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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3080_Библиотеки_им_академика_М_И_Перельмана
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ISTUDY
Clinical Cases
in Critical Care
Alice Myers
Department of Intensive Care Medicine
East Surrey Hospital
UK
Theophilus Samuels
Department of Intensive Care Medicine
East Surrey Hospital
UK
Clinical Cases
in Critical Care
This edition rst published 2023
© 2023John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as
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http://www.wiley.com/go/permissions.
The right of Alice Myers and Theophilus Samuels to be identied as the authors of this work has been
asserted in accordance with law.
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Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientic research, understanding, and discussion
only and are not intended and should not be relied upon as recommending or promoting scientic method,
diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment
modications, changes in governmental regulations, and the constant ow of information relating to the use
of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided
in the package insert or instructions for each medicine, equipment, or device for, among other things,
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disclaim all warranties, including without limitation any implied warranties of merchantability or tness
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or recommendations it may make. This work is sold with the understanding that the publisher is not engaged
in rendering professional services. The advice and strategies contained herein may not be suitable for your
situation. You should consult with a specialist where appropriate. Further, readers should be aware that
websites listed in this work may have changed or disappeared between when this work was written and when
it is read. Neither the publisher nor authors shall be liable for any loss of prot or any other commercial
damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging- in- Publication Data applied for
PB: 9781119578901
Cover Design: Wiley
Cover Images: © Tempura/Getty Images (back cover) © Chaikom/Shutterstock, © Tempura/Getty Images
Set in 11.5/13.5 STIXTwoText by Straive, Pondicherry, India
For Alex
1978 – 2018
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Foreword and How to Use This Book ix
Author Information x
Acknowledgements xi
List of Abbreviations xiii
PART I Introduction 1
Section 1 A Brief Introduction to Critical Care3
Section 2 Intubation of the Critically Unwell Patient13
PART II The Cases23
Case 1 The Patient with Rising Vasopressor Requirements 25
Case 2 The Patient with Respiratory Distress I37
Case 3 The Patient with Respiratory Distress II48
Case 4 The Patient with Abdominal Pain and Vomiting60
Case 5 The Patient Involved in a Road Traffic Collision71
Case 6 The Patient with a Raised Temperature82
Case 7 The Patient with Haematemesis94
Case 8 The Patient Who Is Difficult to Ventilate 104
Case 9 The Patient with Chest Pain118
Case 10 The Out- of- Hospital Cardiac Arrest Patient130
Case 11 The Patient with Hyponatraemia 139
Case 12 The Patient in Status Epilepticus155
Case 13 The Patient Who is Hypotensive165
Contents
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Contents
viii
Case 14 The Patient Who Deteriorates Post Intubation177
Case 15 The Patient with Reduced Consciousness187
Case 16 The Patient Who had A Stroke201
Case 17 The Patient with Chest Pain and a Rash213
Case 18 The Young Patient Who Collapses 225
Case 19 The Patient Who has Taken an Overdose 238
Case 20 The Unwell Obstetric Patient254
Case 21 The Patient in Cardiac ICU265
Case 22 The Patient Who was in A House Fire280
Case 23 The Patient with Low Platelets293
Case 24 The Patient with COVID- 19306
PART III Test Yourself319
Multiple Choice Questions321
Single Best Answer Questions327
Answers 333
Index 349
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Foreword
T
he authors would like to express deepest gratitude to their families for the
continued support and encouragement they gave during the writing of
this book.
Alice would like to thank Gordon and Auntie Margaret.
Theophilus would like to thank Kat, Joshua and Electra.
How to Use This Book
This is not intended to be an exhaustive didactic textbook of critical care
medicine. The aim of this book is to try and cover a large section of core
intensive care medicine (ICM) knowledge in a practical way, keeping the
science relevant to your daily work in ICU. The introductory sections provide an
overview of critical care medicine and include material which is often encoun-
tered in examinations.
The main body of the book consists of the clinical cases. Cases are ordered
randomly to reect the unpredictability of clinical work and, we hope, to keep
things interesting. Each case is based around a ctional vignette which amal-
gamates various real cases managed by the authors. As many core topics as
possible are explored through relevant questions and answers as each case
develops. Try and answer the questions as you go. We hope this will keep you
engaged during self-
study. We’ve done our best to ensure that the cases are
accurate and free from error. However, if you spot any mistakes please feel
free to let us know.
The answers provided to the questions are often more detailed than you
would be required to give in an examination and individual cases are longer
than most viva voce examinations. If you are practising for an oral examination,
we suggest you either take a section of a case with about ve or six questions
and drill down into the details or take a longer segment but aim for only the
main bullet point answers.
At the end of the book is a Test Yourself section. Some of the answers to
these questions can be found within the cases, others cover new material to
further expand your knowledge.
We hope that you nd this book a useful and engaging tool for revision,
learning new topics and preparation for examinations.
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Author Information
Dr Alice Myers MBBS BA(Hons) MRCP FRCA EDIC FFICM
Consultant in Intensive Care Medicine and Anaesthesia
Surrey and Sussex Healthcare NHS Trust
Department of Intensive Care Medicine
East Surrey Hospital
Canada Avenue
Redhill
Surrey RH1 5RH
alicemyers@nhs.net
Dr Theophilus Samuels MBBS, BSc(Hons), FRCA, FFICM, Cert Maths
(Open), Dip Maths (Open), Dip Stats (Open), BA(Hons) Math Stat
(Open), AMIMA, GradStat
Level 2 British Society of Echocardiography TTE accredited
Consultant in Intensive Care Medicine and Anaesthesia
Surrey and Sussex Healthcare NHS Trust
Department of Intensive Care Medicine
East Surrey Hospital
Canada Avenue
Redhill
Surrey RH1 5RH
theophilus.samuels1@nhs.net
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W
e are very grateful to friends and colleagues who have supported us by
reading and commenting on the cases whilst they were in development.
Nawaf Al-
Subaie MD(Res)
FRCA EDIC FICM
Consultant in Anaesthesia and
Intensive Care Medicine
Giada Azzopardi BSc MBBS MRCP ST4 Renal Medicine and Intensive
Care Medicine
Gordon Bird MBBS BSc(Hons)
MRCP FRCA EDIC FFICM
Consultant in Anaesthesia and
Intensive Care Medicine
Joshua Burns MBBS BSc Clinical Fellow in Critical Care
George Chater MB
BChir MRCP (UK)
ST3 Anaesthetics
Muhammadawais Cheema MBBS Clinical Fellow in Intensive Care
Medicine and Critical Care
Echocardiography
Terry Collingwood MBBS
BSc(Hons) MRCP FFICM DipIMC
Consultant in Intensive
Care Medicine
Catherine Collins RD FBDA Critical Care Dietitian
Jamie Conti BSc MBBS MRCP ST4Intensive Care Medicine
Nicholas Courtenay-
Evans
MBBChir MA(Cantab)
FRCA PGDip
Consultant Anaesthetist
Paul Crowest BMBS BSc
FRCA FFICM
Consultant in Anaesthesia and
Intensive Care Medicine
Alexa Curtis MBBS BSc(Hons)
MRCP FRCA FFICM
ST8 Anaesthetics and Intensive
Care Medicine
Jordan Durrant MBBS FRCS(Urol) Consultant Urologist
Gareth Ennew BSc(Hons) MBBS
FRCEM FFICM
Consultant in Emergency Medicine
and Intensive Care Medicine
Lynn Evans BSc MBBS MRCP
FFICM PG Cert Med Ed
Consultant in Acute Medicine and
Intensive Care Medicine
Professor Lui Forni MB PhD Consultant in Renal Medicine and
Intensive Care Medicine
Rebecca Gray MBBS
FFICM FRCP MSc
Consultant in Acute Medicine and
Intensive Care Medicine
Guy Hickson MBBS BSc FRCR Consultant Interventional
Radiologist
Luke Hodgson MD MSc MRCP
EDIC FFICM BSc
Consultant in Respiratory Medicine
and Intensive Care Medicine
Fiona Jones PGDip RGN Hepatology Clinical Nurse
Specialist
Acknowledgements
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