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Clinical Cases in Critical Care, First Edition. Alice Myers and Theophilus Samuels.
© 2023 John Wiley & Sons Ltd. Published 2023 by John Wiley & Sons Ltd.
Index
Notes:
Abbreviations used in the index are listed on pages 13–14.
Page numbers in italics indicate gures and those in bold denote tables.
‘60/60’ sign, 123
A
Abbreviated Injury Score (AIS), 288, 290
ABCDE approach/assessment
COVID‐19, 316
drug overdose, 240–241
re/burns injury, 280–281
haematemesis, 94
maternal haemorrhage, 261
polymorphic ventricular tachycardia, 225–226
road trac collision, 71
seizures, 157
ABCDEF bundle (acronym), 153
ABCS (Alignment, Bony Structures, Cartilage and
Soft tissues), 282
abdominal pain
biliary colic, 65
pancreatitis see pancreatitis, acute
severe, causes, 65–66
vomiting with, 60–70
diagnostic imaging, 67
see also diabetic ketoacidosis (DKA)
abducens nerve (VI), 190, 207
ABO blood groups, 75, 76
abscesses, intracranial, 188
acetylcholinesterase inhibitors, 53
N‐acetylcysteine (NAC), 241, 242–243, 245
aciclovir, 159, 162, 164
acidaemia, metabolic
in diabetic ketoacidosis, 61, 62, 63
in haematemesis, 95
acidosis
metabolic see metabolic acidosis
mixed respiratory and metabolic, 133, 157
acid suppression therapy, 95
Acinetobacter, 10
acquired immunodeciency syndrome
(AIDS) see AIDS
acrodermatitis enteropathica, 235
acronyms see mnemonics and acronyms
activated charcoal, 242, 243
activated coagulation time (ACT), 269
ACURASYS trial, 111
acute cardiac event
chordae tendinae rupture, 39, 266
respiratory distress I in, 39
see also cardiac arrest; myocardial infarction (MI)
acute heart failure, 184–186
denition and types, 184
treatment principles, 184–185
acute inammatory demyelinating
polyradiculoneuropathy (AIDP), 48
acute kidney injury (AKI)
after cardiopulmonary bypass, 269
CRRT in see continuous renal replacement
therapy (CRRT)
‘early’ vs ‘late’ renal replacement therapy, 113
hepatorenal syndrome, 250
in obstetric patient, 256, 258
pre‐renal, in diabetic ketoacidosis, 64
in rhabdomyolysis, 87
mechanism, 87–88
in sepsis and critical illness, 113, 214
severity
creatinine and urea use, 89
KDIGO classication, 87, 88
troponin levels, 215
acute liver failure see liver failure, acute
acute medical care unit (AMU), 293
acute motor axonal neuropathy (AMAN), 49
acute motor sensory axonal neuropathy
(AMSAN), 49
acute respiratory distress syndrome (ARDS),
69, 79, 111
in acute pancreatitis, 69
after blast injury and re, 280, 285, 286, 289
CABP complication, 268
chest radiography, 110, 110
in chest sepsis, 110, 110, 112, 114, 264
in COVID‐19, 308, 310, 314
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description, 111
diagnosis, criteria, 289
in re/burns injuries, 286
inhalational burns injury, 285, 286, 289
risk of, 285–286
ventilation diculty, 287, 289
in lung injury after massive transfusion, 102
lung protective strategy to reduce risk, 285
management
APRV management, ventilator settings, 328, 342
ECMO, 111
neuromuscular blockade (controversial),
111–112, 114
prone positioning, 114, 115
rescue methods for critical hypoxaemia, 114
steroids, 113–114
ventilation and settings, 328, 342
mortality, 286
Murray (LISS) score/grading, 111
outcome, 116
prediction, V
T
:C
RS
, 314
right heart failure with, 327, 341
after road trac collision, 79
secondary to pneumonia, obstetric patient, 264
severity categories, 111, 289
ADAMTS13 protease, 301, 302, 305
activity levels, scoring systems, 302–303, 303
antibodies, 188, 302, 303
admission, refusal, criteria, 3
adrenaline, 19
mechanism of action as vasopressor, 172
advanced critical care practitioners (ACCPs), 7, 8–9
‘advance decision’, 238–239
Advanced Life Support (ABCDE approach), 71,
225–226, 240–241
see also ABCDE approach/assessment
Advanced Life Support, Cardiac surgery protocol, 271
Advanced Trauma and Life Support®
(ATLS®), 71, 281
aerosols, 307
afterload, 182
denition, 182
left ventricle, 182
noradrenaline action, 172
right ventricle
increase, in passive mechanical ventilation, 34
reducing, prone positioning, 115
reducing, thrombolytic therapy in acute PE, 127
reducing, vasodilators in acute PE, 128
in severe aortic stenosis, 182
stroke volume depending on, 112, 112
agitation
in chest sepsis, 104, 213
in delirium, 149, 150, 152, 153, 278
in drug overdose, 238
failure to wake after IABP and, 277, 278
in haematemesis, bleeding varices, 94, 95
in hyponatraemia and delirium case, 149,
150, 152, 153
postcardiac surgery and atrial brillation, 278
RASS (scale), 149, 149, 332
in recreational drug use, 82, 83, 85
in stroke, MCA infarction, 203
AIDS, 221
opportunistic infections, 219
see also HIV infection
air‐borne disease, 307
transmission reduction methods, 307
‘air hunger’ (Kussmaul breathing), 39
airway
assessment
in re/burns injury, 280
in haematemesis, 94
see also ABCDE approach/assessment
dicult, 15
see also intubation, of critically unwell patient
management
with cervical spine control, 17, 71, 157, 160, 280
in re/burns patient, 280, 281–282
in respiratory distress type I, 42
obstruction, 38
grading, FEV
1
, 43
protection/securing, 13
in drug overdose, 240–241, 247
intubation for, 13
in low GCS, 189
tracheostomy indication, 55
see also intubation, of critically unwell patient
resistance, in obstetric patient, 259
swelling, after re, 280
airway pressure release ventilation (APRV), 114,
115, 328, 342
AKIKI trial, 113
alanine aminotransferase (ALT), 293, 294
albumin, 330, 345
alcohol
drug overdose with, 238, 240
encephalopathy due to, 160
misuse, chronic liver disease due to, 248
withdrawal, seizures associated, 156
alfentanil, 17, 21
A‐lines (reverberation artefacts), 28, 29, 173, 325, 339
pneumothorax and, 329, 344
alkalosis
metabolic, 227, 228
respiratory see respiratory alkalosis
allergic reaction, chest pain and shortness of
breath, 214
allylamines, 223, 223
alpha‐2 adrenergic agonist, 21, 278
alpha waves, EEG, 162
alteplase
in pulmonary embolism, 127
in stroke, 202, 324, 338
alveolar‐arterial gradient (A‐a), oxygen, 120
alveolar gas equation, 40
alveolar oxygenation, 40
aminoglycosides, 216
amitriptyline, 240, 241
ammonia
conversion to ammonium, lactulose action, 244
elevated, 188, 240, 244
drug overdose, 240, 244, 249
glutamine formation, 245
metabolism (normal), 244
metabolism in liver failure, 244
ammonium, 244
amniotic uid embolism, 256, 257
amoxicillin, 216
amylase, serum, 66
anaemia, in severe malnutrition, 236
acute respiratory distress syndrome (ARDS) (cont’d)
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anaesthesia
emergency caesarean section, 260
secondary brain injury prevention, 192
analgesia
in acute pancreatitis, 69
in burns injury, 288
in subarachnoid haemorrhage, 195
anaphylaxis, 38, 165
anastomotic leakage
conrmation by CT, 35
after hemicolectomy, 26
rising vasopressor needs see vasopressor(s)
risk factors, 26–27
surgery and perioperative risks, 35–36
aneurysm, cerebral see cerebral aneurysm
anion, 323, 337
anion gap (AG), 61, 62–63
calculation and interpretation, 62–63, 228
elevated, causes, 61, 63, 228
normal, 63, 228
anorexia, 229
cardiovascular complications, 230
anorexia nervosa, 229–230
BMI calculation, 231
critically unwell, management guidelines, 231
diagnosis, 229–230
enteral nutrition, 234, 235, 236
management in HDU, 229, 231, 234
outcome, and mortality, 237
refeeding syndrome prevention, 234
refusal of critical care, 230
risk assessment (MARSIPAN), 231–232
anterior cerebral artery (ACA), 323, 336
occlusion, neurological decit, 203
anterior communicating artery aneurysm, 193, 195
antiacetylcholine antibodies, 48–49
antibiotics
beta‐lactam, 170, 174, 175, 215
broad‐spectrum, 169, 216
cephalosporins, 175
cephamycins, 175
choice, 170, 216
for gram‐negative bacilli, 174
indications
burns injury, 288
chest sepsis, 106
community‐acquired pneumonia, 42, 106
possible meningitis, status epilepticus, 159
seizure patient, 159
septic shock/sepsis, 169, 170, 216
meropenem, 174, 216
monobactams, 175
nephrotoxic, in burns injury, 288
penicillins, 175
prophylactic
after liver transplantation, 252
in variceal bleeding, 100
resistance, 175
see also individual antibiotics
antibradycardia pacing, 269–270, 270, 277
anticoagulation
abnormal thromboelastography in, 276
continuous RRT, adverse eect, 92
in COVID‐19, 309
intra‐/post‐operative, CABG and AV
replacement, 269
see also venous thromboembolism (VTE),
prophylaxis
antidiuretic hormone (ADH), 323, 336
circulating levels, serum osmolality, 143
decrease after subarachnoid haemorrhage, 199
factors inuencing synthesis, 144, 323, 336
mechanism of action, 143, 143–144
overproduction, SIADH, 199, 200
release, 143, 323, 336
factors inuencing, 144
in MDMA overdose, 84, 86
see also vasopressin
antiepileptic drugs, 158, 163
antibrinolytic agent, 78
anti‐freeze, 238–239
antifungal drugs, 223
mechanisms of action, 223, 223
oral candidiasis, 218
prophylactic, after liver transplantation, 252
anti‐GD1a antibodies, 52
anti‐GM1 antibodies, 52
anti‐GQ1b antibodies, 49, 52
antimicrobials
chest pain and rash (HIV) patient, 213, 215, 216
seizure patient, possible meningitis, 159, 162
see also antibiotics; antifungal drugs; antivirals
anti‐PF4 antibodies, 297
antiphospholipid antibodies, 119
antiphospholipid syndrome (APS), 119
antiplatelet therapy, 102
abnormal thromboelastography, 276
antipsychotic drugs, 9
adverse eects, 9
delirium management, 278
neuroleptic malignant syndrome due to, 85
Antiretroviral Cohort Collaboration, 224
antiretroviral treatment (ART), 219, 221–222
adverse eects, 222
combination (cART), 222
prognosis/survival with, 224
symptoms worsening after, IRIS, 219
antituberculosis drugs, 222–223
antivirals
antiretrovirals see antiretroviral treatment (ART)
inuenza, respiratory distress I, 42
prophylactic, after liver transplantation, 252
seizure patient, possible meningitis, 159, 162
aortic cross‐clamp, 268
cardiac ischaemia prevention, cardioplegia, 268
‘prolonged’, outcome, 268
aortic sclerosis, 178, 180–181
aortic stenosis
calcic, 178, 180
causes (acquired/congenital), 180
echocardiography, 178, 178–179
low‐gradient, types, 179–180
LV hypertrophy, 181
moderate, 178, 178
preload in, 181, 182
prevalence, 180
rheumatic, 180
severe, 178, 178
acute heart failure, 184–186
afterload in, 182
echocardiographic criteria, 178
left ventricle changes, 181
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mortality, risk factors, 183
non‐severe vs, 179, 180
percutaneous interventions, 183
surgical intervention, 183
symptomatic, prognosis, 184
treatment options, 183
severity grading, 178, 178
aortic valve (AV)
area in aortic stenosis, 178, 178
bicuspid, 180
calcied, 178, 180, 183
ow (transvalvular) velocity, 178
normal area range, 178
replacement, 265
CPB and see cardiopulmonary bypass (CPB)
prognosis after, 279
surgical, 183
transcatheter, 183
aortic valve area (AVa), 179, 180
aortic valve area indexed (AVai), 179, 180
APACHE II score, 43, 68, 116
apnoea, 17
apnoea test, 209, 210
method, 210
APRV (airway pressure release ventilation), 114,
115, 328, 342
aquaporins, 143, 143
ARDS see acute respiratory distress
syndrome (ARDS)
ARDSNet, 285
arginine vasopressin see antidiuretic hormone (ADH)
arrhythmias
adverse features, 225
in anorexia nervosa case, 232
after ‘on‐pump’ CABG, prevention, 269
polymorphic ventricular tachycardia see
ventricular tachycardia
tricyclic antidepressants causing, 247
artefact(s)
A‐lines, 28, 29, 173, 325, 339
hypotension after CABG and AV replacement, 266
arterial blood gas (ABG)
burns patient, 284
chest sepsis, 107, 114
COVID‐19, 308
diabetic ketoacidosis, 62, 65
out‐of‐hospital cardiac arrest, 133
polymorphic ventricular tachycardia, 227, 228
pulmonary embolism diagnosis, 119–120, 124
see also carbon dioxide; oxygen; pH
ART trial, 114
ascites, cirrhotic, 324, 339
asenapine, 9
aspartate aminotransferase (AST), 293, 294
aspiration
concerns, in low GCS, 189
in obstetric patient, 256, 259
risk in life‐threatening haematemesis, 100
risk in pregnancy, 259
risk reduction, intubation position, 16
during seizure, 257
aspiration pneumonitis, 189
aspirin
in acute thrombotic stroke, 202
after CABG, 269
low‐dose, 97
toxicity/overdose, 238
pathophysiology, 246–247
see also salicylates
asthma, 38
acute, nebulised terbutaline, 331, 345–346
astrocytoma, 187
asystole, ventricular pause and, 324, 338
atelectrauma, 107
Atlanta classication, 68
ATLS® (Advanced Trauma and Life
Support®), 71, 281
ATN study, 92
ATOM‐FC (pneumonic), 73
atrial brillation, 201
postoperative, 277–278
atrial septal defect, 17
atropine, in bradycardia, 324, 337
attention disturbances/reduced, 150, 151
in delirium, 150, 152
re cause, 281
audit, 11
autoantibodies
in Campylobacter jejuni infection, 52–53
RBC destruction, 300
see also specic antibodies
autoimmune conditions, 48, 49
chronic liver disease due to, 249
increased destruction of platelets due to, 296
low GCS due to, 188
autoimmune encephalitis, 188
automated infrared pupillometry, 135
autonomic nervous system,Guillain–Barré
syndrome, 50
autonomic neuropathy, 50
autonomy, 239
autoregulation, cerebral blood ow,190–191, 323, 337
awake prone positioning (APP), 309
axonal degeneration, 54
azathioprine, in myasthenia gravis, 54
azoles, 223, 223
B
Bacillus fragilis, 175
back, burns, 282
bacteria
cell wall, 174, 175, 215
gram‐negative, gram‐positive, 174
bacterial infections
antibiotic choice, 170, 216
chest sepsis due to, 106, 112
community‐acquired pneumonia, 37, 106
gram‐negative bacilli, 173, 174
investigations, 215
meningitis due to, 159
opportunistic, 219
urosepsis due to, 165, 174
balloon tamponade, 99, 101
balloon valvuloplasty (BV), in severe aortic
stenosis, 183
Balthazar index, 68
band ligation, variceal bleeding control, 99–100
barcode (stratosphere) sign, 325, 339
barotrauma
blast injury, res and, 281
aortic stenosis (cont’d)
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COVID‐19 patients, 310
dyssynchrony with ventilator, 107
basal metabolic rate (BMR), 233, 290
calculation, 235
Beck’s triad, 270
bed capacity, 5, 6
bedside focused lung ultrasonography, 73–74,
74, 309
bedside imaging, COVID‐19, 309
Bedside index of severity in acute pancreatitis
(BISAP) score, 68
benecence, 239
benzodiazepines, 18, 85, 151
benzylpiperazines, 82
Bernau system, acute liver failure, 248
best interests, principles, 230, 239
in pregnant patient, 254
beta‐blockers, 185, 240
beta‐D‐glucan, 220
beta‐lactam antibiotics, 170, 174
mechanism of action, 175
resistance, 175, 215
beta‐lactamase, 175, 215
extended spectrum (ESBL), 175
inhibitors, 170, 175, 215, 216
beta‐receptors, 185
beta waves, EEG, 162
bicarbonate, levels in diabetic ketoacidosis, 61,
62, 64, 65
bicarbonate therapy, in rhabdomyolysis, 88
Bickersta’s brainstem encephalitis, 49
biliary colic, 60, 65
bilirubin
indirect, test, 299, 300
metabolism, 300
unconjugated (‘indirect’) form, 300
BISAP score, 68
bispectral index (BIS), 135
blast injuries, 281
bleeding
assessment at bedside, in haematemesis, 95
categories (mild, moderate, severe), 95
decreased production of platelets, 296
occult, 165
risk in acute‐on‐chronic liver failure, 331, 346
source/site, after road trac accident, 75
in thrombocytopenia, 294, 296
thrombolytic therapy disadvantage, 127–128, 132
variceal see varices
see also haematemesis; haemorrhage
B‐lines, 28, 29, 73–74, 325, 339
cardiogenic pulmonary oedema, 173
pneumothorax excluded, 74, 329, 344
pulmonary oedema, 28, 173, 329
blinking, absent in brainstem death, 209
blood–brain barrier, 189, 205, 206
antimicrobial penetrating, 216
mannitol, hypertonic saline and, 191, 206
blood groups
blood transfusion considerations, 75–76
most common, 75
blood pressure
in cerebral vasospasm, management, 198
intra‐arterial monitoring, 125
targeting, in OHCA survivors, 134
see also hypertension; hypotension
blood storage, massive transfusion
complications, 101
blood tests
anorexia nervosa, 227, 228, 232
cardiac arrest in obstetric patient, 258
collapse case (polymorphic ventricular
tachycardia), 227, 228
COVID‐19, 309
after decompressive hemicraniectomy, 206
malignant MCA syndrome, 206, 211
for organ donation, 211
pulmonary embolism diagnosis, 119–120
blood transfusion
in anaemic hypoxia, 41
blood typing and, 75–76
complications, 102
in obstetric patient, 262
cross‐matched
haematemesis, 94, 95
trauma patient, 76
group O, in life‐threatening bleeding, 75–76
haemoglobin level for, in variceal bleeding, 98
in haemothorax, 75
in major haemorrhage, 100, 101
massive, 101
complications, 101–102
in massive haematemesis, 100, 101–102
in obstetric patient, 261, 262
in maternal haemorrhage, 261, 262
platelets see platelet transfusion
universal donor (group O, Rh negative), 76
blood transfusion service, alerting in major
haemorrhage, 101
blood typing, 75–76
blood volume, in pregnancy, 258
blunt cardiac injury (BCI), 79
diagnosis and evaluation, 80
frequency, 79
myocardial injury patterns, 80
trauma‐related injuries associated, 79–80
body mass index (BMI)
calculating, 231
low, 229, 231
NHS recommended range, 231
refeeding syndrome risk, 233
body surface area (BSA), burns, 283
bone ap, decompressive hemicraniectomy, 206
bone marrow disease, 296
Borrelia burgdorferi, 49
botulism, 49
bougie, 20
bowel sounds, hyperactive, 96
bradycardia
management, 323–324, 337–338
prevention after CABG and AV replacement,
269–270, 270
brain
arterial circulation, 323, 336–337
contusions and haematomas, 77
grey to white matter densities (GWR), 136
ketone use, 232, 233
pressure–volume relationship, 190, 191
venous drainage, thrombosis, 189
brain death, 163
brain herniation, 190, 207–208
patterns, 207–208
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brain injury, 161
hypoxic, in re/burns cases, 286
hypoxic ischaemic, prognosis, 328, 342
irreversible damage, 208
secondary, 191
prevention, 191–192
see also traumatic brain injury (TBI)
brainstem
compression, 205
damage, tonsillar herniation, 205, 208
osmotic demyelination syndrome, 146
brainstem death, 208
communication with next of kin, 208, 210, 211
denition, 210
organ donation after, 211, 251
see also organ donation
testing, and preconditions for, 208–209
completion impossible, signicance, 210
doctors performing, 209
global variability in, 210
nerves tested, 209
tests performed, 209
brain tumours
low GCS due to, 187–188
secondary, causes, 187
types, 156, 187–188
WHO classication, 156
breathing
assessment in haematemesis, 94
cessation, facemask use, 17
diculty
cardiogenic pulmonary oedema, 173
after central line insertion, 173
chest pain, and pulmonary embolism, 118
hepatopulmonary syndrome, 325, 339
respiratory distress type I, 37, 40, 41, 45
rising vasopressor needs, anastomotic leak, 25
management in respiratory distress type I, 42
paradoxical movement, 72
spontaneous, trial, weaning plan after, 57
work of
decrease, tracheostomy and, 55
increased in respiratory distress type I, 40, 41, 45
increased in ventilation diculties, 104, 105, 107
breath stacking, 313, 313, 314
bridging device, 272
after failure to wean from CPB, 272, 273, 274
IABP see intra‐aortic balloon pump (IABP)
VA ECMO, 272, 273, 273
weaning from, 277
British Society of Echocardiography, 178
British Thoracic Society guidelines, 345–346
bronchitis, acute, 37
bronchoalveolar lavage, in burns injury, 288
bronchoconstriction, inhalational burns injury, 286
bronchoscopy, 13
breoptic, 288
in inhalational burns injury, 288–289
risks, 289
bronchospasm, management, 331, 345–346
Brugada syndrome, 226
bruises, on head, 240
B‐type natriuretic peptide (BNP), 120
bullous pemphigoid, 217
burns injuries
airway management/intubation, 280, 281–282, 287
ARDS see acute respiratory distress
syndrome (ARDS)
assessment, 282
percentage and depth, 283
burns sepsis syndrome, 283–284
cardiovascular concerns after, 280
chest, 280
escharotomy, 284
extensive, 281, 282, 284, 290
outcome, 291
rst‐degree, 283
uid resuscitation, requirements, 283
gut failure, 289, 290
hyperthermia after, temperature control
diculty, 286, 287
immediate management, 282–284
inhalational see inhalational burns injuries
management/monitoring/investigations,
282–283
mortality, 290, 291
organ dysfunction, severity grading, 289–290
outcomes, 291
pain, causes and management, 286, 288
pre‐existing lung disease and, 287, 289
premorbid status/frailty, 289
renal failure, causes, 286, 287–288
second‐degree, 283
specialist burns centre, indications, 283–284
survivors, problems after, 291
temperature control diculties, 287
third‐degree (full‐thickness), 283, 288
ventilation
diculties, reasons, 286–287, 288
settings, 285–286
burns sepsis syndrome, 283–284
BURP pressure, 20
burst suppression, 163–164
C
cabotegravir, 222
caesarean section
emergency, 255, 260
peri‐mortem, 255
caloric intake restriction, 229
CALS (CSU‐ALS), 271
CAM‐ICU (Confusion Assessment Method for
ICU), 149, 151
Campylobacter jejuni, 51, 52
Candida albicans, 218
candidiasis
oesophageal, 219
oral, 217, 218, 219
cannulae/cannulation
in cardiopulmonary bypass circuit, 267, 267
in haematemesis, initial management, 94
large‐bore peripheral IV, 25
problems after CABP, 269
securing, before intubation, 16
Can’t Intubate Can’t Ventilate emergency, 20
capacity, mental, 230, 238–239
denition, 239
drug overdose case, 238, 239
independent mental capacity advocate, 162, 163,
328–329, 343
caplacizumab, 303
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carbapenem, 174, 216
resistance, 175
carbon dioxide
alveolar partial pressure, 40
partial pressure
cerebral blood ow relationship, 192
re/burns cases, 286
hepatic encephalopathy after overdose, 244
pulmonary embolism, 120
respiratory distress I, 37
secondary brain injury prevention, 192
carbon monoxide, 281, 282
levels, 285
toxicity, mechanism and management, 285
carboxyhaemoglobin, 285
cardiac arrest
in acute high‐risk pulmonary embolism, 119
arterial blood gas interpretation, 133
after CABG and AV replacement, 271
Cerebral Performance Category Scale,
137, 137, 138
chain of survival, 130
denition, 130
echocardiography, role, 132–133
4Hs and 4Ts, 131, 256
hyperoxaemia association, 133–134
immediate coronary angiography after, 132
immediate management, 130, 132
in‐hospital (IHCA), 134
obstetric patient see obstetric patient
modied Rankin Scale (mRS), 137, 138
mortality, 131, 134
neurological outcome see under out‐of‐hospital
cardiac arrest (OHCA)
obstetric patient see obstetric patient
out‐of‐hospital see out‐of‐hospital cardiac
arrest (OHCA)
postresuscitation management, 133
in pregnancy see obstetric patient
prognosis, 133
focused echocardiography for, 133
neurological outcome, tests, 135–136
reversible causes, treating, 131
targeting hypothermia in survivors, 134
targeting MAP in survivors, 134
thrombolysis, evidence for/against, 131–132
cardiac arrhythmias see arrhythmias
cardiac complications, after subarachnoid
haemorrhage, 196
cardiac cytoprotection, 272
cardiac disease, maternal death, 255
cardiac enzymes, blunt cardiac injury diagnosis, 80
cardiac failure see heart failure
cardiac lling, decreased, in sepsis, hypotension, 169
cardiac ICU, 265–279
care optimisation after CPB and IABP, 277
see also cardiopulmonary bypass (CPB); coronary
artery bypass grafting (CABG)
cardiac ischaemia, prevention, in cardiopulmonary
bypass, 268
cardiac muscle, myobrils in preload, 181
in aortic stenosis, 182, 182
cardiac output
decreased, in drug overdose case, 240
Frank–Starling curve and, 33, 33, 169, 181, 182
measurement, 29–32
echocardiography, 31, 31
pulse contour analysis, 30
thoracic electrical impedance, 32
transoesophageal aortic Doppler, 31–32
transpulmonary lithium dilution, 30
transpulmonary thermodilution, 29–30
monitoring
in postcardiotomy cardiogenic shock, 266
in septic shock, 113
in pregnancy, 258
‘cardiac standstill’, 133
cardiac surgery
AV replacement see aortic valve (AV)
CABG see coronary artery bypass grafting (CABG)
pericardial eusion after, 270
tamponade after, presentation, 270–271
management, 271–272
see also open heart surgery
Cardiac surgery Advanced Life Support
protocol, 271
cardiac tamponade see tamponade
cardiogenic pulmonary oedema (CPO), 173, 185
cardiogenic shock, 166
echocardiography, 170
Impella device use, 274
intra‐aortic balloon pump use, 276
obstetric patient, 331, 346
postcardiotomy, 266
pulmonary embolism complication, 128
ventricular assist device in, 273
cardiology review, 43
cardioplegia, cardiopulmonary bypass, 268
cardiopulmonary bypass (CPB), 266
in CABG and AV replacement, 265, 271, 272
circuit, 266, 267, 267–268
description, 267, 267–268
complications, 266, 268–269, 272
epicardial pacing wires use, 269–270, 270, 277
failure to wean from, causes, 272
management options, bridging device,
272, 273, 274
weaning from bridging device, 277
indications, 266
protamine after, 268, 269
cardiopulmonary resuscitation (CPR), 130, 132
gravid uterus displacement, 255
in pregnant patient, 254–255
see also resuscitation
cardiovascular care/status improvement
in septic shock, 112, 113
techniques in ICU, 6
cardiovascular collapse, 39, 72, 128
cardiovascular complications, of CPB, 268–269
cardiovascular disease, primary prevention, 97
cardiovascular events
hypotensive (sepsis) patient, 165
pulmonary embolism complication, 129
cardiovascular toxicity, MDMA, 84
CARE (Cardiac Advanced Resuscitation
Education), 271
‘Care bundles’, 10
casirivimab, 312–313
catecholamines, 172, 196
organ donation (category III donation), 211
see also noradrenaline
catheterisation, techniques requiring, 6
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Index
356
cations, 323, 337
CCHASM (acronym), 146–147
CD4
+
(T‐helper cells), 220, 221, 222
CD4
+
/CD8
+
ratio, 220, 222
CD8
+
, 220, 222
ceftriaxone, 159
central tentorial herniation, 207
central venous catheterisation (CVS)
cardiogenic pulmonary oedema after, 173
complications, 173
hypotension in sepsis case, 171, 173
monitoring after intubation, 21
uses/applications, 21
central venous pressure, after CABG and AV
replacement, 270
cephalosporins, 100, 175
cephamycins, 175
cerebellar tonsil herniation (‘coning’), 190, 207–208
cerebral aneurysm, 156, 192, 193
fusiform, 193
rupture, 193
saccular (‘berry’), 193
cerebral blood ow
autoregulation, 190–191, 323, 337
optimisation, secondary brain injury
prevention, 192
pressures relationship, 192
cerebral irritation, headache and vomiting in, 187
cerebral ischaemia, 191
cerebral oedema
in acute liver failure, 188
in diabetic ketoacidosis, 64–65
in hepatic encephalopathy, 244
hyponatraemia and, 142, 144, 146
in malignant MCA syndrome, 205
in raised ICP due to blood volume increase, 190
reduced risk with CRRT, 92
risk after decompressive hemicraniectomy, 206
Cerebral Performance Category (CPC) Scale,
137, 137
cerebral perfusion pressure (CPP),190–191,
323, 336, 337
A waves (Lundberg waves), 198
normal range, 191
cerebral salt wasting (CSW), 199, 200
cerebral toxicity, MDMA, 84
cerebral vasospasm, 77
blood pressure management in, 198
investigations/diagnostic methods, 197
management, 197–198
after subarachnoid haemorrhage, 196, 197, 199
treatment, 195
cerebral venous sinus thrombosis, 189
cerebrospinal uid (CSF), 322, 335
manometry, and drainage, 197
production and composition, 322, 335
cerebrovascular event
low GCS due to, 187
see also stroke
cervical spine
management in seizure case, 160
manual inline stabilisation, 17, 71, 157,
160, 280, 281
chain of survival, 130
channelopathy, inherited, 226
chemotherapy, encephalopathy due to, 160
chest
burns, 280, 282
ail, 72
paradoxical movement, 72
chest drain
output, decrease in tamponade, 266
in tension pneumothorax, 316, 317
chest pain, 118–129
cardiac, 39, 118
see also pulmonary embolism (PE)
causes, 118
investigations, 214–215
respiratory, 118
chest radiography
cardiogenic pulmonary oedema, 173
chest sepsis and ventilation diculty, 110,
110, 112, 113
COVID‐19, 310
after intubation, 21
overdose case, 241
pulmonary embolism, 120
chest sepsis
ARDS and, 110, 110, 111, 114, 264
causes, 106–107, 112
see also community‐acquired
pneumonia (CAP)
deteriorating, 105–106
inadequate MAP, vasopressin for, 330, 344
severe, 110, 112
ventilation diculties, 104, 105–106
XDR‐TB, 327, 342
see also septic shock
chest trauma
life‐threatening, ATOM‐FC, 72
pneumonia and respiratory failure after, 79
pneumothorax after, 72
Cheyne–Stokes breathing, 207
child/children
meningitis, 159
separation from mother in critical care, 263
Child–Pugh classication, 97–98, 249
cholestatic injury, drugs causing, 247
chordae tendinae, rupture, 39, 266
chronic heart failure, 185
chronic kidney disease, hepatorenal syndrome, 250
chronic obstructive pulmonary disease (COPD)
acute exacerbation, 38
home oxygen, re/burns injury, 286, 287, 289
increased lung compliance, 41
right ventricular dysfunction, 44–45
chronic thromboembolic pulmonary hypertension
(CTEPH), 129
ciclosporin, 54
circle of Willis, 193, 194
circulation
assessment in haematemesis, 94
impaired, regional hypoxia, 41
management in respiratory distress type I, 42
see also ABCDE approach/assessment
cirrhosis of liver
Child–Pugh classication, 97–98
‘compensated’, 97
decompensated, 98
haematemesis in, case history (case 7), 94, 95, 97,
98, 100, 101, 103
severity, nitric oxide levels, 325, 339
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357
varices, development, 97
see also varices
cisatracurium, 21, 111
citrate, 92
Claasen grading system, 194
clinical assessment, 12
clinical governance, 11–12
clinical trials, COVID‐19, recruitment, 310
clipping, subarachnoid haemorrhage treatment, 195
clonidine, 21
Clostridium botulinum, 49
Clostridium dicile (C. di), 10
Clostridium perfringens, 345
Clostridium septicum, 345
clot formation, dynamics, TEG for, 274
clotting derangement, burns injuries, 290
clotting factors, in pregnancy, 258
CNS tumours, 156
see also brain tumours
coagulation
abnormalities
cirrhosis, with massive haematemesis, 102
massive transfusion complication, 101
in obstetric patient, 258
status, after CABG and AV replacement, 269
coagulation factors
in disseminated intravascular coagulation, 299
in pregnancy, 258
coagulopathy, from liver impairment after
overdose, 244
co‐amoxiclav, 216
coiling, subarachnoid haemorrhage treatment, 195
cold agglutinins, 300
collapse in young patient, 225–237
see also anorexia nervosa; ventricular tachycardia
colorectal POSSUM score, 36
COMACARE trial, 134
‘comet tails’ see B‐lines
communication
COVID‐19 patient in critical care, 312
dicult, respiratory distress type I case, 46–47
on ICU, 9–10
community‐acquired pneumonia (CAP), 37
ARDS due to see acute respiratory distress
syndrome (ARDS)
chest sepsis, 104, 106, 116
complications, 116
inadequate MAP, vasopressin for, 330, 344
mortality risk, scores, 116
pathogens causing, 37, 106
respiratory distress type I in, 37
severe, 116
steroids in, 113–114
compartment syndrome, 284
compliance, homeless patient and, 161, 164
compulsory treatment order, 230
computed tomography (CT)
acute pancreatitis diagnosis, 67
chest, COVID‐19, 310
head/brain
acute thrombotic stroke, 202, 203, 204
burn injury patient, 284, 286
cerebral vasospasm after SAH, 197
epidural/extradural haematoma, 77, 77
head trauma, 159
hypoxic ischaemic brain injury, 328, 342
in low GCS, 189, 190
obstetric patient, 258, 263, 264
OHCA survivors, 136
overdose case, 241
PRES (posterior reversible encephalopathy
syndrome), 263, 264
road trac accident case, 76, 78
subdural haematoma, 76–77, 77
necrotising pancreatitis, 70
rising vasopressor requirements (case 1),34, 35
trauma patients, 76, 78
computed tomography angiography (CTA), acute
thrombotic stroke, 202
computed tomography pulmonary
angiography (CTPA)
indeterminate results, 121
obstetric patient, 258, 263, 331, 346
pulmonary embolism, 121, 125–126
respiratory distress type I case, 43
condentiality, 10, 220–221
confusion
delirium, 150
Guillain–Barré syndrome due to toxins, 49
HIV infection, 220
MDMA use and, 83
meningitis, 212
rising vasopressor needs (anastomotic leak), 25,
26, 29, 34, 35
septic shock, 167, 168
Confusion Assessment Method for ICU
(CAM‐ICU), 149, 151
congenital heart disease, 226
‘coning’ (tonsillar herniation), 190, 207–208
consciousness
altered level, in delirium screening, 151
decreased, brain herniation, 207
loss, road trac accident case, 76, 77
consumptive coagulopathy see disseminated
intravascular coagulation (DIC)
continuous renal replacement therapy (CRRT)
access, 90
advantages, vs intermittent RRT, 89–90, 92
anticoagulation, 92
characteristics, 89–90
costs, 92
disadvantages in critical care, 92
dose, 92
indications in critical care, 89, 92
in recreational drug use case, 89, 92
timing of initiation, 89
urea removal, 90
continuous venovenous haemoltration
(CVVH), 90, 91
dose, 88
rhabdomyolysis management, 88, 92
septic shock case management, 113
contusions
brain, 77
heart, 80
pulmonary, 79, 287
convection, haemoltration, 90
cooling, in hyperpyrexia, 85–86
Coombs test, 299, 300
corneal reex, 135, 209
‘Cornish Pasty’ method, prone positioning, 115
coronary angiography, after cardiac arrest, 132
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coronary artery bypass grafting (CABG)
acute blockage, 266
antibradycardia pacing after,269–270, 270, 277
aortic cross‐clamp time, signicance, 268
bleeding after, 272
management, 271, 272
failure, aspirin to prevent, 269
hypotension after, causes, 265–266
indications, 266
myocardial infarction after, 266
‘o‐pump’, 266
‘on‐pump’, 266
description, 266
outcome, vs ‘o‐pump’, 266
see also cardiopulmonary bypass (CPB)
prognosis after, 278
tamponade after see tamponade
coronary heart disease, 181, 226
coronary thrombosis, in obstetric patient, 256
coronavirus infection, 106
see also COVID‐19
corticosteroids
in bacterial meningitis, 160
in myasthenia gravis, 54, 321, 334
in sepsis, 172–173
in severe CAP, low MAP, 113–114, 330, 344–345
in thrombotic thrombocytopenic purpura, 303
see also steroids; individual corticosteroids
CORTICUS trial, 321, 334
cough reex, absent in brainstem death, 209
counterpulsation, 274
coup contre‐coup injury, 77
coup contusions, 77
COVID‐19, 306–317
causative virus, 308
chest radiography/CT, 310
corticosteroids, 309, 310
critical care
admission concerns, 311
consultant, discussion with, 317
management in, 312, 316
desaturation/hypotension emergency, 315, 316
ECMO in, 317
initial main concerns, 308
intubation, 309, 312, 313
management before intubation, 309–310
oxygen therapy
awake prone positioning and, 309, 310
high‐ow nasal oxygen, 308, 309, 310, 311
non‐invasive devices, 308
pharmacological treatment, 309, 310, 312–313
pneumothorax development, 316, 329, 344
serious disease, 308
ventilation, 313–315, 317
breath stacking, 313, 313, 314
driving pressure, 314, 315
overdistension, 315, 315
COVID‐19 pandemic, 4, 306
challenges, 4
critical care bed capacity, 5
‘hot’/’cold’ areas, quarantine areas, 306
psychological issues amongst ICU sta, 10
CPB see cardiopulmonary bypass (CPB)
cranial nerves, brainstem death testing, 209
craniectomy, 195
CRASH‐2 trial, 75
CRASH‐3 trial, 78
C‐reactive protein (CRP), 293
creatine kinase, serum
post‐traumatic rhabdomyolysis, 88
recreational drug use and, 86, 87, 88, 89
creatinine, serum
KDIGO classication, acute kidney injury, 88
in overdose and liver failure, 249
recreational drug use and, 87
crepitations, lung, 25, 173, 217, 226
cricoid pressure, 20
cricothyroidotomy, 20
critical care
current trends, keeping up to date, 11
description and synonyms, 3
interface with hospital, 6–7
postcritical care issues for patients, 58–59
space, sta and stu (pandemic planning), 311
subspecialty, 6
see also intensive care unit (ICU)
critical care outreach, 7–8
critical care team, 7–9
critical care without walls, concept, 7
critical illness myopathy (CIM), 325, 340
critical illness neuropathy (CIP), 325, 340
CROP index, 332, 347
cross‐infection
prevention, 10–11
screening, 10
cross‐matching see under blood transfusion
CR‐POSSUM, 36
CRRT see continuous renal replacement
therapy (CRRT)
crystalloid solution, administration
anastomotic leakage case, 25
haematemesis case, 95
hypotension in sepsis case, 169
rhabdomyolysis management, 88
septic shock case, 113
see also uid resuscitation/therapy
CTX‐M enzymes, 175
CURB‐65 score, 116
‘curtain sign’, 74
Cushing reex, 197
Cushing’s triad, 208
cyanide poisoning, 281, 282, 284–285
CYP450, 242, 243, 285
D
damage‐associated molecular patterns
(DAMPs), 324, 338
dantrolene, 86
‘DBD’ donation, 211, 251
D‐dimer, serum levels, 299, 300
pulmonary embolism, 120
death
brainstem see brainstem death
circulatory, organ donation after, 211, 251
denition, 210
debrieng, 10
deceleration injuries, 77, 79
decompressive hemicraniectomy (DHC), 205, 206
complications, 207
management in neurocritical care, 206
deep vein thrombosis (DVT)
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