemiology
Pathophysiology
Clinical features
Treatment
The thyroid gland in critical illness
Related topics of interest
Tracheostomy
Key points
Indications
Timing of tracheostomy
Percutaneous dilatational tracheostomy
Contraindications to PDT
Complications of PDT
The technique of PDT
Displaced tracheostomy
Related topics of interest
Transplant medicine
Key points
Introduction
Hepatic transplantation
Cardiothoracic transplantation
Renal transplantation
Pancreas transplantation
Stem cell transplantation
Tissue transplantation
Graft rejection
Immunosuppression
Conclusion
Related topics of interest
Transport of the critically ill
Key points
Introduction
Impact of transport
Adverse events
Benefits
Prevention of adverse events
Transport
During transfer
Inter-hospital transfer
Aeromedical transfer
Related topics of interest
Trauma – primary survey
Key points
Epidemiology
Pathophysiology
Physiological response to haemorrhage
Systemic inflammatory response syndrome
Pre-hospital management
Trauma networks
The trauma team
The primary survey and resuscitation
Airway and cervical spine control
Breathing
Circulation
Disability
Exposure/environment
Tubes
Radiology
Related topics of interest
Trauma – secondary survey
Key points
Objectives of the secondary survey
Head
Face and neck
Thorax
Pulmonary contusion
Cardiac contusion
Blunt aortic injury
Rupture of the diaphragm
Oesophageal rupture
Tracheobronchial injury
Abdomen
Extremities
Spinal column
Burns
Medical history
Analgesia
Systemic analgesia
Local and regional analgesia
Related topics of interest
Trauma – anaesthesia and critical care
Key points
In-hospital airway management for the trauma patient
Cervical spine protection
Failed intubation
Induction drugs in the haemodynamically compromised trauma patient
Neuromuscular blocking drugs
Cricoid pressure
Bag-mask ventilation during rapid sequence induction and intubation
Intra-operative management
Management of the trauma patient on the critical care unit
Venous thromboembolism
Fat embolism syndrome
Related topics of interest
Traumatic brain injury
Key points
Epidemiology
Pathophysiology of secondary brain injury
Immediate assessment and resuscitation
Management of intubation
Breathing
Circulation
Disability
Exposure
Management of critically raised intra-cranial pressure
Steroids
Management of seizures
Identifying head-injured patients who require immediate life-saving neurosurgery
Reducing cerebral metabolic requirements
Investigations
Computed tomography
Monitoring
Adjunctive therapy
Outcome
Related topics of interest
Upper gastrointestinal bleeding
Key points
Epidemiology
Pathophysiology
Clinical features
Investigations
Diagnosis
Treatment
Complications
Related topics of interest
Vasculitides
Key points
Epidemiology
Pathophysiology
Clinical features
Polyarteritis nodosa
Granulomatosis with polyangiitis: previously known as Wegener's granulomatosis
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis: previously known as Churg-Strauss syndrome
Behçet's syndrome
Giant cell arteritis
Takayasu's arteritis
Other autoimmune disorders associated with vasculitis
Investigations
Urinalysis
Blood tests
Imaging
Histology
Diagnosis
Treatment
Complications
Related topics of interest
Venous thromboembolism
Key points
Epidemiology
Pathophysiology
Clinical features
Risk factors
Diagnosis
Investigations
Prophylactic measures
Physical
Pharmacological
Insertion of IVC filter
Treatment
Anticoagulation
IVC filter – indications for its use include:
Thrombolytic
Embolectomy
Contraindications to pharmacological measures
Related topics of interest
Weaning from ventilation
Key points
Epidemiology
How to wean
Mode of ventilation support for patient who fail initial weaning
Weaning protocols
Cardiac failure
Muscle wasting
Tracheostomy
Related topics of interest
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