Case-based Review in Critical Care Medicine: A Comprehensive Preparatory Book for the Examinee Subhal Bhalchandra Dixit, Atul Prabhakar Kulkarni, Rahul Anil Pandit, Kapil Gangadhar Zirpe
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abciximab 150
Abdomen 235
Abdominal closure, temporary 311
Abdominal surgery, upper 166
Abscess, intra-abdominal 122
Acetaminophen 314, 318
Acetylcholine 254, 287
Acetylcholinesterase inhibition 285
Acidemia 43
Acidosis 243, 247, 266
management 89
Acinetobacter 32
infections 381
Acquired immunodeficiency syndrome 21, 110, 111
Acute worsening, causes of 370
Acyclovir, intravenous 216
Adenosine deaminase 362
activity 15
Adenovirus 9, 10
Adipose tissue 295
Adrenal failure 141
Adrenal insufficiency 121, 259, 260
Adrenalin 61, 151, 358
adverse effects of 358
Advanced cardiovascular monitoring, role of 158
Advanced hemodynamic monitoring 317
Advanced trauma life support 233, 233b
Aerosol therapy 52
Aerosolized short-acting B-agonists 46
Aggressive bronchodilator therapy 66
Agitation 2
under sedation 111
Airway 1, 2
assessment of 215
breathing and circulation 5
changes 186
management of 196
pressure release ventilation 98, 99
protection 111
with cervical spine clearance 234
Akin classification 293t
Alanine aminotransferase 181, 361
Alberta stroke program 205
Albumin 322, 361
across albumin impermeable membrane 322
bound toxins 320
dialysis, single-pass 322
levels, normal 197
Alcohol 277
abuse 299
active 12
chronic 169
Aldicarb 288
Alemtuzumab 132
Alkalanisation 287
Alkaline phosphatase 297
Alkalinization 288
Alkalosis 367
chronic respiratory 366
management 89
Allograft rejection 132
acute 129
chronic 129
Allopurinol 114
Alteplase 77, 208, 358
Alternaria 119
Alveolar-arterial gradient 342, 366
Alzheimer's disease 37
Amanita phalloides 314
silibinin in 319
Amantadine 15
Amaurosis fugax 207
American Academy of Neurology 328
American Association for Study of Liver Diseases 314
American College of Cardiology 153
American College of Gastroenterology 309
American College of Obstetricians and Gynecologists 182
American European Consensus Conference 85
American Heart Association 153, 327
American Pancreatic Association 309
American Thoracic Society 12, 15, 16, 25, 49, 176
Aminopenicillins 143
Aminophylline 46
Amiodarone 134, 358, 375, 376
Amitriptyline 277, 368
Ammonia 321
absorption 318
levels 316
lowering agents 318
Amoxicillin 122, 386
Amphetamine 277
Amphotericin B 358, 372, 381
Ampicillin 122
addition of 386
Ampulla of Vater, stenosis of 308
Amyloidosis 383
Anaerobic metabolism 173, 174
diagnosis of 174
Anaerobic oral flora 10
Analgesia 5, 249
adequate 157
epidural 168
opioids for 167t
Analgesics 277
Analog octreotide 301
Anaphylaxis 69
Ancillary tests 328, 329, 346, 370
types of 329
Anemia 185, 248
hemolytic 184
presence of 82
Anesthetic agents
inhalational 61
inhaled general 66
short-acting 167
Aneurysm 181
coiling of 199
repair 199
Angina 157
unstable 148
Angiodysplasia 299
Angiography 122, 189
Angiopathy, thrombotic 185
Angioplasty, rescue 150
Angiotensin converting enzyme 160
Antagonism, receptor 183
Antiarrhythmic 358
class of 358
drugs 382
classes of 382
Antibiotic 32, 46, 216, 374
broad-spectrum 371
choice of 18
continuation of 44
empiric choice of 15
empirical 346
prophylaxis 167
selection of 33fc
stewardship 138fc, 219
programs 124
role of 219
substrate 143
susceptible 143
therapy 15
Antibody
anticardiolipin 185
antiganglioside 253
antinuclear 8, 293
antiphospholipid 185
Anticholinergic agent 285
Anticholinisterase drugs 277
Anticipate autonomic storm 330
Anticoagulant drugs 151t, 320
Anticoagulation 372
empiric 76
Anticonvulsants 134, 308
Antidepressant poisoning, tricyclic 280
Antidepression 277
Antidiuretic hormone secretion, syndrome of inappropriate 260, 384
Antidotes, specific 278
Antiepileptic
agents 328
drug, second 217
Antifungal therapy 118, 372
Antigen 106
antibody tests 119
test 129
Anti-glomerular basement membrane 293
Antihistamines 175
Antihypertensive 345
therapy 207
Anti-lymphocyte globulin 132
Anti-mannan antibody 119
Antimicrobial 134
spectrum for drug 358
Anti-neutrophil cytoplasmic antibody 293
Antiphospholipid antibody syndrome 184
Antiplatelet
agents 152
drugs 150t
medicines, role of 160
therapy 209, 299
Anti-pneumocystis effect 131
Antipseudomonal activity 32
Antipseudomonal beta-lactam plus fluoroquinolone 15
Antipseudomonal penicillin 32
Antirestenotic drugs 152
Antithrombotics immediately, use of 369
Anti-thymocyte globulins 132
Antituberculosis drugs 314
Antiviral prophylaxis 129, 133
Aorta 158
Aortic
dissection 373
injury, traumatic 233
pathologies 373
Aphasia 189, 207
Apixaban 76, 152
Apnea test 328, 329
Appendicitis 122
Apraxia 207
Areflexia 254
Arginine vasopressin 330
Argon plasma coagulation 302
Arm drift 202
Arrhythmias 17, 199
absence of 365
Arterial blood 85
gas 9, 41, 43, 45, 50, 59, 63, 71, 109, 111, 187, 258, 285, 308, 326, 341, 342
analysis 82
tests 206
pressure 363
trace 379
Arterial carbon dioxide, partial pressure of 43, 50
Arterial line tracing 339
Arterial oxygen
partial pressure of 12
saturation 72
tension, low 131
Arterial pressure waveform 158
Arterial pulse 227f
Arterial thrombosis 121
Arterio-arterial embolism 206
Artery thrombosis, large 206
Arthralgia 106
Artificial liver support devices 321, 321t, 322t
Ascaris 308
Ascites 319
Aspartate aminotransferase 181, 361
Aspergillus 17, 129, 130, 308
fumigatus 120
terreus 381
Aspiration 79, 83
pneumonitis 8, 372
Aspirin 149, 150, 299, 314
heparin 151
Asplenia 12
Asthma 70, 82
acute severe 59, 60
exacerbation 8, 69
management of 60
signs of 59
Atorvastatin 149
Atrial appendages, left 158
Atrial fibrillation 43, 107, 151, 152, 155, 161
Atrioventricular nodal blocks 107
Atropine 281, 284
refractoriness 286
Atropinization 285
rapid 285
Auscultation 3, 4, 97
Autoimmune disease, flares of 132
Automated weaning 27t
systems 26
Automatic tube compensation 25, 176
Autonomic dysfunction 254
Autonomic nervous system 192
Auto-positive end expiratory pressure 61
detection of 51f
Avian influenza 10
Axial spine injury 233
Axonal injury 326
Azathioprine 308
Azole antifungals 134
Azotemia 263
B
Bacteremia 7, 329
Bacteria 109, 308
Bacterial infection, invasive 132
Bacterial invasion, intramural 120
Bacterial translocation 120
Balthazar score 309, 374
Barbiturate coma 197, 228
Barring overwhelming sepsis 329
Bedside lung ultrasound 41
Behavioral pain scale 166
Benzodiazepine 62, 168, 279, 282, 287, 292
short-acting 322
Bereavement care support 337
Berlin definition 85, 85t
Berry aneurysm, rupture of 369
Best motor response 193, 224
Best verbal response 193
Beta-adrenoceptor agonists 294
Beta-blockers 277, 375
nonselective 302304
Beta-lactamases, classification for 143, 359
Bicarbonate 2, 232, 294, 329
therapy 271
Bicarbonaturia 259
Bickerstaff's brainstem encephalitis 253
Bilevel positive airway pressure 255
trial of 7
Bilirubin 181
raised 184
Bioartificial extracorporeal liver 321
Bioartificial liver support
devices 321t
system 321
Bioartificial systems 321
Biolimus 152
Biomarkers, role of 18, 294
Bioscavenger therapy 287
Bipolar disorder 201
Bisap score 374
Bismuth 299
Bispectral index 326
Bivalirudin 151
BK virus 129
Blastomyces dermatitidis 10
Blatchford score 298, 298t
Bleeding 107, 237
control 299
intra-abdominal 325
intracerebral 332, 341
presence of 305
substantial 238
Blindness 201
Blood 119, 121
alcohol 222
level 206
brain barrier 197, 222
components, management of loss of 300
concentrations 133
consumption, assessment of 238, 239
count, complete 201, 206, 215, 222, 240, 326
culture 13, 128, 215
cytomegalovirus 128
glucose 222, 269f
ketones 275
lactate levels 319
loss 171, 259
manage 300
pressure 59, 165, 171, 187, 201, 215, 265, 313, 325, 332
control 183, 198, 209
diastolic 363
management 369
monitoring of 157
systolic 70, 109, 157, 241, 284, 327, 363, 377
target 209
products 221
transfusion of 106, 121
samples 233
smear 185
streaked stool 299
sugar
drops 273
levels 270
target for critically ill 274
tests 254
urea nitrogen 12, 43, 44, 268
Bloodstream infections 31
catheter-related 118
central line associated 118
Body ache 7
Boerhaave syndrome 303
Bone fractures, temporal 223
Botulism 252
Bowel
disease, inflammatory 122
irrigation, whole 280
ischemia 121, 366
obstruction 259
perforation, intraperitoneal 122
preparation, selective 167
Bradyarrhythmia 151
Bradycardia 277, 278, 332
symptomatic 383
Bradypnea 278
Brain 361
abscess 201, 216
cells, swelling of 263
death 325, 328, 330, 370
function of 328
gamma aminobutyric acid 328
imaging 328
imminent herniation of 333
injury 221
hypoxic-ischemic 326
predictive of 227
primary 222
secondary 222
traumatic 193, 197, 221, 222fc, 223t
natriuretic peptide 41, 45, 73, 75
parenchyma 196, 224
tissue 211, 215
oxygen monitoring 226
oxygen tension 226
oxygenation 233
trauma foundation guidelines 224, 225
tumors 181
type natriuretic peptide 26
Brainstem 192
dysfunction requiring 208
herniation 330
reflexes 193, 225
absent 328
response 192, 193
Branched-chain amino acids 318
Breath sounds, reduced 69
Breathing 1, 2
and circulation 196
and ventilation 234
difficulty 69
rate of 2
room air 201
work of 2, 30
British Society of Gastroenterology 302
British Thoracic Society 22
Bronchiectasis 82
acute exacerbation of 8
Bronchiolitis obliterans
organizing pneumonia 19, 33
syndrome 129
Bronchitis
acute 8
chronic 69
Bronchoalveolar lavage 12, 130, 329, 372
Bronchorrhea 278
Bronchoscopy 14, 128, 329
Bronchospasm 66
treat 377
B-type natriuretic peptide 86
Budd-Chiari syndrome 318, 319
Bulk flow 97
Bundle branch block, right 75
Burkholderia pseudomallei 18
Burkitt's lymphoma, diagnosed case of 360
Burns 247
Burr cells 185
Burst suppression 217
Butyrophenones 175
Butyrylcholinesterase 288
C
Caffeine 277
Cairo and Bishop classification 113t
Calcaneal injury 233
Calcium 294, 295
channel blocker 199, 277, 287, 373, 382
gluconate 294
receptor antagonism 183
Campylobacter 254
infection 256
jejuni infection 253
Canadian Critical Care Trials Group 97
Cancer 21
Candida
albicans 119
infection 129
lusitaniae 381
Capillary oxygen saturation, peripheral 313
Capnography obstruction 378
Carbamazepine 134, 260
Carbapenem 310
resistant organism 144, 145
Carbohydrate loading 167
Carbolic acid 368
Carbon
dioxide 139, 249
partial pressure of 2, 9, 41, 109, 139fc, 232, 233, 341
tetrachloride 314
Carcinomas, bronchogenic 8
Cardiac arrest 76, 157b, 378
causes of 325
Cardiac complication 17, 199
Cardiac contractions 97
Cardiac failure
congestive 41, 69
decompensated 17
Cardiac function 26
Cardiac index 165, 166
Cardiac life support, advanced 63, 149, 245, 380
Cardiac medications 3
Cardiac output 142, 162, 172f
monitoring 158, 342
Cardiac rhythm abnormalities, hyperkalemia induced 384
Cardiac risk index 157b
Cardiac status 46
Cardiac tamponade 221
Cardiac toxicity 280
Cardiac troponin, elevation of 155
Cardinal signs 328
Cardiomyopathy 107, 112
Cardiopulmonary disease, chronic 70
Cardiorenal syndrome 293
Cardiothoracic valvular surgery 242
Cardiovascular diseases 46
Cardiovascular system 107, 330, 384
Cardioversion 376
Carina, level of 329
Carotid artery, internal 204f, 207
Carvedilol 304
Casopitant 175
Caspofungin 134
Catecholamines 197
Catheter
intraventricular 226
thrombolysis 78
Cefazolin 143
Cefepime 32, 118, 310
Cefotaxime 143
Ceftazidime 32, 118, 310
Ceftriaxone 216, 219, 301
Cell
count 216
cycle, dysregulation of 223
Cellular
component 321
membrane disruption 222
Cellulitis 118
Centers for Disease Control and Prevention 10, 34
Central line infection 364
Central nervous system 30, 46, 107, 132, 201, 218, 314
disorders 260
infection 31, 118
Central pontine myelinolysis 261
Central venous
catheters 118
oxygen saturation 139fc, 317, 365
pressure 3, 158, 165, 166, 187, 361, 365
Cephalosporins 32, 122
Cerebellar
ataxia 7
hemispheres 205
Cerebellum 326
Cerebral
aneurysm 198
angiography 189, 370
artery territory
anterior 207
posterior 207
artery, middle 203, 204
blood flow 195, 224
autoregulation of 195f
blood volume 197, 222
contusions 223
dysfunction, higher 207
edema 201, 271, 273, 320
pathophysiology of 190
hemispheres, bilateral 192
herniation, signs of 221
ischemia 199, 330
delayed 198
malaria 181
metabolic rate 328
microdialysis 226, 227
performance category 326
perfusion pressure 195, 210, 222
resuscitation, cardiopulmonary 376
scintigraphy 370
vascular tone 224
vasculature 195
vasodilation 207
vasospasm 199
venous
channels 189
thrombosis 181, 188
Cerebrospinal fluid 36, 119, 181, 194, 215, 222, 252, 254, 371
drainage 196, 228
examination 254
Cerebrovascular
accident 49, 150, 268
disease, history of 157
Cervical
arteries, dissection of 207
collar 235
protection 235
spine 235
Charcoal, activated 285
Charlotte and Miniati rules 70
Chemotherapeutic agents 120
Chemotherapy drugs 308
Chest
discomfort 353
imaging 85
radiograph 7, 8, 12, 22
X-ray 31, 45, 74, 117, 118, 129, 130
Chikungunya 106
virus 106
Chlamydia
pneumoniae 13, 21
psittaci 21
Chlamydophila
pneumoniae 10, 12
psittaci 10
Chlorhexidine 35
Chlorpromazine 183, 260
Cholecystitis 184, 364
acalculous 31
Choledochocele 308
Cholelithiasis 308
Cholestatic liver abnormalities 185
Cholinergic
crisis 286
reaction toxicity, acute 252
Cholinesterase
enzymatic site 288
inhibitor 281, 288
Chronic obstructive pulmonary disease 810, 26, 35, 4143, 47f, 69, 70, 82, 109, 332, 354, 367
assessment test 47f
new classification of 47f
acute exacerbation of 8, 41, 43, 45, 48, 50, 69
Cilastatin 118
Cincinnati prehospital stroke scale 202
Circulation 1, 3
Cirrhosis 112, 260, 314
advanced 303
Cisatracurium 93
Citrate toxicity 238
Citrobacter 143
Clarithromycin 134
Clevidipine 209
Clichy-Villejuif criteria 319
Clindamycin 122
Clinical pulmonary infection score 32, 34b
Clofibrate 260
Clonidine 277, 287, 292
Clopidogrel 149, 150, 299
Closed loop system, trade name of 27
Clostridium difficile 118, 122, 144
colitis 129
infection 31, 122, 381
diagnosis of 123
fulminant 123
nonsevere 123
pathogenesis of 122
recurrent 124
severe 123
spread, prevention of 124
types of 123
Clostridium septicum 120
Coagulation 384
abnormalities 184
profile 222
tests, normal 237
Coagulopathy 243, 299, 315
Cocaine 277
Coccidioides immitis 10
Codman microsensor 196
Cognitive dysfunction 37, 189
Colitis
infectious 122
ischemic 122
Collapse 33
Coma 111, 194, 262, 278, 328
severity of 193
Combination anticoagulant, role of 209
Community-acquired pneumonia 7, 10, 12, 16, 17, 265, 355
antimicrobial treatment of 16t
bundle 22
cause of 10
clinical features of 7
clinical presentation of 7
complications of 17
development of 9, 10t
differential diagnoses of 7, 8t
judging severity of 9
management of 17, 18
Compartment syndrome 235, 238, 247
abdominal 293, 300, 311
Compound muscle action potential 36, 288
Compression ultrasonography, complete 73
Computed tomographic venography 189
Computed tomography 45, 88, 117, 121
findings 130t
pulmonary angiography 75, 371
scan 5
thorax 14
Congestive cardiac failure, severe 303
Conjugate vaccine 21
Conjunctival suffusion 106
Connective tissue disorders 215
pulmonary manifestation of 8
Consciousness
level of 192, 193, 203
loss of 192
Consolidation 33, 43
Cord sign 372
Corneal injury 254
Corneal reflex, bilateral 328
Coronary angiogram 329
Coronary angiography 159
emergency 327
Coronary artery
bypass grafting 156
disease 41, 128, 325, 332, 349
left circumflex 149
nonobstructive 156
revascularization prophylaxis 159
right 149
Coronary syndrome, acute 148
Coronary thrombosis 155
Coronavirus 9, 12
Cortical ribbon sign 203
Cortical venous thrombosis 107, 216
Corticosteroid 36, 87, 131, 175, 186, 320
associated mortality 18
concomitant 131
deficiency 141
inhaled 46
insufficiency, critical illness-related 17
Cortisol deficiency 262
Cotrimoxazole 216
Cough 7, 106
reflex 328
Coxiella burnetii 10, 21
Coxsackie 308
Craniectomy, decompressive 211, 228
Craniocaudal pressure gradient 215
C-reactive protein 18, 31, 44, 45
Creatine phosphokinase 293, 361
Creatinine 319, 321
Crimean-Congo hemorrhagic fever 106
Critical pain observation tool 166
Crohn's disease 361
Crush injury 235
Cryptococcus neoformans 10, 129
Cryptosporidium 308
Crystalloids 171, 269
Culprit artery 148, 149
Cushing's reflex 330
Cushing's triad 192, 194
Cyanoacrylate 301
Cyanosis 277, 278
Cyclophosphamide 120, 260
Cyclosporine 134, 134t
Cyproheptadine 282
Cystatin C 294
Cystic fibrosis 15
Cytarabine 120
Cytokines, inflammatory 330
Cytomegalovirus 10, 12, 129, 130, 132, 308, 314, 317, 329
infection 131, 132
pneumonia 130
syndrome 132
D
Dabigatran 76
Damage control
resuscitation 247
surgery 247
Daptomycin 216
Daunorubicin 120
D-dimer 73, 75
Decremental peep method 94
Deep gray nuclei 326
Deep vein thrombosis 5, 31, 34, 42, 69, 75
Deferoxamine 281
Dehydration 107
mild 107
severe 275
Delirium 291, 292, 337
tremens 291
Dengue 105, 106
fever
differential diagnosis of 106
provisional diagnosis of 105
hemorrhagic fever 105107
complications of 107
hemorrhagic shock 105
outbreak of 105
Dense clot sign 372
Dental infections 31
Deoxyribonucleic acid 114
anti-double stranded 293
Desaturation, severe 69
Desmopressin 260, 262
Dexamethasone 175
Dexmedetomidine 168
Dextrose-containing fluids 273
Diabetes 21
insipidus 330
mellitus 128, 201, 207, 265
Diabetic ketoacidosis, management of 271t
Dialysis 280, 294
detoxifies 322
low-efficiency 115
Diamond-Forrester classification 152
Diaphoresis 278
Diaphragm sign, continuous 374
Diarrhea 106, 112, 118, 278
Diastolic dysfunction 356
Diazepam 183, 217, 287
dosages of 292
Dicrotic notch 339
Diethyl organophosphate poisoning 286
Diffuse axonal injury 223
Digital subtraction angiography 329
Digoxin 279
Diltiazem 134, 375, 382
Dilute infant formula 260
Dimenhydrinate 175
Direct tubular injury 111
Disseminated intravascular coagulation 111, 300, 315
Distension, abdominal 121
Diuretics 87
Dobutamine 151
Dofetilide 382
Dolasetron 175
Doll's eye movement 328
Dopamine 140
infusion 294
Doppler scans 72
Dot sign 204
Doxorubicin 120
Dressler's syndrome 376
Driving pressure 90
Droperidol 175
Drowning, near 83
Drug 134
adverse effects of 358
eluting stents 152
overdose 83
spectrum for 358
toxicity 129
Dry cough 131
Dry skin 278
Dual antiplatelet therapy 160
Duodenal obstruction 308
Dynamic tone technology 366
Dysarthria 202
Dyselectrolytemia 109, 364, 366, 381
Dysesthesias, presence of 254
Dysfunction, surfactant 84
Dyspnea 43, 131, 337
acute onset 69t
persistent 111
Dysuria, complaints of 351
E
Early appropriate antimicrobial therapy 128
Ebola 106
Echinocandins 372
Echocardiography 5
Eclampsia 181183
Edema
acute pulmonary 8
cardiogenic pulmonary 86, 373
intestinal 120
origin of 85
progression 235
Edoxaban 76
Electrical impedance tomography 368
Electrocardiogram 8, 69, 75
Electrocardiographic changes, role of 157
Electrocardiography 45, 82, 85
Electroencephalogram 287
Electroencephalography 184, 326, 370
Electrolyte 233
abnormalities 238
disturbances 199, 270
Electromyography 286
Elevated aspartate aminotransferase 106
Elevated erythrocyte sedimentation rate 248
Embolectomy 78
surgical 79
Embolism syndrome 249t
Embolization 122
Emergency
cardiovascular care guidelines 327
delivery, plan for 386
medical service 327
room 265, 349
thoracotomy 349
transfusion score 239
Empiric antifungal therapy 119
Empty delta sign 372
Empyema 17
Encephalitis 107, 118, 181, 216, 291
Encephalomyelitis, acute demyelinating 107
Encephalopathy 107
hypertensive 201
hypoxic-ischemic 328
End diastolic volume, left ventricular 142
End organ dysfunction 132
Endemic fungi 18
Endobronchial ultrasound 20
Endocarditis, infective 31
Endoclip 302
Endocrine 330
complications 199
dysfunction 330
End-of-life care 332, 333
process pathway 334fc
Endoscopic variceal ligation therapy 304
Endothelial dysfunction 173
Endotracheal aspirate 13, 34
Endotracheal intubation 110
Endotracheal tube 30, 61, 96, 196, 329
blockage 64
cuff leak 64
displaced 378
displacement 64
occlusion 30
End-tidal carbon dioxide 327, 354
Enterobacteriaceae 32
Enzyme
immunoassay 123
inhibitors 114
linked immunosorbent assay 73
Eosinopenia 43
Eosinophilia 293, 381
Epidural monitor 226
Epilepsy, management of 217
Eptifibatide 150
Erythrocyte sedimentation rate 31, 249
Erythromycin 134, 301
Escherichia coli 32, 143, 381
Escitalopram 277
Esmolol 161, 282
Esophageal balloon pressure 302
Esophageal rupture 303
Esophageal stricture 303
Esophageal varices, small 304
Ethanol 281
European Respiratory Society 49
European Society for Medical Oncology 118
European Society of Cardiology 77
Euthermia 207
Exacerbation 367, 373
Expiratory positive airway pressure 9, 49
Extended spectrum beta-lactamases 143t, 144, 382
Extracellular fluid 259, 260
volume of 258
Extracorporeal carbon dioxide removal 87
Extracorporeal life support 66
Extracorporeal liver
assist device 321
support 320
therapies, use of 322
Extracorporeal membrane oxygenation 67, 87, 98, 162, 366, 383
role of 79
Extremity, upper 193, 225
Extrinsic airway obstruction 284
Extubation 28
failure 56t
failure, high risk of 55
Eye
opening response 193
response 193, 225
Eyelids 225
F
Facial
droop 202
injury 233
palsy 203
surgery 96
trauma, severe 96
Falciparum malaria infections 215
Fast flush test 364
Fat embolism 83
syndrome 25, 82, 235, 248
pathogenesis of 249t
Fatal toxicity-serotonin syndrome 281
Febrile neutropenia 109, 117, 117b, 118, 118fc, 121fc
Fecal microbial transplantation 124
Feeding 5
Fentanyl 167, 244
patient-controlled analgesia 310
Fetal lung maturity 184, 186
Fetus, delivery of 184
Fever 7, 106, 122, 131, 199
continuing 120
enteric 106
hemorrhagic 106
high grade 82
noninfectious causes of 120, 121b
persistent 121fc
postoperative 121
revealed mild 201
severe 106
Fibrillation, ventricular 327, 380
Fibrin specific agents 149
Fibrinogen, functional 305
Fibrinolysis, intra-arterial 204
Fibrinolytic therapy 204
Filtered sodium, fraction of 293
Fine-needle aspiration 20
Flail chest 233
Flecainide 161, 376, 382
Flotrac device 366
Fluconazole 134
Fluid 1
balance 3, 4
positive 169
collection, extravascular 297
loading 167, 376
management 89, 92, 316
overload, complications of 386
responders 235
resuscitation 285, 309
sequestration 259
therapy, intravenous 272
use of 322
Flumazenil 279
Fluoroquinolones 15, 122
Fluoxetine 134
Fluvoxamine 134
Focal neurological
deficits 189, 198, 215
syndrome 207
Foley's catheter 4
Fondaparinux 151
Food and Drug Administration 140
Forced alkaline diuresis 280
Forced expiratory volume 47f
Forced vital capacity 3, 47f
Fosfomycin 358
Fosphenytoin 217
Fractional plasma separation adsorption 322
Fracture, unstable 96
Fragmentation 78
Francisella tularensis 21
Free fatty acid 267f, 295
Free oxygen radical injury 222
Fresh frozen plasma 238, 288, 297, 305, 322
Fungal
infection 132, 347
meningitis 215
Fungi 109, 130
Furosemide 308
Fusarium 119
G
Gag reflex 328
Gamma-aminobutyric acid 168, 321
Gas exchange, mechanisms of 97, 344
Gastric
balloon 302
content 177
distension 64
lavage, role of 285
port 302
suction port 302
varices 304, 305
Gastrointestinal
bleeding 5, 121, 168, 325
persistent 122
upper 297, 301
decontamination 279
injury, acute 311
mucosal injury 120
Gemcitabine 120
Generation devices 210
Genetic mutations 308
Geneva score 70
Geniculate body, lateral 371
Glargine 274
Glasgow Blatchford score 298
Glasgow coma scale 4, 28, 193t, 221, 224, 224t, 232, 234, 284, 288, 313, 332, 345, 374
Glasgow outcome scale 228
Glimepiride 201, 362
Global end diastolic volume 142
Glomerular filtration rate 267f, 293
Glomerulonephritis 7
Glucagon, level of 295
Gluconeogenesis 266, 295
Glucose 216
6-phosphate dehydrogenase deficiency 114
control 6
Glutamate dehydrogenase antigen 123
Glutamine 316, 318
contributes 315
Glycerol phenylbutyrate 318
Glycogenesis, stimulates 385
Glycogenolysis 266
Glycopeptide-cephalosporin heterodimer antibiotic 21
Glycoprotein 150, 208
Glycopyrrolate 284, 285
Glycosylation end-product, advanced 83
Graft-versus-host disease 238
Gram stain 15, 362
Gram-negative bacilli 17
Gram-positive bacilli 362
Granisetron 175
Granulocyte colony stimulating factor 121, 133
Ground-glass opacity 130
Growth hormone 295
Guillain-Barré syndrome 36, 107, 252, 252t, 254
classification 252
Gum elastic bougie 243
Gunshot injury 233
H
H1N1 10, 15
H5N1 10
Haemophilus influenzae 9, 13, 16, 32
Halo sign 130
Haloperidol 175, 292
Hantavirus 12, 106
Harmless acute pancreatitis score 309
Head
injury 233
trauma 181
Headache 105, 188, 207, 215
moderate 201
Health stroke scale 202
Hearing loss 216
Heart 97, 134
block, complete 151
catheterization, right 153
defects, congenital 325
disease
cyanotic congenital 82
ischemic 157, 325
failure 41, 107, 325
congestive 8, 129, 157, 260
lung interactions, complex 363
normal 171
rate 41, 72, 82, 109, 128, 171, 201, 232, 265, 332
monitoring of 165
sounds 3
transplant 134
Heliox 60, 66
HELLP syndrome 184186, 320
classification 185t
Helmet cells 185
Hematemesis 299
Hematochezia 299
Hematologic dysfunction 109
Hematologic malignancies 21, 115, 169
Hematolymphoid 121
Hematoma
bilateral subdural 360
epidural 222, 223, 229
extradural 223
intracerebral 121
intracranial 223
Hematopoietic stem cell transplant 119, 129
Hemiparesis 188, 189
Hemiplegia 189, 203f, 204f
Hemithorax 2
Hemodialysis 280
Hemodynamic 316
Hemodynamic instability
Broaden antibiotic coverage for 120
severe 96
Hemodynamic stability 25, 176
Hemodynamic status, monitoring 322
Hemodynamic support, adequate 159
Hemoglobin 165
concentration, regional oxygenated 174
Hemolysis 181, 184, 185
Hemolytic transfusion reactions 238
Hemolytic uremic syndrome 107, 181, 184, 185, 293, 386
Hemoperfusion 280, 288
Hemoperitoneum 221
Hemoptysis 72, 349
Hemorrhage 107, 181, 208, 216
intracerebral 107, 223
intracranial 369
intraventricular 121, 184
score, severe 239
subarachnoid 188, 192, 193, 198t, 199, 199t, 201, 215, 223, 360
subdural 223
symptomatic 204
variceal 298
Hemorrhagic transformation, risk of 204
Hemospray therapy 302
Hemostatic abnormalities 241
Hemothorax 221, 235, 248
traumatic 349
Heparin, unfractionated 76, 151, 189
Hepatic enzymes 168
Hepatic failure, fulminant 279
Hepatic function 83
derived 321
tests 206
Hepatic venous pressure 303
Hepatitis 184, 185
B 129, 308
infection 320
surface antigen 320, 329
virus 320
C 129
virus 329
Hepatobiliary system 107, 384
Herbal products 277
Herpes simplex virus 12, 129, 308, 314
encephalitis 129
Heterogenicity, areas of 374
High dependency unit 268
High extravascular lung water index 365
High flow nasal cannula 9, 35, 49, 60, 87, 88, 110
oxygenation 49
High frequency
oscillation 87
oscillatory ventilation 96
High peak
airway pressure 63fc, 169
inspiratory pressure 88
High resolution computed tomography 8
scan 130
Higher tidal volume 52
Histoplasma 119
capsulatum 10
Hit hypothesis 169
Horizontal eye movement 203
Hormone, adrenocorticotropic 141
Horner syndrome, ipsilateral 207
Hospital cardiac arrest, out of 325
Human albumin solution 318
Human fibroblast cultures 133
Human immunodeficiency virus 10, 21, 215, 293
Human leukocyte antigens 170
Human metapneumovirus 9, 12
Human neutrophil antigens 170
Hydralazine 198, 209
Hydration 272, 372
Hydrocephalus 197, 199, 369
Hydrochlorothiazide 201
Hydrogen, potential of 233
Hydrolysis, spontaneous 288
Hyperacute rejection 129
Hyperalimentation 364
Hyperammonemia 210
Hyperammonemic disorders 315
Hypercalcemia 111, 210, 308
Hypercapnia 65, 207, 228, 258
transient 76
Hypercarbia 271
Hyperchloremia 381
suggestive of 367
Hyperdense vessel sign 203
Hyperfibrinolysis 377
Hyperglycemia 6, 36, 199, 210, 265267, 275
correction 278
management 330
Hyperglycemic
crisis 268, 272
emergency, treatment of 270
hyperosmolar
nonketotic coma 265
state 265, 267f, 269f, 385
Hyperinflation 62
dynamic 44, 62, 63, 65
Hyperkalemia 112, 238, 241, 247, 295, 384
etiology of 294
management of 184, 294
Hyperleukocytosis 109, 111, 364
Hyperlipidemia 308
Hypermagnesemia 60
Hypernatremia 199, 210, 330
Hyperosmolar therapy 197
Hyperphosphatemia 384
management of 115
Hypertension 128, 188, 199, 201, 207, 278, 332, 349, 361
arterial 209
chronic 182, 195
thromboembolic pulmonary 77, 78
control 386
intra-abdominal 311
intracranial 227, 315
persistent 183
Hypertensive disorders, classification of 182
Hyperthermia 31, 192, 277
Hypertonic saline 244
Hypertriglyceridemia 168
Hyperuricemia 109, 384
management of 114
Hyperventilation 197
therapeutic 221
Hyperviscosity syndromes 115
Hypervolemia 197, 199
Hypnotic agents 243
Hypocalcemia 141, 238, 247, 248, 300, 384
Hypoechoic space 42
Hypofibrinogenemia 248
Hypogammaglobulinemia 132
Hypoglycemia 201, 210, 216, 273, 291, 315, 319
Hypokalemia 238, 262, 271, 273, 315, 316, 342, 381, 385
common causes of 343
concurrent 371
Hypomagnesemia 300, 301, 381
Hyponatremia 199, 210, 216, 258, 262, 315, 319, 347
causes of 258
chronic 261, 262
hypertonic 271, 371
hypervolemic 371
hypotonic 384
severe 258
chronic 262
symptomatic 259fc
Hypoperfusion 258, 366
peripheral 316
signs of 316
Hypophosphatemia 270, 315
Hypotension 70, 105, 157, 207, 221, 232, 299, 314, 350
causes of 151, 245t
persistent 157, 285
Hypothalamic pituitary
adrenal 46
axis 140
Hypothermia 175, 197, 237, 238, 243, 247, 277, 315
therapeutic 228
Hypothesis, threshold 169
Hypothyroidism 260
Hypoventilation 197
Hypovolemia 112, 165f, 171, 315, 318, 366
presence of 317
Hypoxemia 76, 111, 207, 316
refractory 84, 93
severe 98
treat 210
Hypoxemic respiratory failure, risk of 227
Hypoxia 64, 206, 216, 258
cellular 139
severe 76
sustained 221
Hypoxic seizures, manage 327
Hysteria 202
I
Ibutilide 376
Idiopathic thrombocytopenic purpura 386
Idiosyncratic reactions 314
Illegal drugs, use of 325
Imipenem 32, 118
Immobilization 36, 70, 72
Immune thrombocytopenic purpura 185
Immunization, role of 21
Immunoglobulin
A 107
E 8
G 253
intravenous 133
Immunosuppressive medications 132
Impacted mucus, bronchoscopic removal of 66
Imrie score 374
Inactivated influenza vaccine 21
Indian Association of Palliative Care 334
Indian Society of Critical Care Medicine 334
Infarction 8, 121
subcortical 203
Infection
community-acquired 129
intra-abdominal 31, 129
opportunistic 129
risk of 226
screen for 255
worsening sites of 120
Infectious Diseases Society of America 12, 15, 16, 31
Inflammation 120
Influenza 10, 129
viruses 9
A 12
B 12
Injury
abdominal 308
bilateral lower limb 233
cancer related 111
inhalational 83
therapy-related 111
Inotropes 3, 330
Inspiration 2
Inspiratory positive airway pressure 49
Inspiratory pressure, maximum 30
Inspiratory time, reducing 377
Inspired oxygen, fraction of 2, 7, 12, 43, 48, 63, 85, 110, 327
Insular ribbon
loss of 369
sign 203
Insulin 270, 272, 294
infusion 330
intravenous 270, 271
intravenous 273
levels 315
omission of 268
preoperative treatment with 157
regimen, maintenance 274
regular 274
subcutaneous 271
Intensive care 1
service 105
unit 1, 9, 12, 16, 26, 32, 35, 36, 41, 75, 76, 83, 85, 109, 128, 181, 258, 277, 286, 291, 313, 325, 333, 340
acquired weakness 36, 37
admission 12
Intercostal drainage 373
Intermediate syndrome, classical symptoms of 286
International Association of Pancreatology 309
International normalized ratio 233, 297, 319
International Society on Thrombosis and Hemostasis 112
Interstitial lung disease 8, 41, 109, 129
Interstitial syndrome 378
Intestinal leukemic infiltration 120
intra-abdominal measuring kits 4
Intra-aortic balloon
counterpulsation 162
pump 3, 162, 379, 380
role of 162
Intracellular glucocorticoid function, suppress 141
Intracranial arteries, smaller 195
Intracranial hemorrhage, risk of 208
Intracranial pressure 96, 181, 192, 194, 195, 196, 222, 226, 227f, 234, 244, 258, 333, 360
invasive 317
management of 196
raised 65, 332
waveforms 226
Intranasal live attenuated influenza vaccine 21
Intraparenchymal monitor 226
Intubation 60
drug assisted 242
rapid sequence 322
traumatic 284
Ipratropium bromide 46
Iron 281
Ischemia 129, 181, 195, 216, 235, 293
reperfusion injury 330
Ischemic attack, transient 150, 206
Ischemic heart disease, severe 162
Ischemic stroke, management of acute 208, 209
Isolation, indication for 144
Isophane 274
Isosorbide mononitrate 304
Isotonic
crystalloid solution 309
fluids 221
Itraconazole 134
J
Jaundice, onset of 313
Jet nebulizer 52
Jugular bulb oximetry 317
Jugular venous
internal 375
oximetry 226, 227
pressure 4, 76
K
Keratinocyte growth factor 99
Ketamine 60, 168, 244
infusion 66
intravenous 60
Ketoacidosis 268, 273, 366
diabetic 265, 267f, 269f, 275, 385
Ketoconazole 134
Ketogenesis 266
Ketolide 21
Ketone levels 267
Ketonuria 259
Ketosis 265, 267, 275
presence of 266
resolution 274
Kidney 133, 134
disease 292
chronic 292
injury
acute 107, 109, 113, 113t, 114, 168, 291, 292, 292t, 293, 293t, 294, 295, 315, 381
molecule-1 294
transplant 134
tumor infiltration of 111
Killip classification 152
Killip-Kimball classification 152
Klebsiella 143, 381
Kussmaul's respiration 268
Kyphoscoliosis 82
L
Labetalol 209, 358
Lacosamide 218
Lactate 365
arterial 174
dehydrogenase 14, 293, 361
Lactic acidosis 66, 241, 315, 366, 380
clearance of 366
Lactulose 318
use of 318
Lacunar infarcts 207
Langfitt curve 194f
Language 203
Laparotomy
decompressive 311
underwent exploratory 354
Laryngeal edema 284
Laryngitis 69
Laryngoscopes 243
Lassa virus 106
Leg swelling, unilateral 72
Legionella 10, 308
antigen 13
pneumonia 18, 21
infection 7
pneumophila 12, 21
urinary antigen test 13
Legionnaires’ disease 21
Lenticular obscuration 203
Leptospira 308
Leptospirosis 106, 215
Lesions, storage 241
Lethal triad 243t
Leucovorin 120
Leukemia 115, 364
Acute
lymphocytic 116
myeloid 109, 341
promyelocytic 112
Leukemoid reaction 364
Leukocyte 34
larceny 364
Leukocytosis 82
Leukopenia 12, 82, 106, 381
Leukostasis treatment 116
Leukotriene inhibitors, intravenous 61
Levetiracetam 217, 218, 258
Levofloxacin 32
Levosalbutamol 46
Life-sustaining treatment
withdrawal of 336
withholding of 335
Life-threatening
arrhythmias 281
cardiac arrhythmias, prevention of 115
hypoxemia 50
Limb ataxia 203
Linezolid 216, 281
Linton-nachlas tube insertion 301
Lipid peroxidation 241
Lipogenesis 385
Lipolysis, preventing 270
Lipooligosaccharides, bacterial 253
Lispro 270
Listeria 129, 386
meningitis 216
Lithium toxicity 201
Liver 134
disease 299, 305, 306
chronic 303t
chronic severe 12
decompensated 316
end-stage 169, 319, 319t
model for end-stage 319
dysfunction 107
enzymes 181, 184
elevated 181, 184, 185, 281
failure 313, 318, 325
acute 313, 314, 314t, 315, 318, 319t, 320
fulminant 314
in pregnancy 319
subacute 314, 320
subfulminant 314, 321
function test 105, 181, 184, 215, 233
revealed bilirubin 313
injury, traumatic 320
transplant 134
recipients 169
transplantation 318t
Lobectomy 355
Lorazepam 216, 217, 292
Low molecular weight heparin 76, 151, 189
Low platelet count 181
syndrome 184
Lower limb fractures 233, 235
Lumbar puncture 198, 206, 215
role of 198
Lung 133
abscess 20
approach, open 94
biopsy
open 14
surgical 130
cancer 129
compliance 84
contusion 83
disease
granulomatous 82
recurrence 129
severe obstructive 12
structural 12
examination, ultrasonographic 86f
function tests 255
infiltrates 118
injury
acute 85, 169, 170
drug induced 373
factors causing direct 83
minimize ventilator-induced 357
transfusion-associated 248
transfusion-related acute 170, 301, 384
ventilator-induced 379
protection 330
protective ventilation 88, 374
strategy 354, 357
scintigraphy 74
sliding 42
ultrasound 42
specificity of 42t
Lyme disease 383
Lymph nodes 373
Lymphadenopathy, retroperitoneal 111
Lymphatics traversing, blockage of 311
Lymphocyte depleting agents 132
Lymphohistiocytosis, hemophagocytic 111
Lymphoma 373
Lymphomatous meningitis 215
Lysozymuria 111
Lytic cocktail 183
M
Macrolide 15
Macular edema 107
Magnesium 161, 267f, 287
prophylaxis 184
regimens 183
sulfate 183, 187, 188
Magnetic resonance
angiography 75
imaging 5, 120
Maintain euvolemia 167
Malaria 106
Malnutrition 36, 371
Maneuver
recruitment 87, 94, 95
stepwise recruitment 94
Mannan antigen 119
Mannitol 258
Marathon runners 259
Marfan syndrome 207
Mass lesion
evacuated 225
nonevacuated 225
Massive blood transfusion, complications of 300
Massive hemothorax 349, 373
Massive pleural effusion 248
Massive transfusion 169, 237, 240, 240fc
complications of 238b
score 239
Maternal platelet count 186
McGinn-White sign 377
Mean airway pressure 96, 139, 317, 327
Measles 10
Mechanical thrombectomy 209, 210
Mechanical thromboaspiration 205
Mechanical ventilation 25, 26, 28, 60, 66, 87, 89
invasive 50, 88, 109, 110
optimized 66
Mechanical ventilator settings, optimizing 66
Meclizine 175
Mediastinal mass excision 353
Mediastinal tumors 260
Medical and neurological complications 199
Medical Research Council Score 36
Meduri's group 93
Melena 5, 299
Meningitis 31, 118, 181, 202, 291
aseptic 107
bacterial 193, 215, 216
carcinomatous 215
treatment of 216
Meningococcal meningitis 215
Meningococcus 216
Meningoencephalitis, herpetic 329
Mental disturbance 252
Mental status 43, 44
impaired 50
Meropenem 32, 118, 216
Mesenchymal stem cells 99
Metabolic acidosis 69, 141, 247, 265, 281, 315, 316, 319, 367
causes of 342
high anion gap 366
management of 141
severe 141, 381
Metabolic alkalosis 316, 385
Metalloproteinases, classification of 143
Metastatic disease 129
Metastatic infection 19
Metformin 362
Methanol 281
Methemoglobinemia 281
Methicillin-resistant Staphylococcus aureus 20, 32, 33, 118, 121, 130, 144, 145
community-acquired 16, 20
Methotrexate 111, 279
Methylene blue 281, 368
Methylprednisolone 28, 175
Methylxanthines 46, 66
Metoprolol 149, 382
Metronidazole 308, 310
intravenous 124
Microangiopathic hemolytic anemia 185
Microangiopathy, thrombotic 112, 185, 386
Microcirculatory disturbances 293
Microcytic red blood cells 300
Microribonucleic acid 326
Microvascular flow index 174
Midazolam 62, 183, 217, 218, 244, 286, 344
Migraine 202
Miller-Fisher syndrome 253
Milrinone 151
Minnesota tube 301, 302, 303f
Minor ischemic stroke 208
Miosis 278
Mirtazapine 134
Mississippi-triple class system 185
Mitochondrial dysfunction 139
Mitochondrial function 173
Mitral valve
prolapse 207
vegetation 379
Moclobemide 281
Modular extracorporeal liver support system 321
Monoclonal antibodies 131
Monocrotophos 286
Monoparesis 189
Monopolar diathermy compresses 302
Monotherapy, role of 15
Monro-Kellie doctrine 223, 224, 224f
Moraxella catarrhalis 10, 13
Morphine 167
Moxifloxacin 32, 216
Mucorales 119
Mucosal surface, disruption of 120
Multidose insulin regimen 274
Multifocal conduction blocks 255
Multimodal nonopioid analgesia 167
Multiorgan dysfunction
sets 300
syndrome 36
Multiorgan failure 17
Multiple organ
dysfunction syndrome 17, 98, 242, 315, 316
failure 314
Multisystem trauma 83
Mumps 308
Muscarinic antagonist, short-acting 46
Muscle
relaxation 87
trauma 259
Myalgia 106
cruris 107
Myasthenia gravis 36, 252
Mycobacteria 109, 130
Mycobacterium 17
tuberculosis 10, 12, 21, 129, 219
Mycophenolate
acid 131
mofetil 128
Mycophenolic acid 134
Mycoplasma
infection 19, 253, 254, 308
pneumoniae 10, 12, 13, 21
infection 7
Mydriasis 278
Myelinolysis, extrapontine 261
Myelodysplastic syndrome 119
Myeloid cells 31
Myeloid leukemia, chronic 353
Myeloma 293
multiple 115
Myocardial contusion 233
Myocardial infarction 17, 121, 156, 157b
acute 148, 150, 150t152t
diagnosis of 158
inferior wall 376
managing perioperative 159
perioperative 155157
Myocardial injury 66, 156, 158
acute 155, 158
chronic 158
Myocardial ischemia 148, 156, 158
signs of 148
types of 148
Myocardial oxygen 155, 156
Myocardiopathy 325
Myocarditis 107, 325
Myocardium, posterior 160
Myoclonic jerks 326
Myoclonus 107
Myofascial compartment 247
N
N-acetyl cysteine 287, 288, 317
Nadolol 304
Naloxone 279, 281
Nasal cannula 297
Nasogastric tube 5, 167, 302
Nasopharyngeal airway 243, 285
National Institutes of Health Stroke Scale 202, 203t
Nausea 106, 121
postoperative 175
severe 260
Nebulizer, types of 52
Neck
pain 207
stiffness 215
Necrosis 120
Necrotizing pneumonia 17
Neoplasm 201
Neostigmine 311
Nephropathy 107
obstructive 111
Nephrotic syndrome 112, 260
Nephrotoxic injury 294
Nephrotoxicity 111
Neuraminidase inhibitor 15
Neuraxial techniques 187
Neurogenic pulmonary edema 199
Neuroinvasive disease 252
Neurologic disease 192
Neurologic leukostasis 116
Neurological complications 199
Neurological deterioration 204
Neurological examination 192
Neurological injury 207
Neurological monitoring 317, 322
Neurological symptoms 263
Neurological system 4
Neuromonitoring 317
advanced techniques of 226
Neuromuscular blockade 36, 93, 242, 243
Neuronal injury 222
Neuropathy
acute motor
axonal 252, 253, 255
demyelinating 253
sensory axonal 252, 253
critical illness 252
Neurosurgeon 332
Neurosurgical procedure 346
Neutral protamine hagedorn 274
Neutropenia 117, 120, 132
profound 117
protracted 117
severe 117
Neutropenic enterocolitis 120
etiology of 120
management of 122
pathogenesis of 120
Neutrophil count, absolute 116, 118
New York Heart Association 162
Nicardipine 209, 373
Nicotinamide adenine dinucleotide 267
Nicotine 260
Nimodipine 199
Nitrates 149
Nitric oxide, inhaled 99
Nitrogen balance 340
Nitroglycerin 55, 373
Nitroprusside 373
N-methyl D-aspartate 183, 222
Nocardia 109, 129
Nodular opacity 130
Nonabsorbable disaccharides 318
Nonacetaminophen 318
Noncardiac surgery 156
Nonfibrin specific agents 149
Noninvasive blood pressure 363
Noninvasive near-infrared spectroscopy 326
Noninvasive ventilation 9, 28, 44, 4850, 60, 87, 109111, 349
therapy 50
Nonopioid analgesics 166
Nonpharmacologic strategies 87
Nonresponding pneumonia 19
causes of 19
Non-ST elevation myocardial infarction 148
Nonsteroidal anti-inflammatory drugs 61, 157, 166, 299
Nonstructural protein 1 106
Nontuberculous mycobacteria 10
Nonvitamin K antagonist oral anticoagulant 76
Noradrenalin infusion 155
Noradrenaline 17, 151, 384
high-dose infusion 341
Norepinephrine 140
Norfloxacin 301
Nosocomial infections 129
Nosocomial Legionnaires’ disease 19
N-terminal pro-brain natriuretic peptide 54
Nucleic acid 106
amplification test 123
Nutrition 4, 92
total parenteral 122
Nutritional risk screening 50
O
O'grady system 313
Obesity 82, 207
Obstruction, intestinal 122
Obstruction, intratubular 111
Obstructive lung disease, chronic 44
Oculocephalic reflex 328
Oculovestibular reflex 328
Odor 278
Oleander 277
Oliguria 232
Ondansetron 175
Opiate 281
derivatives 260
Opioids 278
Opsoclonus 107
Optic nerve sheath diameter 226, 375
Optic neuropathy 107
Oral antibiotics 18
Oral anticoagulant
newer 240
role of new 152
Oral contraceptives 72
Oral fidaxomicin 124
Oral steroids 46
Organ donation 325
and transplantation, Global data in 128
Organ donor, potential 329
Organ dysfunction 107, 330
scores 36
Organ failure
assessment, high sepsis-related 88
assessment, sequential 109
based scores 309
Organocarbamate
compounds 288t
poisoning 288
Organophosphate 281, 285, 286, 288t
coma, delayed 287
compound 285
poisoning 284288
acute 284286, 287t
severe 287
Organophosphorous
compound 288
poisoning 252
Ornithine phenylacetate l-ornithine 318
Oropharyngeal airway 243
Orthostatic blood pressure 299
Orthostatic hypotension 297, 299
Orthotopic liver transplantation 318
Oseltamivir 15
Osmolality 262
Osmolytes 261
Osmotic demyelination syndrome 261
high risk of 260
Osmotic diuresis 258
Osmotic therapy 228, 369
Otorrhea 222
Outpatient antibiotic therapy, failure of 12
Overdamped arterial waveform 363
Overzealous fluid therapy 317
Oxacillin 143
Oxazolidinones 21
Oxidase enzyme 114
Oximes 285, 286
use of 286
Oxygen 328
consumption 26
delivery
devices 358
index 165
desaturation 328
extraction capabilities 139
low partial pressure of 249
partial pressure of 2, 85, 233, 341
saturation 59, 70, 187, 206
supplementation 221
therapy 48, 48b, 48fc
Oxygenation 2, 30, 85, 90
adequate 25
status 34
Oxytocin 260
P
Pain control, postoperative 188
Pain management 166, 309
Pain
abdominal 122, 252, 278, 299, 350, 381
nonresolution of 350
Palonosetron 175
Palpation 24
Pancreas
congenital malformations of 308
divisum 308
Pancreatic cell damage, hyperglycemia induced 330
Pancreatic ischemia 308
Pancreatico-pleural fistula 311
Pancreatitis 31, 121, 184, 259
acute 83, 308, 309, 311
common causes of 308
mild 309
moderately severe 309
severity of 308, 309, 374
Pandysautonomia 253
Panic attack 69
Papillary muscle rupture 375
Papilledema 215
Paradoxical breathing 2
Parainfluenza virus 9, 10
Paralytic agents postintubation 62
Parapneumonic effusions 17
Parenchymal disease, drug-induced 33
Parenchymal fibrosis 33
Parenteral nutrition, total 340, 364
Paresthesia 254
Paroxetine 134
Paroxysmal nocturnal dyspnea 8
Paroxysmal supraventricular tachycardia 376
Partial thromboplastin time, activated 76, 305, 361
Peak expiratory flow rate 59
Peak inspiratory
airway pressure 348
flow rate 377
Pediatric trauma 241
Pelvic
fractures 233
injury 233
sepsis 118
Pendelluft means 97
Penetrating injury 233
Penicillin 216
Penumbra 211
Peptic ulcer disease 299
Percutaneous coronary intervention 149, 150
Perforation, intestinal 342
Perfusion pressure, abdominal 311
Periampullary malignancy 308
Pericardiac arrest 76
Pericardial effusion, large 379
Pericardial tamponade 69, 376
causes of 376
Pericarditis 107, 376
Periodic paralysis 252
Periodontal disease 7
Peripancreatic fluid collection, acute 310
Peripheral neuropathy, chemotherapy induced 385
Peritoneal lavage, diagnostic 246
Peritonitis 259
Permissive hypercapnia 88
Permissive hypotension 221
Perphenazine 175
Personal communication 286
Petechiae after tourniquet test 105f
Pethidine 183
Phenobarbital 134
Phenothiazines 175, 260
Phenytoin 121, 134, 183, 217
equivalent 218
Phosphate therapy 270
Phosphorus 314, 385
Physical symptoms 335
Physiotherapy, active 178
Pioglitazone 362
Piperacillin 32, 118
Plasma 197
ammonia level 315
exchange 256
filtration therapy, selective 322
glucose 266, 268
magnesium level 183t
ratios 300
transfusion of 83
Plasmapheresis, high volume 322
Plasminogen activator inhibitor 84
Plateau pressure 348
Platelet 238
count 186, 206
Pleural effusion 12, 33, 69, 129
Pleural fluid in pancreatitis 310
Pleural line, loss of 42
Pleural syndrome 42
Pneumatocele 130
Pneumococcal bacterial meningitis 216
Pneumococcal infections 216
Pneumococcal meningitis 216
Pneumococcal vaccine, role of 21
Pneumococcus 215, 216
Pneumoconiosis 82
Pneumocystis 109
jirovecii 9, 12, 14, 119, 130
infection 17
pneumonia 10, 130
pneumonia, epidemiology 130
pneumonia 129131
Pneumomediastinum 374
Pneumonia 31, 33, 42, 62, 64, 82, 83, 118, 129, 131, 291, 374
atypical 21, 373, 379
bacterial 16
bilateral 69
eosinophilic 33
incidence of 228
prevention of 21
severity
index 9
scoring 374
slow resolving 19
ventilator-associated 170, 199
Pneumonitis
hypersensitivity 8
radiation 8
Pneumothorax 42, 62, 64, 69, 82, 233, 235, 248
bilateral 374
right-sided 374
Poisoning
mixed 277
unknown 277
Poliomyelitis 252
Polyclonal antibodies 131
Polycythemia 115
Polydipsia, primary 260
Polymerase chain reaction 13, 111, 120, 128
reverse transcriptase 106
Polymyxin 143, 216
B 142
Polyneuropathy, acute inflammatory demyelinating 255
Polyradiculoneuropathy
acute inflammatory demyelinating 253
chronic inflammatory demyelinating 254
Polysaccharide vaccine 21
Polytrauma 232
Polyuria 330
Porphyria neuropathy 252
Portacaval shunt surgery 305
Portal hypertension 300
Portal hypertensive gastropathy 299
Posaconazole 134, 372
Positive airway pressure, continuous 9, 26, 85, 329
Positive cumulative fluid balance 311
Positive end-expiratory pressure 2, 25, 63, 76, 84, 85, 89, 110, 111, 311, 328, 341
Postcardiac arrest 279, 327
prognostication 326
Postcoronary bypass 162
Posterolateral alveolar syndrome 42
Postextubation respiratory failure 55
Post-heart transplant 383
Posthypoxic myoclonus 327
Postintubation hypoxia, causes of 64
Post-stenotic perfusion 206
Post-thoracic surgery 376
Post-transplant
infections, timeline of 129, 129t
lymphoproliferative disease 129
Post-traumatic seizures 228
Potassium 267f, 295
level 316
redistribution of 294
Potential organ donor, management of 329
Potentially inappropriate treatment 332
Pralidoxime 281
Prasugrel 150
Preadmission counseling 167
Predicted body weight 354, 379
Predictive value, positive 318
Prednisolone 46, 128
Predominant bulbar involvement 252
Pre-eclampsia 182, 188
with severe features 182t
Pre-eclamptic woman 187
Preemptive antifungal therapy 119
Pregnancy 73, 96
acute fatty liver of 184, 185, 386
related complications 318
test 206
Preprimary prophylaxis 303
Pressure measurements mean 64
Pressure
intra-abdominal 311
intracompartmental 247
intravesical 293
time curve 95f
time scalar waveforms 91f
volume loop 90, 90f
Primidone 134
Procainamide 376, 382
Procalcitonin 18, 19, 31, 138fc
based algorithm for sepsis 137fc
based antibiotic regimes 137
role of 18, 44
Proinflammatory state 267
Prokinetic agents 301
Promethazine 175, 183
Promotility agents 311
Propafenone 382
Prophylactic antibiotics 301, 310
Prophylactic antiepileptic drugs 207
Prophylactic antifungal therapy 119
Prophylaxis 133
against overcorrection 262
primary 304, 304t
secondary 304
Propofol 218, 244
infusion syndrome 168
Propoxyur 288
Propranolol 304
Prostacyclin 99
synthesis inhibitors 260
Protease enzymes 222
Protein 216
Proteinuria 295
Prothrombin time 315, 319, 361
activated 315
Pseudohyponatremia 371
Pseudomembranous colitis 122
Pseudomonas 129
aeruginosa 9, 13, 118
spp 368, 381
Psychiatric illness 202
Psychogenic polydipsia 263
Pulmonary angiography 74
Pulmonary arterial hypertension 82
Pulmonary artery 158
systolic pressure 379
wedge pressure 86
Pulmonary calcinosis 129
Pulmonary capillary
pressure 152
wedge pressure 85, 152
Pulmonary congestion 152
Pulmonary contusion 248
Pulmonary disease, underlying 131
Pulmonary edema 33, 42, 69, 82, 111, 185, 248, 273, 373, 378
diagnosis of weaning-induced 55
re-expansion 33
weaning induced 53
Pulmonary embolism 33, 6971, 71fc, 72, 72fc, 73, 73, 73fc, 74t, 75, 77, 78, 78t, 79, 79t, 82, 121
common risk factors for 69
long-term treatment of 79
rule-out criteria 71, 72t
severity index score 70
simplified 73
severity score 377
thrombolysis 78
treatment of 75, 77t
Pulmonary embolus 8
Pulmonary fibrosis 82
Pulmonary function test 8, 255
Pulmonary hemorrhage 33
Pulmonary hypertension 84
Pulmonary infection 109
score 32
Pulmonary leukostasis 116
Pulmonary tumors 260
Pulmonary vascular
permeability index 365
resistance 70
Pulmonary vasodilators 99
Pulsatile tinnitus 207
Pulse 44
pressure 171, 232
variation 44, 165, 171, 340
rate 70
Pulseless 376
electrical activity 51
ventricular tachycardia 327
Pulsus paradoxus 59
Pupillary light reflex 286
bilateral 328
Pupillary size tachycardia 277
Pupils 194
bilateral 277
fixed dilated 332
pin-point 287
Putamen 371
Pyelonephritis, emphysematous 374
Q
QRS complexes, wide 360
Quadrants, number of 84
Quinidine disopyramide 382
Quinolone 301, 310
R
Rabies 129
Ramosetron 175
Randomized controlled trials 9, 61, 110
Randomized optimal platelet 300
Ranson's criteria 308
Ranson's score 309
Rapamycin, mechanistic target of 132
Rasburicase 114
Recreational drugs 314
Rectal examination 299
Red blood cell 106, 242, 246
packed 112, 236, 237, 241t, 300
Refeeding syndrome 295, 364
Refractory bronchospasm, management of 66
Regimen magnesium sulfate 183
Regional analgesia 167, 168
Rejection episodes, acute 131
Renal abnormalities 184
Renal disease
chronic 159
end-stage 21
Renal dysfunction 377
Renal failure 260, 316, 319, 366
acute 185, 197, 247, 315
management of 115
Renal function
evaluation of 83
issues 384
tests 206, 215
Renal glutaminase, production of 316
Renal hypoperfusion 112, 293
Renal inflammation 293
Renal replacement therapy 110, 111
continuous 115, 315, 383
Renal sodium loss 258
Renal syndrome 106
Renal system 107
Renal transplant 128
Renal tubular acidosis 259, 367
Renal vein using sclerosants 305
Renal water excretion 258
Renin-angiotensin-aldosterone system 140
Reperfusion injury 83
Reperfusion therapy 382
acute 209
Repolarization, shorten 382
Rescue strategies 79
Rescue therapies 87, 93
Resistant gram-negative organisms 118
Respiration 225
pattern 193
Respiratory
acidemia 111
acidosis 315
alkalosis 315, 367
distress 2, 76
distress syndrome
acute 17, 31, 35, 41, 42, 54, 69, 8286, 99, 110, 129, 185, 248, 273, 344, 381
incidence of 184
emergencies, acute 42fc
failure 48, 48b, 49, 254
acute 42t, 43, 109111, 129, 260
acute hypoxemic 82
cause of 129
etiology of 109
management of 109
postoperative 165, 176
type 1 355
infection 129, 130fc
involvement 131
rate 25, 30, 41, 63, 89, 110, 215, 332
sudden 378
support 374
syncytial virus 9, 10
system compliance, low 84
tract infection
lower 129, 137
upper 82
viruses 9
Resuscitation, cardiopulmonary 77, 325, 327, 335
Revascularization strategy 375
Rhabdomyolysis 107, 235, 281, 293
Rheolytic thrombectomy 79
Rheumatoid arthritis 115
Rhinorrhea 222
Rhinovirus 9, 10
Ribonucleic acid 137
Rickettsial infection 106
Rifampin 134
Rifaximin 318
Right ventricular systolic pressure, measurement of 379
Rigors 106
Rimantadine 15
Ritonavir buspirone 281
Rivaroxaban 76, 152
Road traffic accident 25, 360
history of 346
Rockall score 298t
Rocuronium 244, 358
Rolapitant 175
Ryle's tube 375
S
Salbutamol 46
Salicylate 279, 308, 366
Salmonella 308, 381
Salt-wasting nephropathy 259
Sarcoidosis 383
Scedosporium spp 381
Schistocytes 293, 377
Sclerosis, multiple 201
Scopolamine 175, 285
Scoring systems 350
Scrub typhus 215
Second generation devices 210
Secretions 3, 97
Sedation 5, 66, 197
agents of 168
choice of 61
management of 62
Sedatives 277
Segmental ulceration 120
Seizure 111, 188, 201, 222, 278
activity
control of 278
termination of 217t
control 287
hypoxic 327
prevention of 183
recurrence of 183
treatment of 183
Self-inflating bag 378
Sengstaken Blakemore tube 301303, 303f
Sensorium, level of 261
Sensory 203
nerve action potential 36
symptoms 189
Sepsis 36, 83, 106, 142, 210, 293, 314
and multiorgan failure 252
and septic shock 140, 141
biomarkers for 31
intra-abdominal 118
Septic shock 106, 136, 139, 141, 142
trial 140
prevention of 141
vasopressors in 140
Serotonin selective reuptake inhibitors poisoning 281
Serotonin syndrome 281
Serotonin-reuptake inhibitors 260
Sertraline 134
Serum
albumin 14
bicarbonate 266, 272
creatinine 268, 293, 294, 315
preoperative 157
electrolytes 206, 222, 326
galactomannan 119, 372
glutamic
oxaloacetic transaminase 297, 313
pyruvic transaminase 297
ketones 268
osmolality 263, 268
drops 272
osmolarity 371
potassium 385
procalcitonin 136
sodium 262, 272, 291
Shallow breathing index, rapid 30
Shellfish poisoning 252
Shigella 381
Shock 107, 112, 232, 247
absence of 87
acute circulatory 172
anaphylactic 358, 380
cardiogenic 148, 151, 161, 162, 245
circulatory 169
compensated 107
distributive 245
hemorrhagic 201, 202, 232, 232t, 244
hypovolemic 245
index 239
modified 174
obstructive 245
rapidly progression of 351
type of 245
Shred sign 86
Sick euthyroid state 330
Sinus
bradycardia 151
rhythm 362
tachycardia 74
venous thrombosis 201
Sinusitis 31
Sirolimus 131, 134, 134t, 152
levels 134
Sitagliptin 362
Sjögren's syndrome 115
Skin decontaminations 279
Skull fractures 223
Sleep apnea, obstructive 332
Smoking 169, 207
Snake bite 247
Social justice 334
Sodium 267f, 295
balance 271
bicarbonate 358
adverse effects of 358
role of 141
strengths of 358
loss, extrarenal 259
nitroprusside 282
Solid organ 121
injury 235
transplant 128, 129, 132, 135
recipient 128, 130, 133
Somatosensory evoked potential 326
Somatostatin 301
Speech 203
Spherocytosis 115
Spinal cord injury 235
Spinal fractures, unstable 96
Spinal hematoma, epidural 187
Splanchnic parameters 322
Splenorenal collateral 305
Spontaneous awakening trial 176
Spontaneous breathing trial 25, 2730, 53, 66, 89, 175, 177fc, 385
optimal duration of 28
Spurious hypoxemia 364
Sputum culture 13
Squamous temporal bone fractures 223
Stable angina pectoris, chronic 148
Staphylococcus aureus 7, 9, 1718, 20
infection 20
pneumonia 13
Status epilepticus 215217
ST-elevation myocardial infarction 327, 382
Stem cell therapy 99
Steroid 92, 93, 216
dose 93
role of 17, 92, 141, 186
Stool, occult blood in 299
Streptococcus 381
pneumoniae 7, 9, 10, 13, 15, 16, 19, 21, 32
pyogenes 21
Streptokinase 77
Stress
biomarkers 294
index 91, 91f
Stridor 69, 36, 284
Stroke 159, 208, 216
acute 205
ischemic 201, 207, 208, 209, 382
diagnosis of 203
ischemic 201, 202, 208, 210, 345, 368
management of 203, 207
mechanism of 206
severity of 203
volume 162, 171, 339, 363
index 165
variation 3, 44, 158, 165, 166, 171
variation, low 366
Strongyloides 129
Subarachnoid hemorrhage, management of 198
Subcortex 371
Subdural hematoma 223, 229, 291
right-sided acute 370
Subendocardial ischemia, significant 157
Subsequent fluid administration 142
Succinylcholine 244, 285
Sudden cardiac arrest 325327
Sulfa drugs 308
Sulfamethoxazole 131
Sulfasalazine 308
Sulfhydryl variable 143
Supraorbital pressure 328
Supratentorial bleed 369
Surgical lung biopsy 20
Suxamethonium 244
Swallow nasogastric feeding 256
Sweating 2
excessive 259
Swinging air 97
Systemic embolism 206
Systemic inflammatory response syndrome 36, 300, 309
Systemic injuries 221
Systemic lupus erythematosus 115, 184, 185
Systemic steroids, role of 44
Systemic vascular resistance 341, 365
T
Tachyarrhythmias 151
Tachycardia 2, 66, 69, 105, 148, 201, 277, 299, 353
pre-excited 376
regular narrow complex 375
ventricular 151, 376, 380
Tachypnea 50, 69, 148, 232, 278
Tacrolimus 128, 134, 134t
Tazobactam 118
Tazobactam 32
T-cell leukemia-lymphoma virus 329
Tenecteplase 77, 208
Tennessee classification 185
Tension pneumothorax 64, 221, 248, 374
Terlipressin 301, 302
Tetracycline 308
Thalamus 371
Theophylline 46, 277
Therapeutic range 134
Thiamine, role of 366
Thiazide 308
diuretics 260, 262
Thiopentone 244
Thoracentesis 14
Thoracoscopic surgery, video-assisted 20, 111
Thrombalastograph 305
Thrombectomy
catheter-directed 371
rotational 79
suction 79
Thrombin 301
generation assays 320
time 206
Thrombocytopenia 184186, 248, 297, 305, 315, 375
progressive 353
severe 106
syndrome virus 106
Thrombocytopenic purpura, thrombotic 181, 184, 185, 293
Thrombocytosis 115
Thromboelastogram 353, 368
Thromboelastography 305
role of 305
Thromboelastometry, rotation 305
Thromboembolic events 235
Thromboembolism 129, 248
Thrombolysis 77, 148, 150, 190, 205, 208, 211, 371
catheter-directed 78, 79
failed 150
indications for 209, 347
intravenous 208, 209
low-dose 77
Thrombolytic agents 78
Thrombolytic therapy 190
role of 77
Thrombophlebitis 31
Thromboprophylaxis 5, 167
Thymoma 373
Thyroid hormone 277, 278, 330
Ticagrelor 150
Tick paralysis 252
Tidal volume 30, 89, 110
low 87
Tigecycline 358
proteus for 143
Tirofiban 150
Tissue
biopsy 128
Doppler mitral annulus 27
hypoperfusion 173
signs of 366
invasive disease 132
oxygen delivery 173
oxygenation, adequate 165
plasminogen activator 77
Tobacco smoking 21
Today's multicultural society 337
Todd's paralysis 202
Total leucocyte count 123
Tourniquet test 105
Toxicology screen 206
Toxidromes 278t
Toxins 293, 366
Toxoplasma 129, 308
Tracheal secretions 34
Tracheostomy 255, 286
Tramadol 167
Tranexamic acid 240, 241, 305
Transbronchial biopsy 20
Transesophageal echocardiography 157, 158
Transformation, hemorrhagic 204f
Transplanted organ, types of 132
Transpulmonary
pressure, measurement of 379
thermodilution 366
Transthoracic echocardiography 74, 158, 159
Transvenous pacing, temporary 376
Trauma 235, 237
multiple 96
Trauma-induced coagulopathy, pathogenesis of 237fc
Traumatic brain injury
pathophysiology of 222
primary 223
Tree-in-bud opacity 130
Trichosporon beigelii 120
Tricuspid regurgitation velocity 379
Tricyclic drugs, ingestion of 368
Trimethoprim 131
Tropisetron 175
Troponin 75, 158
elevation 199
Troubleshoot high pressure alarms 62
Tuberculosis meningitis 215
Tubular necrosis, acute 315
Tumor
extrathoracic 260
retroperitoneal 311
Tumor lysis syndrome 111, 112, 113t
Cairo and Bishop classification 113t
management of 114
U
Ulcer prophylaxis 6
Ulinastatin 143
Ultrasonic nebulizer 52
Ultrasonography 42, 64, 120, 121
Ultrasound 129
assisted thrombolysis 78, 79
role of 14
Underdamped system 363
United States Food and Drug Administration 114, 140
Upper gastrointestinal bleed, management of 298
Urea 263
Uremia 210, 216
adverse effects of 295
Urinalysis 129
Urinary alkalinization 115
Urinary antigen 13, 215
testing, limitations of 13
Urinary output 365
Urinary tract infection 31, 129, 291, 368
catheter-associated 120
Urine
culture 128, 129
ketone 272, 273
negative 275
urinalysis for 268
osmolality 293
output 165, 272, 293
monitor 329
sediment 293
sodium 293
Urokinase 77
V
Valganciclovir 133
Valproate 217
Valproic acid 217, 308, 328
Valsalva maneuvers 375
Valvular heart disease 188
Vancomycin 123, 216, 371
resistant enterococci 144, 145
Variceal band ligation 302
Variceal bleeding 304t
Variceal haemorrhage, prevention of 304
Varicella zoster virus 12, 308
Vasculitis 202, 308
Vasoactive drugs 3
Vasodilators, inhaled 87
Vasogenic edema 190
Vasopressin 140, 358
extravasation of 381
low-dose 317
Vasopressors 317, 330
administration of 141
adrenergic 36
Vasospasm, incidence of 199
Vaughan Williams classification 382
Vena cava
filter, role of 79
inferior 341, 365
Venereal disease research laboratory 329
Venlafaxine 134
Venoarterial extracorporeal membrane oxygenation 79
Venous thromboembolism 69, 70t, 72, 112, 167, 256
risk of 188
Venous thrombosis 121
Virchow's triad of 69
Ventilation 60, 76
adaptive support 27
and oxygenation problem 384
control mode of 66
invasive 87
lung pulse indicating lack of 86f
mandatory minute 27
perfusion 99
positive pressure 63, 260
pressure support 25, 361
proportional assist 27
sedation, protective 249
Ventilator 2
associated condition 35
infection-related 35
associated events 34, 35
associated pneumonia 25, 31, 32, 33fc, 34, 35
bundle 34, 35t
associated tracheobronchitis 32
dissynchrony, causes of 168
graphics show 357
settings 65
Ventilatory support, long-term 37
Ventricular assist device, role of left 161
Ventricular drainage, external 195, 199
Ventricular dysfunction, pathophysiology of right 71fc
Ventricular end-diastolic volume, right 75
Ventricular free wall rupture 375
Ventricular septal rupture 375
Ventricular tachycardia, episode of 361
Ventriculoperitoneal shunt 199
Verapamil 134, 287, 382
Vertebrobasilar arterial territory 207
Vesicular breath sounds, normal 69
Vesicular lesions 118
Vibrating mesh nebulizer 52
Vincristine 120, 260
Viral and bacterial 376
Viral components 106
Viral encephalitis, acute 215
Viral hemorrhagic fevers 106
Viral hepatitis 106, 314
use of antivirals in 319
Viral infections 10, 118, 130, 253
Viral pneumonia 15
mixed 16
Virchow's triad 69
Viruses 9, 10, 109, 308
Visceral injury, abdominal 233
Viscoelastic testing 306
Visual field test 203
Vital signs 97
Vitamins and micronutrient 295
Voice, hoarseness of 284
Vomiting 106, 112, 121, 175, 188, 222
von Willebrand factor 84, 320
Voriconazole 134, 372
W
Waldenstrom's macroglobulinemia 115
Warfarin therapy 332
Warrant liver transplant 318
Water intake, excessive 260
Water-soluble substances 322
Weaning 29
classification of 29fc, 53t
difficult 29
failed 53
failure 29
causes of 30fc, 54t, 385
indices 30t
trial 53
Well's criteria 71
Well's score, modified 71t
West Nile virus 252
Wheeze 278
bilateral 69
Whipple's procedure 171
White blood cell 12, 45, 109
Wilson's disease 319
Windscreen injury 233
Wolff-Parkinson-White syndrome 376
World Health Organization 15, 105
Wound
infections 129
open abdominal 96
X
Xanthochromia 198
Y
Yellow fever 106
Z
Zanamivir 15
Zika virus infection 106
Zinc 318
Zotarolimus 152
×
Chapter Notes

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How to Examine an ICU Patient in the Examination?CHAPTER 1

Rahul Anil Pandit,
Atul Prabhakar Kulkarni
 
INTRODUCTION
Intensive care patients are very complex and sick. They also have a confusing array of monitoring and tubes attached that can change in a very short span of time.
The key to clinical examination of ICU patient lies in integrating the information available from the medical technology, and correlate it with patient's clinical findings and arrive at diagnosis and treatment plan.
A large amount of information is available at bedside, in order to assimilate all this, it is important to have a structured approach towards examination of patient. Following approach would be one of the ways towards a structured examination.
 
SYSTEM-BASED APPROACH
  • Airway: Tube type, size and position (at which fixed)
  • Breathing: Lungs, ventilation, oxygen delivery systems
  • Circulation: Heart, vascular devices, cardiovascular drugs
  • Disability: Central and peripheral neurological examination, pain, sedation
  • Exposure
  • Fluids: Status, balance, management
  • Gastrointestinal: Abdominal examination, nutritional and renal examination
  • Examination of the peripheries.
 
Approach toward Clinical Examination of the Patient
When one approaches the patient, it is very important to adhere to infection control policies of that intensive care unit (ICU). Hand washing practice is imperative, either with alcohol-based rub or soap and water. Some ICUs insist on gown and gloves for all patients or for contact isolation only. If any respiratory infection precaution is to be taken then it must be strictly adhered to.
The initial urge to approach the patient straight away should be curbed. Take a step back and have a good look at the patient and the patient's surroundings in the cubical. There is a lot of information which one could gain just by been observant. It is most important to know that this information once missed is likely to stay missed and not picked up. This may result on one missing the broad focus of the examination. Sometimes a lead question may be asked as an introduction towards clinical examination. It is important to focus on this lead question when one is approaching clinical examination.
Look at the patient, his position in bed and for any sign of pain, discomfort and distress. Observe the tubes that are attached such as drains, urine and color of drains. Look at the monitors, ventilator settings and the infusion or syringe pumps. Ask relevant questions, if permitted, e.g. dilution of vasopressors, or type of nasogastric feed that is being administered.
Ensure patient privacy, by drawing up curtains. Lower the bed and bed railings to an appropriate height so that you are comfortable. Expose the patient completely for a thorough examination, taking care that private body parts are shielded with bed sheet or towels. Please introduce yourself and any other observers to the patient. Be polite and ask their permission to examine them if the patient is awake. “Hello Sir/Madam, I am Dr ……………, I would like to examine you, are you OK with that? Warn them if you are going to use a stethoscope (often cold due to AC in the ICU), “Sir this might feel a bit cold.” Alternatively you 2can warm the diaphragm of the stethoscope by rubbing against the back of your hand (after hand-washing of course). Similarly also ask their permission if you are going to expose them, “Sir, I need to see your chest or abdomen, and I need to remove your clothes. May I do that?” Make sure a female nurse or doctor is present when you examine a female patient, particularly if you are going to expose her body. Always draw the curtains of the cubicle closed. A similar warning needs to be given if you are going to perform an ultrasonographic examination, please tell the patient that you are going to use cold and sticky jelly. Make sure you clean the probe with Clinisept® or other antiseptic solution (nonalcohol-based, so as to not damage the probe), and the patient's body part has to be wiped with tissue to clean the jelly after the USG.
Ask them to perform some simple task like opening the mouth. This will immediately give you an idea about the patient's condition especially the neurology, while observing the surroundings you would have definitely checked whether sedation is being administered. Inform them about your plan to examine.
 
Airway
After introduction, assess if the patient is capable of maintaining his airway or not. Examine the airway of the patient: Intubated or not intubated? Is the patient on noninvasive ventilation? A simple way to assess that is to check neurological status, pattern and rate of respiration and clearance of secretions.
If patient has an endotracheal tube in place then, look at the size of tube, smaller size tubes often pose difficulty in suctioning and weaning process. Look at the position of endotracheal tube at angle of mouth and compare it with the insertion position recorded in the chart. Assess the cuff pressure; it should be less than 30 cm H2O. Assess the ties of the tube; make sure they are not too tight or loose. Some patients may have a tracheostomy in place. Quite frequently, it is inserted for comfort and weaning. However, sometimes it may be inserted for anatomical or pathological reasons. In such case understand the reason for insertion of tracheostomy. Complete a cuff and tie check for tracheostomy as well. Look for the skin at the insertion site.
 
Breathing
Start the analysis of respiratory system with observation:
  • Paradoxical breathing
  • Unequal rise of hemithorax with inspiration
  • Work of breathing
  • Rate of breathing.
Respiratory distress may present with following signs:
  • Sweating
  • Tachycardia
  • Agitation
  • Patient ventilator dyssynchrony: Often obvious to people who possess the knowledge about it, however, the incidence is fairly common. Unfortunately the most common response to ventilatory dyssynchrony is often sedation, which in some cases may be an inappropriate response.
Look at any chest drains that may be present, observe any bubbling, swinging of column, and color of drain fluid.
Study the ventilator:
  • Look at settings—note, if patient is breathing spontaneously, or on a controlled mode.
  • Study the fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), mode and other settings on the ventilator.
  • Look at the ventilator graphs, loops and understand the resistance and compliance of the lung.
  • A detailed look at the history of these graphics will give important information of the respiratory mechanics over time.
  • Special tests like compliance, plateau pressure and intrinsic PEEP (iPEEP) may be estimated to have a better understanding of patient's current respiratory status.
 
Oxygenation
  • Observe the saturation on monitor and try to correlate it with FiO2 and PEEP settings.
  • If available now is the time to look at the arterial blood gas for pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and bicarbonate.
 
Palpation and Percussion
  • In critically ill ICU patients, both palpation and percussion may be unhelpful in providing you good clinical information
  • Specifically if you are wearing gloves, percussion is often difficult to elicit.
  • However, if the patient is not ventilated then it is an important tool to complete your respiratory system examination.3
  • Examine the trachea and determine if it is in center.
  • Palpate both sides of the chest and see if the respiratory mechanics are equal.
 
Auscultation
  • Auscultate both the lungs fields completely.
  • Quite often this may be challenging, due to presence of dressings, positioning of patients, etc.
  • Rolling patients on one side, or in awake patients sitting them up will allow a complete auscultation on the back as well.
  • Hear the breath sounds, compare if they are equal on both sides.
  • Any ronchi, crepitation or abnormal breath sounds are important findings.
 
Secretions
  • Look at the quantity, consistency and color of secretions.
  • Observe the chart to look at the secretions history.
  • A trend is often helpful to determine a decision for extubation, decannulation or development or progress of a new respiratory problem.
 
Other
  • If patient is awake then try and assess the patient's ability to cough. Look at the strength and force of cough.
  • Ask patient to take a big breath in and out to determine the forced vital capacity (FVC). Usually if a patient is able to generate more than 15 mL/Kg of tidal volume on minimal ventilator settings then they should be able to breathe comfortably postextubation as well.
  • If possible and available and if you know how, and permitted by examiner you should try to do ultrasonography of the lungs. If you do not know how, keep your trap shut!
 
Circulation
 
Observation
  • Start with a look at the monitor.
  • Note the heart rate and blood pressure on the monitor.
  • Is the rhythm paced, are there arrhythmias on the monitor?
  • Look at the blood pressure, importantly the mean arterial pressure. It is more importantly physiologically.
  • If any other indices like central venous pressure (CVP), stroke volume variation (SVV), etc. are being monitored, then study them, note them down and check the trend, if available.
  • A very high or low CVP would be of significance. Similarly stroke volume variation and cardiac index assessment will give details about the patient's volume and hemodynamic status.
 
Palpation
  • Start with peripheral circulation.
  • Temperature of the hands and legs, if cold, note up to what level the extremities are cold, ankle, knees, thighs, etc.
  • Check that there is no difference in temperature of limbs on either side.
  • Check the color of the periphery, note down capillary refill time.
  • Check for peripheral pulses.
  • Feel for and observe pulsations over the precordium and any other abnormal pulsations elsewhere.
 
Percussion
Limited utility in circulatory system examination in the critically ill patient.
 
Auscultation
  • Carefully listen to the heart sounds.
  • This may be challenging specifically due to distracting noises and sounds in ICU.
 
Other
  • Other features of circulatory adequacy are mentation in absence of sedation, urine output and the acid-base balance, importantly lactate level.
  • If permitted, available and if you know how try to perform a transthoracic echocardiography. Otherwise keep your mouth shut about this too!
 
Interpretation
  • All this needs to be interpreted in the context of several variables.
  • Vasoactive drugs
  • Inotropes
  • Intra-aortic balloon pump
  • Cardiac medications
  • Fluid balance.4
 
Fluid Balance
  • It is important to look at the fluid balance. Especially the cumulative fluid balance and daily weight of patient, if it is possible or the input and output chart.
  • Skin turgor, peripheral edema, raised jugular venous pressure (JVP) or CVP are other coarse methods for assessing fluid status.
 
Devices
  • Always look at the site of intravascular devices
  • Look for signs of infection, thrombosis or ischemia.
 
Neurological System
 
Important Considerations
  • Level of sedation, pain relief with opioids or analogs and use of muscle relaxants (sometimes).
  • This needs to be considered before embarking on a neurological examination.
 
Examination
  • Start with trying to elicit some response with verbal commands.
  • If no response then a gradual graded painful stimulus starting from periphery to central would be necessary to give a good understanding of Glasgow Coma Scale (GCS). Calculate the GCS score for components and total score and note it down.
  • If patient is responsive then ask them to perform simple tasks, assess their limb muscle tone and power.
  • Spend some time eliciting deep tendon reflexes and plantar response.
  • Pupillary examination, looking for size, response to light is important.
  • Look at signs which suggest lateralizing signs. This will help in assessing the complete neurological system.
  • Look at any neuromonitoring devices, such as intracranial pressure monitors or operative wounds incisions (fresh), scars (old).
  • Look in the chart and compare your neurological findings to those noted before, this will give an objective assessment of the further course.
 
Abdominal, Renal and Nutrition
As opposed to the cardiovascular and respiratory system a continuous monitoring of gastrointestinal and renal system is not possible. However, pathologies may be hidden and could be difficult to assess. Hence a careful examination of the abdomen is absolutely necessary.
 
Observation
  • Observe the general shape and respiratory movements of the abdomen.
  • Look for any distension, presence of surgical wounds, scars, drains, stoma and their contents.
  • Look for Foley's catheter and in male patients always look for any signs of phimosis.
 
Palpation
  • Make the patient fully supine
  • Carefully palpate the abdomen, looking for any organomegaly.
  • Watch for any signs of pain or distress during palpation.
  • Note if patient is on pain medication or has received muscle relaxant.
 
Percussion
  • Percussion in ICU patients may help determine the presence of ascites
  • Otherwise percussion is of limited clinical benefit.
 
Auscultation
  • Hear carefully for presence or absence of bowel sounds, note if they are abnormally high pitched and increased.
Sometimes the intra-abdominal pressure may be an important marker to measure. It is best measured using a three way Foleys, or special intra-abdominal measuring kits. Remember to note that an absolute value and trend both are important in decision making. Check if it is being measured, not the value and trend of available.
 
Nutrition
  • Look if the patient is being fed by the nasogastric, nasojejunal or by percutaneous gastrostomy or jejunostomy route. Ask and note if the feeds are given as continuous drip or by bolus method.
  • Note the type of feeds, volume and rate at which it is delivered.
  • It is important to ask for gastric residual volumes which tell a lot about feed absorption.
  • If patient is not being fed then look at nasogastric aspirates, study the trend and the aspirates.5
  • Ask for bowel movements, as diarrhea and constipation, both are common in ICU patients.
  • Always look for any evidence of gastrointestinal (GI) bleed in form of altered blood in nasogastric tube or melena.
 
Exposure and Periphery
  • Look for any rashes, eschar, ecchymosis, petechiae, blebs, etc. all over the body. If present check for any anatomical distribution.
  • Relevant history, bite marks are necessary to be ruled out.
  • Note the type, feel and location of rash.
  • Some rashes are specific, e.g. malar rash is seen over the face.
  • Observe for any ulcers or sore in the pressure areas
  • Specific spots, like heels, sacrum and back should be examined meticulously
  • Look for any peripheral signs; which may be relevant in the clinical examination like presence of clubbing, cyanosis, icterus or presence of lymphadenopathy.
  • Try and correlate these signs with your clinical examination to arrive at a conclusion.
 
Documentation
It is important to note down the relevant history points, document positive findings in your examination. Do not rely on memory, write it down for later reference during viva. Always look at the ICU monitoring chart, this gives a wealth of information on trends, medications and how the patient has progressed.
Always review the blood investigations, it is important to review them in a tabular form if possible to understand the trends. Special investigations like echocardiography, computed tomography (CT) scan or magnetic resonance imaging (MRI) should be reviewed and reports seen wherever relevant. Always review the X-ray of chest, airway, breathing and circulation (ABG) and electrocardiograph (ECG) of patient.
Review the medication chart and look at specific medications, like antibiotics, cardiac medicines and their dosages, etc. If trade names are written which are unfamiliar to you, ask for the actual name of the drug.
 
Housekeeping
Fast hug has become a standard for ICU practitioners. A number of variants have been developed and in other units you will hear some of them. Here is an example of what they cover:
 
F—Feeding
Ensuring the patient is appropriately fed is an important care issue. We will deal with this in more detail in a subsequent module, but suffice to say that you should at least consider the need for feeding for each patient.
F is also sometimes used for feces management and fluids.
 
A—Analgesia
Check if the patient is formally assessed for their level of pain and note their current analgesia regimen. Perhaps there are other agents you could consider, or even a regional pain solution such as an epidural might help.
 
S—Sedation
Sedation is an important component of ICU care, because it enables patients to tolerate some of the more uncomfortable treatments they require (for example, mechanical ventilation). In the past, clinicians have taken a “if little bit is good, more must be better” approach. Try to note the sedation and delirium score of the patient, if written. If not assess with the score you are familiar with and note the score.
However, it is also important to remember that most therapies also have complications, and so it is true for sedatives. Increasingly, we are becoming aware of the risks of over sedation, including prolongation of mechanical ventilation, and there is evidence that reducing it to the minimum level required results in better outcomes for patients.
 
T—Thromboprophylaxis
All patients in the ICU should be considered high risk for the development of deep venous thrombosis (DVT). In fact, in a sentinel paper of mechanically ventilated patients in ICU, up to 2.7% already had significant proximal leg DVT on admission! The need for chemical and physical thromboprophylaxis should be considered on a daily basis, and the risks versus benefits carefully analyzed.
 
H—Head up to 30°
It may sound a little strange, but such a simple maneuver (45% head up) can reduce the risk of hospital-acquired pneumonia, an important ICU complication. Unless there is a good reason not to, all ventilated patients should be nursed with their head and torso at 30° from the horizontal.6
 
U—Ulcer Prophylaxis
There are a number of factors common in ICU patients that predispose them to developing gastric stress ulcers, with the consequent potential for gastrointestinal bleeding. Consider the need for prophylaxis, something we will come back to in a later module.
 
G—Glucose Control
Hyperglycemia has been associated with a higher risk of complications for ICU patients. In fact, this has been associated with worse outcomes in many other patient groups too, such as acute myocardial infarction and stroke. For a while, very tight glycemic control was advocated in ICU patients. However, subsequent research has suggested that tight control is no better than standard range targets, and may even worsen outcome, possibly due to hypoglycemic episodes. You should check your unit's policy on this and ensure it is followed.
Check the patient's blood sugar level if recorded, look at trend and see if the patient is on insulin infusion.
 
Final Thoughts
Always complete your examination by thanking the patient and leaving the bedside as neat and clean as possible. Post-examination hand-washing is compulsory.
Try and formulate a problem list, separate the problems which are active and inactive. Formulate a treatment plan or investigation plan as per the priority of problem, e.g. if oxygenation or hypotension is the problem then it needs to be addressed with priority over other non-life-threatening problems.
Remember there are no trick questions in an examination. Usually the lead question is formulated by the examiner with intent to lead the candidate to a problem.
Enjoy your work in ICU so you are happy in your chosen life work; remember there are no shortcuts to success.
All the best for your examinations!!!
If you are exam going soon, we do not wish to see you again next year as a delegate!!!
FURTHER READING
  1. Cook DJ, Crowther M, Meade M, Rabbat C, Schiff D, Geerts W, et al. Deep venous thrombosis in medical-surgical ICU patients: prevalence, incidence and risk factors. Crit Care Med. 2005;33:1565–71.
  1. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354(9193):1851–8.
  1. Robertson L. Recognizing the critically ill patient. Anesth Int Care Med. 2013;14(1):11–4.
  1. Vincent JL. Give your patient a fast hug (at least) once a day. Crit Care Med. 2005;33(6):1225–9.