Critical Care Medicine Principles of Diagnosis and Management in the Adult 4th Edition by Joseph Parrillo, Phillip Dellinger ISBN 0323089291 978-0323089296

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ISBN 10: 0323089291 
ISBN 13: 978-0323089296
Author: Joseph Parrillo,  Phillip Dellinger

Take the best possible care of adult critical care patients with Critical Care Medicine: Principles of Diagnosis and Management in the Adult! Editors Dr. Joseph Parrillo and Dr. Phillip Dellinger, two of the most respected names in critical care medicine, combine their extensive knowledge with that of hundreds of top authorities in the field to bring you expert, state-of-the-art answers to any clinical question you may face in the intensive care unit.

• Offer your adult critical care patients the most effective care with practical, evidence-based guidance from many of the most trusted experts in critical care medicine.

• Learn from the best ICU specialists worldwide with contributions from an increased number of international authorities.
• Effectively manage common complications in the ICU with updated coverage of severe sepsis, septic shock, surgical infections, neurogenic and anaphylactic shock, severe heart failure, acute coronary syndromes, and Acute Respiratory Distress Syndrome.
• Access the complete contents online at Expert Consult, along with an image bank and instructional videos!

Critical Care Medicine Principles of Diagnosis & Management in the Adult 4th Table of contents:

Part 1: Critical Care Procedures, Monitoring, and Pharmacology

Chapter 1: Cardiac Arrest and Cardiopulmonary Resuscitation

Epidemiology and General Principles

Cardiopulmonary Resuscitation and Advanced Cardiac Life Support

Postresuscitation Care

Chapter 2: Airway Management in the Critically Ill Adult

Structure and Function of the Normal Airway

Assessing Adequacy of the Airway

Management of the Airway

Physiologic Sequelae and Complications of Tracheal Intubation

The Difficult Airway

Confirming Tube Position in the Trachea

Surgical Airway

Extubation in the Difficult Airway Patient (Decannulation)

Tube Displacement in the Critical Care Unit

The NAP4 Project

Common Problems in Airway Management

Chapter 3: Assessment of Cardiac Filling and Blood Flow

Cardiac Filling

Hemodynamic Status and Blood Flow

Goal-Directed Therapy

Conclusions

Chapter 4: Arterial, Central Venous, and Pulmonary Artery Catheters

Arterial Catheters

Central Venous Catheters

Pulmonary Artery Catheters

Chapter 5: Cardiac Pacing

Indications for Permanent Pacemaker Implantation

Indications for Temporary Pacing

Conditions That Do Not Normally Require Pacing

Esophageal and Transthoracic Pacing

Transcutaneous Pacing

Epicardial Pacing

Transvenous Pacing

Special Considerations in Temporary Pacing

Complications of Permanent Pacemaker Implantation

Special Considerations in Permanent Pacing

Conclusions

Chapter 6: Pericardial Tamponade: Clinical Presentation, Diagnosis, and Catheter-Based Therapies

Etiology of Pericardial Effusion and Tamponade

Clinical Presentation

Diagnostic Role of Echocardiography

Catheter-Based Diagnostic and Therapeutic Strategies

Pericardiocentesis

Open Surgical Pericardial Window

Percutaneous Balloon Pericardiotomy

Other Pericardial Interventions

Chapter 7: Intra-aortic Balloon Counterpulsation

History

Physiology

The Intra-Aortic Balloon Pump Apparatus

Preparation

Balloon Insertion

Timing

Adjunctive Pharmacotherapy

Balloon Removal

Indications

Contraindications

Complications

Newer Technologies

Chapter 8: Echocardiography

Approach to Echocardiography

Additional Echocardiographic Modalities

Indications for Echocardiography

Hemodynamic Assessment

Stroke and Other Systemic Emboli

Summary

Chapter 9: General Principles of Mechanical Ventilation

History

Mechanical Ventilation

Indications for Mechanical Ventilation

Mechanical Breath Generation

Ventilator Modes

Other Modes of Mechanical Ventilation

Positive End-Expiratory Pressure

Monitoring the Ventilated Patient

Maintaining Support of the Ventilated Patient

Weaning From Mechanical Ventilation

Complications of Mechanical Ventilation

Noninvasive Positive-Pressure Ventilation

Chapter 10: Ventilatory Management of Obstructive Airway Disease

Special Challenges of Patients with Severe Airflow Obstruction

Problems and Hazards of Ventilation with Positive Pressure

Principles of Managing the Ventilated Patient with Severe Airflow Obstruction

Practical Management of the Ventilated Patient

Chapter 11: Mechanical Ventilation in Acute Respiratory Distress Syndrome

History

Physiologic Basis of Mechanical Ventilation

Patient Characterization

Mechanical Ventilation in Acute Respiratory Distress Syndrome: Available Evidence

Individualizing Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome

Possible Adjuncts to Mechanical Ventilation

Chapter 12: Bronchoscopy and Lung Biopsy in Critically Ill Patients

Fiberoptic Bronchoscopy–Induced Physiologic Changes

Airway Evaluation and Management

Diagnosis of Infection

Lung Biopsy—Surgical and Transbronchial

Special Situations

Complications and Death

Summary

Chapter 13: Noninvasive Respiratory Monitoring

Gas Exchange

Respiratory Neuromuscular Function

Respiratory Mechanics

Chapter 14: Tracheostomy

History

The Artificial Airway

Timing of Tracheostomy

Complications of Tracheostomy

Percutaneous Tracheostomy

Chapter 15: Chest Tube Thoracostomy

History

Anatomy and Physiology of the Pleural Space

Drainage Systems

Indications and Contraindications

Chest Tube Size

Technique of Insertion

Management of Thoracostomy Tubes

Complications

Imaging

Chapter 16: Intracranial Monitoring

Intracranial Pressure Monitoring

Cerebral Blood Flow Monitoring

Brain Tissue Oxygenation Monitoring

Summary

Chapter 17: Gastrointestinal Endoscopy

History

Endoscopic Equipment

Anesthesia

Esophagogastroduodenoscopy

Wireless Capsule Endoscopy

Enteroscopy

Colonoscopy

Endoscopic Retrograde Cholangiopancreatography

Endoscopic Ultrasound

Endoscopy in the Pregnant Patient

Chapter 18: Continuous Renal Replacement Therapy

Physiologic Principles

Modalities

Prescription Variables

Technical Considerations

Therapeutic Considerations

Summary

Chapter 19: Use of Sedatives, Analgesics, and Neuromuscular Blockers

PAIN Management in the Intensive Care Unit

Sedation Management

Neuromuscular Blocking Agents

Summary and Conclusions

Chapter 20: Principles of Drug Dosing in Critically Ill Patients

General Pharmacokinetic Principles

Pharmacodynamics

The Effect of Critical Illness on Pharmacokinetics and Pharmacodynamics

Special Considerations Regarding Routes of Administration

Drug-Dosing Considerations in Select Critical Care Populations

Pharmacogenetics

Principles of Therapeutic Drug Monitoring

Conclusion

Part 2: Critical Care Cardiovascular Disease

Chapter 21: Circulatory Shock

Introduction

History

Definitions and Categorization of Shock

Classification

Diagnostic Approach and Evaluation

Management and Therapy

Conclusion

Chapter 22: Cardiogenic Shock

Definition

Epidemiology

Pathogenesis

Clinical Assessment

Therapy

Other Causes of Cardiogenic Shock

Conclusion

Chapter 23: Septic Shock

Overview

Historical Perspective

Contemporary Definitions

Epidemiology

Pathogenesis

Clinical Presentation

Hemodynamic Profile of Septic Shock

Microcirculatory and Mitochondrial Dysfunction

Management of Septic Shock

Summary

Chapter 24: Cardiac Tamponade

Fundamentals of Tamponade

History and Physical Examination

Diagnostic Tests

Overall Assessment

Special Syndromes in Tamponade

Settings in Which Tamponade is Seen

Management

Acknowledgment

Chapter 25: Severe Sepsis and Multiple Organ Dysfunction

Introduction

Definitions

Epidemiology

Pathophysiology

Management

Multiple Organ Dysfunction

Chapter 26: Hypovolemic Shock

Pathogenesis and Pathophysiology

Clinical Features

Diagnostic Approach

Approach to Management

Complications and Prognosis

Conclusion

Chapter 27: Traumatic Shock and Tissue Hypoperfusion: Nonsurgical Management

Classic Neuroendocrine Response

Inflammation in Shock after Injury

Cellular Energetics

Immune Mediator Cascades

Neuroimmune Response to Trauma

Acute Coagulopathy after Trauma

Fluid Therapy

Blood Component Therapy

End Points

Clinical Strategies

Management of Traumatic Shock in the Intensive Care Unit

Special Problems

Chapter 28: Anaphylaxis and Anaphylactic Shock

History and Incidence

Pathogenesis and Pathophysiology

Clinical and Hemodynamic Features

Management

Prophylaxis and Immunotherapy

Acknowledgment

Chapter 29: Severe Heart Failure

Definition, Epidemiology, and Staging of Heart Failure

Pathophysiology

Diagnosis

Prognosis in Acute Heart Failure

Acute Heart Failure Syndromes

Pharmacologic Management of Acute Heart Failure

Transition to Chronic Pharmacologic Therapy for Severe Heart Failure

Coronary Heart Disease and Heart Failure: Special Considerations

Heart Failure with Preserved Left Ventricular Ejection Fraction (Diastolic Heart Failure)

Acute Myocarditis and Heart Failure

Device Therapy: Implanted Cardioverter-Defibrillators and Cardiac Resynchronization Therapy

Mechanically Assisted Circulatory Support: Ventricular Assist Devices

Chapter 30: Acute Coronary Syndromes and Acute Myocardial Infarction

Definitions

ST Segment Elevation Myocardial Infarction

Unstable And Non–ST Segment Elevation Myocardial Infarction

Chapter 31: Cardiac Arrhythmias

Bradycardias

Supraventricular Tachycardia

A Brief Review of Antiarrhythmic Drugs

Ventricular Arrhythmias

Cardiac Arrest and Electrical Storm

Catheter Ablation of Cardiac Arrhythmias

Pacemakers and Implantable Defibrillators

Electrocardiographic Patterns Intensivists Should Recognize

Conclusions

Chapter 32: Valvular Heart Disease in Critical Care

Aortic Stenosis

Aortic Insufficiency

Mitral Regurgitation

Hypertrophic Obstructive Cardiomyopathy

Mitral Valve Stenosis

Acknowledgment

Chapter 33: Acute Aortic Dissection

Introduction

History

Types of TAD

Risk Factors for Thoracic Aortic Dissection

Pathophysiology

Diagnosis

Perioperative Management

Operative Approach

Outcomes and Prognosis

Summary

Chapter 34: Hypertensive Crises

Introduction

Definitions

Pathophysiology

Approach to Management

Specific Clinical Considerations

Hypertensive Urgency

Chapter 35: General Principles of Postoperative Intensive Care Unit Care

Postoperative Evaluation

Recovery From Anesthesia

Best Practices

Postoperative Nutrition

Wound Healing and Care

Acknowledgments

Chapter 36: Postoperative Management of the Cardiac Surgery Patient

Neurologic Care

Cardiovascular Care

Pulmonary Care

Renal Care

Applications of Echocardiography after Cardiac Surgery

Miscellaneous Considerations

Part 3: Critical Care Pulmonary Disease

Chapter 37: Acute Respiratory Failure

Acute Respiratory Failure—Types 1 and 2

Hypoxemic Respiratory Failure

Hypercapnic Respiratory Failure

Acute Respiratory Distress Syndrome

Future Considerations

Summary

Chapter 38: Life-Threatening Asthma

Epidemiology of Life-Threatening Asthma

Triggers of Acute Asthma

Mortality Rates for Asthma

Classification

Pathophysiology and Immunology

Symptoms and Signs

Objective Measurement of Obstruction

Laboratory and Radiographic Data

Inpatient Admission Decisions

Drug Therapy (Table 38.1)

Nontraditional Therapy of Severe Bronchospasm (Table 38.2)

Acute Severe Asthma in Pregnancy

Mechanical Ventilation in Asthma Patients

Complications of Asthma

Approach to Acute Life-Threatening Asthma

Chapter 39: Chronic Obstructive Pulmonary Disease

Definitions

Background

Pathophysiology

Clinical Manifestations

Precipitating Factors

Initial Management

Noninvasive Mechanical Ventilation

Invasive Mechanical Ventilation

Prognosis

Terminal Care for the End-Stage Patient

Chapter 40: Hypoventilation and Respiratory Muscle Dysfunction

Decreased Neuromuscular Capacity

Increased Load

Hypercapnia-Induced Hypoventilation

Summary

Chapter 41: Nonpulmonary Causes of Respiratory Failure

Introduction

Hypoventilation

Mechanisms Underlying Chronic Alveolar Hypoventilation (see Fig. 41.1)

Etiologic Classification

Clinical Recognition and Manifestations

Patient Management

Chronic Ventilatory-Assist Devices

Management of Airway Secretion Clearance

Chapter 42: Pneumonia: Considerations for the Critically Ill Patient

Definitions and Risk Factors

Pathogenesis

Clinical Features

Etiologic Pathogens

Diagnostic Issues

Therapy

Evaluation of Nonresponding Patients

Prevention

Chapter 43: Weaning from Mechanical Ventilation

Pathophysiology of Weaning Failure

Weaning-Predictor Testing

Weaning Trials

Extubation

Conclusion

Chapter 44: Acute Pulmonary Embolism

Prevalence of Venous Thromboembolism in Intensive Care Unit Patients

Risk Factors

Deep Venous Thrombosis

Pathophysiology

Clinical Presentation

Diagnostic Testing for Pulmonary Embolism

Risk Stratification

The Management of Acute Pulmonary Embolism

Special Populations

Prophylaxis

Long-Term Prognosis

Chapter 45: Pulmonary Hypertension

Pathophysiology of Pulmonary Hypertension and Right Ventricular Failure

Clinical Classification of Pulmonary Hypertension

Integrated Approach to the Diagnosis of Pulmonary Hypertension

Management of Arterial Pulmonary Hypertension and Right Ventricular Failure in the Intensive Care Unit

Prognosis

Chapter 46: Massive Hemoptysis

Anatomic Considerations

Causes of Hemoptysis

Management

Chapter 47: Pneumothorax and Barotrauma

Definition and History

Incidence

Pathophysiology

Classification

Clinical Features

Electrocardiographic Features

Diagnostic Imaging Modalities

Differential Diagnosis: Conditions Mimicking Pneumothorax

Management

Complications Related to Management

Chapter 48: Toxic Gas, Fume, and Smoke Inhalation

Introduction

Pathogenesis of Inhalation Injury

Diagnostics and Treatment

Chapter 49: Immunologic Lung Disease in the Critically Ill

Clinicopathologic Considerations during Mechanical Ventilation

Idiopathic Pulmonary Fibrosis

Hamman-Rich Syndrome

Alveolar Hemorrhage Syndromes

Cryptogenic Organizing Pneumonia

Connective Tissue Diseases

Hypersensitivity Pneumonitis

Drug-Induced Respiratory Failure

Summary

Part 4: Critical Care Infectious Disease

Chapter 50: Nosocomial Infection in the Intensive Care Unit

Incidence and Profile

Morbidity and Economic IMPACT

General Infection Control Measures

Nosocomial Infections and Specific Infection Control Measures

Avant Garde Infection Control Measures

Goals for the Future

Chapter 51: Principles Governing Antimicrobial Therapy in the Intensive Care Unit

Adequacy of Initial Empiric Antibiotic Therapy

Unintended Consequences of Antibiotic Therapy

Clinician Responses to Multidrug Resistance

De-Escalation

Minimizing Clinical Resistance

Conclusions

Chapter 52: Antifungal and Antiviral Therapy

Systemic Antifungal Agents

Specific Indications and Uses for Antifungal Therapy

Areas of Controversy in Antifungal Therapy

Antiviral Agents

Specific Indications and Uses for Antiviral Therapy

Chapter 53: Critically Ill Immunosuppressed Host

Definition

Host Defense Mechanisms

General Approach to Management

Management of Specific Patient Populations

Chapter 54: Specific Infections with Critical Care Implications

Overwhelming Infections of the Central Nervous System

Fulminant Endovascular Infections

Primary Bacteremias

Toxin-Mediated Infections

Serious Skin and Skin Structure Infections

Serious Gastrointestinal and Intra-Abdominal Infections

Life-Threatening Infections of the Head and Neck

Serious Vector-Borne Infections

Severe Viral Infections

Potential Agents of Bioterrorism

Part 5: Renal Disease and Metabolic Disorders in the Critically Ill

Chapter 55: Acute Kidney Injury

Definition

Epidemiology

Pathogenesis

Clinical Manifestations

Diagnostic Approach

Prevention

Management of Established Acute Kidney Injury

Prognosis and Outcomes

Chapter 56: Chronic Kidney Disease

Introduction

Physiology

End-Stage Renal Disease

Kidney Transplant Patients

Drug Dosing

Summary

Chapter 57: Acid-Base, Electrolyte, and Metabolic Abnormalities

Acid-Base Homeostasis

Potassium Homeostasis

Water Homeostasis

Calcium Homeostasis

Magnesium Homeostasis

Phosphorus Homeostasis

Chapter 58: Acute Diabetic Emergencies, Glycemic Control, and Hypoglycemia

Diabetes Mellitus: Epidemiology and Classification

Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State

Glycemic Control in the Intensive Care Unit

Hypoglycemia

Chapter 59: Adrenal Insufficiency in the Critically Ill Patient

Incidence and Prevalence

Etiology and Pathogenesis

Clinical Features

Diagnosis

Management

Summary

Chapter 60: Thyroid Disorders

Thyroid Physiology

Diagnostic Approach to Thyroid Disease

Medication Effects

Nonthyroidal Illness Syndrome

Hypothyroidism and Myxedema Coma

Hyperthyroidism, Thyroid Storm, Thyrocardiac Crisis, and Coronary Artery Spasm

Part 6: Neurologic Disease in the Critically Ill

Chapter 61: Coma

Concept and Terminology of Impaired Consciousness

Neuroanatomy, Neurotransmitter, and Pathology

Approach to Coma

Assessment of Coma: General Aspects

General Treatment Approach

Ethical Considerations

Chapter 62: Neurologic Criteria for Death in Adults

Historical Perspective and Definitions

Determination of Brain Death

Confirmatory Testing

Special Circumstances

Conclusions

Chapter 63: Stroke

Historical Background

Overview

Advances in Radiology

Thrombolysis in Stroke

Symptomatic Carotid Disease/Stenting

Anticoagulation in Stroke

Antiplatelet Agents in Stroke

Patent Foramen Ovale

Massive Hemispheric Cerebral Infarct

Critical Care Consultation

Summary

Chapter 64: Muscular Paralysis: Myasthenia Gravis and Guillaine-Barré Syndrome

Clinical Presentation

Acute Neuromuscular Respiratory Failure

Management

Chapter 65: Seizures in the Critically Ill

History

Epidemiology

Nosology and Semiology

Pathogenesis

Pathophysiology

Clinical Manifestations

Diagnostic Approach

Management Approach

Prognosis

Chapter 66: Head Injury

Introduction

Incidence

Diagnostic Approach

Primary Head Injury

Secondary Head Injury

Specific Treatment Considerations

Conclusions

Part 7: Physical and Toxic Injury in the Critically Ill

Chapter 67: Critical Care Management of the Severely Burned Patient

Introduction

Initial Assessment

The Resuscitation Phase

The Wound Coverage Phase

The Rehabilitation Phase

Chapter 68: Poisonings

Resuscitation and Stabilization

Diagnosis

Gastrointestinal Decontamination

Enhanced Elimination

Specific Poisonings

Chapter 69: Hypothermia, Hyperthermia, and Rhabdomyolysis

Hypothermia

Hyperthermia

Malignant Hyperthermia

Neuroleptic Malignant Syndrome

Rhabdomyolysis

Part 8: Administrative, Ethical, and Psychological Issues in the Care of the Critically Ill

Chapter 70: Intensive Care Unit Administration and Performance Improvement

The Present-Day Critical Care Landscape

Idealized Design for Critical Care Practice

State of Critical Care Reimbursement

Critical Care Quality Improvement

Culture Transformation and Organizational Learning

Chapter 71: Ethical Considerations in Managing Critically Ill Patients

The Doctor-Patient Relationship

The Ethics of End-of-Life Care

Research in Critically Ill Patients

Response to Disaster

Chapter 72: Delirium, Sleep, and Mental Health Disturbances in Critical Illness

Overview

Acute Brain Dysfunction or Delirium

Sleep Disruption in the Critically Ill

Posttraumatic Stress Disorder

Long-Term Cognitive Impairment after Critical Illness

Depression

Concluding Thoughts

Chapter 73: Severity of Illness Scoring Systems

Historical Perspective

Severity of Illness Assessment and Outcome Prediction

Developing Predictive Models

Organ Dysfunction/Failure Scoring Systems

Scoring Systems for Specific Clinical Conditions

Directions for Further Research

Chapter 74: Education and Training in Intensive Care Medicine

Training Aspirations for Intensive Care Medicine

The Training Environment

Current Training in Intensive Care Medicine

Competency-Based Training

Defining Core Competencies

Evolving Professional Roles: Implications for Training

Practical Implications of Competency-Based Training

Assessment

Delivering Training and Assessment in the Workplace: Role of Simulation

Summary

Part 9: Other Critical Care Disorders and Issues in the Critically Ill

Chapter 75: Diagnosis and Management of Liver Failure in the Adult

Decompensation of Chronic Liver Disease

Acute (Fulminant) Liver Failure

Chapter 76: Gastrointestinal Bleeding

Clinical Presentation

Upper Gastrointestinal Bleeding

Stress-Related Mucosal Disease

Lower Gastrointestinal Bleeding

Obscure Gastrointestinal Bleeding

Conclusion

Chapter 77: Acute Pancreatitis

Introduction

Definitions and Terminology

Pathogenesis

Etiology and Risk Factors

Clinical Presentation and Diagnosis

Early Management of the Critically Ill Patient with Acute Pancreatitis

Management of the Late Complications of Severe Acute Pancreatitis

Long-Term Outcome and Quality of Life

Conclusions

Chapter 78: Hemorrhagic and Thrombotic Disorders

Approach to a Critically Ill Patient with Hemorrhage or Thrombosis

Laboratory Tests of Coagulation

Disorders of Platelets

Complex Thrombohemorrhagic Disorders

Disorders of Hemostasis

Venous Thromboembolism

Catastrophic Antiphospholipid Syndrome

Anticoagulants

Chapter 79: Use of Blood Components in the Intensive Care Unit

Blood Components and Indications for Transfusion

Adverse Effects of Blood Component Transfusion

Special Transfusion Situations in the Critical Care Setting

Alternatives to Transfusion of Blood Components

Legal Issues in Transfusion Medicine

Chapter 80: Intensive Care of the Cancer Patient

Metabolic and Endocrine Complications

Cardiac Complications in Cancer Patients

Pulmonary Complications in Cancer Patients

Infectious Complications in Cancer Patients

Neurologic Complications in Cancer Patients

Gastrointestinal Complications in Cancer Patients

Genitourinary Complications in Cancer Patients

Hematologic Complications in Cancer Patients

Biologic Therapy

Special Considerations in Bone Marrow Transplantation

Code Status and Intensive Care in Cancer Patients

Summary

Chapter 81: Critical Care Medicine in Pregnancy

Physiologic Changes in Pregnancy

Critical Care Management

Pregnancy-Specific Conditions Requiring Intensive Care Unit Care

Conditions Not Specific to Pregnancy

Chapter 82: Nutrition Support

Malnutrition

Starvation Versus Stress Metabolism

Indications for Nutrition Support

Goals of Nutrition Support

Nutrition Support in Critical Illness

Route and Timing of Administration

Types of Nutritional Formulas

Nutritional Assessment and Monitoring

Chapter 83: Bedside Ultrasonography in the Critical Care Patient

Lung Ultrasonography

Abdominal Ultrasonography

Renal Ultrasonography

Deep Venous Thrombosis Ultrasonography

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