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Index
359
complication, after road trac trauma, 79
in obstetric patient, 256, 258
prevention, 79
see also venous thromboembolism (VTE)
dehydration, 226, 227, 229
anorexia nervosa case, 226, 227
cardiac failure risk, 230
diabetic ketoacidosis, 61
delirium, 9, 150–153
benzodiazepines role in development, 151
denition, 150
features assessed, screening for, 151
hyperactive, 150, 278
hypoactive, 150
incidence in critical care, 9, 150
management, 152–153, 277
ABCDEF bundle (acronym), 153
non‐pharmacological, 152
pharmacological, 152–153, 277
mixed, 150
outcome in ICU patients, 153
postcardiac surgery, 278
risk factors, 150–151
modiable, 150
screening for, 151–152
subtypes, 150
delta waves, EEG, 163
deprivation of Liberty Safeguards (DoLS), 92, 93, 230
desaturation, 17
brainstem death testing and, 210
organ donation timing, 211
desmopressin, 147, 199
dexamethasone
bacterial meningitis, 160
COVID‐19, 309, 310
dexmedetomidine, 21, 278
diabetes insipidus (DI), 200
diabetes mellitus, type 1, 60
diabetic ketoacidosis (DKA), 60–70
abdominal pain/vomiting in see abdominal pain
blood test results, 62
clinical presentation, 60
complications, 64–65
diagnostic criteria, 61
hyperosmolar hyperglycaemic state (HHS) vs, 62
insulin therapy, 63, 64
management/treatment goals, 63
metabolic treatment targets, 64
with normal blood glucose levels, 61–62
pathophysiology, 60–61
resolution of episode, 65
timing (when?), 65
severity, classication, 61
diarrhoea, haemolytic‐uraemic syndrome, 301
diazepam, in hyperpyrexia management, 86
dietitians
anorexia nervosa management, 234, 235
on critical care team, 8
Dicult Airway Society (DAS), 20
failed intubation, management, 20
preintubation checklist, 16
diuse axonal injury (DAI), 78
diusion, 326, 341
haemodialysis, 90–91, 91, 326, 341
digital subtraction angiography (DSA), 197
Dimensionless Index (DI), 178
diploic veins, damage, 77
direct antiglobulin test (DAT), 300
disseminated intravascular coagulation
(DIC), 290, 299
in burns injury, 288, 290
causes, 299
diagnostic algorithm, 304
in hyperpyrexia, 84, 86
increased platelet consumption, 296, 299
laboratory abnormalities in, 299
pathophysiology, 299
renal failure in burns injury, 288
in sepsis, 214, 299
thromboelastography, 276
TTP and HUS dierentiation (algorithm), 304
diuretics
hyponatraemia cause and, 148, 149
intravenous, acute heart failure management, 184
with severe aortic stenosis, 185
loop, 184
diving reex, 321, 333
DNACPR, respiratory distress type I case, 46–47
DNAR form, 329, 343
dobutamine, 185, 345
dobutamine stress echocardiography, 179
doctors, critical care, 7
documentation, ‘one‐way’ extubation
discussions, 46–47
dopamine agonists, 85
driving pressures, ventilator, 22, 314
COVID‐19, 313, 314, 315
droplets (air‐borne particles), 307
drowning, 321, 333
drug(s)
acute/fulminant liver failure due to, 248
after CABG and AV replacement, 279
cardiac arrest in obstetric patient due to, 257
encephalopathy due to, 160
failure to wake after cardiac surgery, 278
gliozins, diabetic ketoacidosis due to, 61–62
hyperosmolar hyperglycaemic state due to, 62
increased destruction of platelets due to, 296
for intubation, 15
intubation method, 17–19
liver injury due to, mechanisms, 247
low GCS due to, 188
motor weakness due to, 50
seizures associated, 156
for tracheostomy, 56
use, recreational see recreational drug use
variceal bleeding treatment, 98–99
withdrawal, seizures associated, 156
drug history, 9
drug misuse
low GCS due to, 188
seizure case, 161
see also recreational drug use
drug overdose, 228, 238–253
airway, concerns, 238
aspirin see aspirin
cardiac arrest in obstetric patient, 257
drug types, 238, 240
emergency management, 240–242
GCS drop/low, 188, 237, 239
imaging, 241
medico‐legal and ethical aspects, 238–239
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Index
360
monitoring and tests, 241
multiple drugs, intoxication, 238, 240
paracetamol see paracetamol
staggered, 240, 243, 245, 246
transfer to critical care, 242
tricyclic antidepressants see tricyclic
antidepressants (TCA)
drug reactions, 38
anaphylaxis, 165
type A or type B, 214
dry drowning, 321, 333
duodenitis, 96
dying
recognising signs, 4
see also death; terminal phase of life
dyspnoea see breathing, diculty
dysrhythmias see arrhythmias
E
early warning system, 7
eating disorders, 226, 228
echinocandins, 223, 223
echocardiography
blunt cardiac injury diagnosis, 80
cardiac arrest management, 132–133
cardiac output measurement, 31, 31
in chest pain and rash (HIV) case, 215
focused see focused echocardiography
hypotension after CABG and AV replacement, 265,
266, 270, 271
hypotension in sepsis, 170–171
hypotension in severe aortic stenosis, 177–179
in obstetric patient, 263, 332, 347
pulmonary embolism, 122–123, 123
real‐time, eusion vs tamponade, 270
respiratory distress type I case, 43
right ventricle, 325, 340
severe aortic stenosis, diagnostic criteria, 178
stroke volume variation measurement, 34, 35
after subarachnoid haemorrhage, 196
transoesophageal see transoesophageal
echocardiography (TOE)
transthoracic see transthoracic
echocardiography (TTE)
use in critical care, increasing, 180
eclampsia, 257, 260
management, 257
‘ecstasy’, 82
ectopic pregnancy, ruptured, 227
eculizamub, in atypical HUS, 302
eective circulating volume (ECV), 140
eusions see pericardial eusion; pleural eusion
EGRIS (Erasmus Guillain–Barré Respiratory
Insuciency Score), 58
ELAIN trial, 113
elderly
hyponatraemia, 139
meningitis, 159
mortality after major burns, 291
electrocardiography (ECG)
blunt cardiac injury diagnosis, 80
left ventricular hypertrophy, 177
overdose cases, 241
polymorphic ventricular tachycardia, 225, 226, 227
in pregnancy, 258
pulmonary embolism, 39, 120
rhythm strip in torsade de pointes, 225, 226
risk categorisation in anorexia nervosa, 232
S1Q3T3 pattern, 120
ST segment elevation, failure to wean from CPB, 272
after subarachnoid haemorrhage treatment, 196
electroencephalography (EEG)
continuous, 162, 163
OHCA survivors, 135, 137
role in intensive care, 162–163
waves, and interpretation, 162–163
electrolytes, 323, 337
concentration in urine, 147
excretion, furosemide action, 141
imbalance
in anorexia nervosa, 226, 227, 228, 234
raised anion gap, 63, 228, 229
management after CABG and tamponade, 277
refeeding syndrome risk, 233, 234
in sepsis, 214
serum concentration, 147
see also specic electrolytes
embolectomy, massive pulmonary embolism, 126
embolus/embolism
amniotic uid, 256, 257
in obstetric patient, 257
pulmonary see pulmonary embolism (PE)
emergency cricothyroidotomy, 20
emergency surgery, perioperative risk assessment
scoring systems, 35–36
emotional distress, 9
emphysema, 41
surgical, 317
employment issues, after ICU, 59
encephalitis
cardiac arrest in obstetric patient, 257
infective and non‐infective causes, 156
low GCS due to, 188, 240
seizures due to, 156
encephalopathy
causes, 159–160
hepatic see hepatic encephalopathy
HIV‐related, 220
hypoxic ischaemic, 159, 160, 163
metabolic, 162
after transjugular intrahepatic
portosystemic shunt, 99
uraemic, low GCS due to, 188, 240
end‐expiratory pressure, breath stacking, 313, 313
end‐of‐life care, 292
see also terminal phase of life
‘endomitotic reduplication’, 295
endoscopic retrograde cholangiopancreatography
(ERCP), 67
endoscopic ultrasonography (EUS), 67
endoscopy
emergency, in massive haematemesis, 102, 103
INR impact in massive haematemesis, 102
variceal bleeding treatment, 99–100, 102, 103
endotracheal tube (ETT), 19–20
blockage, 316
for burns patient, 281, 282
cued or uncued types, 19
in haematemesis, 94
migration, 105
drug overdose (cont’d)
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Index
361
patency, checking, 42, 316
position assessment after intubation, 21
small, in re/burns injury, 282, 287
subglottic secretion drainage ports, 20
uncut, burns patient, 281
energy expenditure, extensive burns injury, 290
enolase, 136
enoxaparin, 310
enteral nutrition
anorexia nervosa case, 234
feeds, composition, 235
severe acute pancreatitis, 69
Enterobacteriaceae, 175
ephedrine, intubation, 19
epicardial pacing wires, 269–270, 277
epidural block, after pelvic exenteration, 332, 346–347
epidural/extradural haematoma (EDH), 77, 77
epidural sensor, 197
epilepsy
aetiology, 158–159
classication, 158
known, or new‐onset, 155
see also seizure(s)
erythema migrans, 50
‘escalation plan’, 4
ESCHAPPM organisms, antibiotics for, 216
eschar, 284
escharotomy, 284
Escherichia coli, 174, 175
Shiga toxin‐producing (STEC), 301
Escherichia coli O157:H7, 301
ethics
drug overdose management, 238–239
pandemics and routine healthcare delivery, 312
Euro‐Phospholipid Project (2002), 119
evidence
GRADE system for assessing quality, 11
hierarchy, 11–12
evidence‐based medicine, 11–12
exhaustion, intubation in, 13
expiratory reserve volume, 44
explosion, re and, 280, 281
exsanguination, life‐threatening
balloon tamponade in variceal bleeding, 99
blood typing considerations, 75–76
transfusion in variceal bleeding, 98
see also blood transfusion; haemorrhage, major
extended‐spectrum beta‐lactamase (ESBL), 175
extracellular uid volume (ECF), 140
extracorporeal cardiopulmonary bypass (CPB)
circuit, 266, 267, 267–268
see also cardiopulmonary bypass (CPB)
extracorporeal membrane oxygenation (ECMO),
111, 114, 116
in ARDS, 111, 114
complications, 273
in COVID‐19, 317
venoarterial (VA ECMO), 272, 273
venovenous (VV ECMO) vs, 272, 273
extradural haematoma (EDH), 77, 77
extravascular lung water (EVLW), 30
extraventricular drain (EVD), 197
extubation, 45
failed, signicance, 45, 46
‘one‐way’, 46, 47
respiratory distress type I case, 45, 46
eyes
in brain herniation secondary to raised ICP, 207–208
deviation, malignant MCA syndrome, 204
examination after neurosurgery, 207, 208
movement, absent in brainstem death, 209
visual disturbances in obstetric patient, 256, 257
F
facemask, 17
factitious seizure disorder, 155
family see next of kin, relatives
FAST (Face, Arm, Speech, Test), 202
fatigue, intubation for, 13
fentanyl, intubation and, 17
ferritin, haemophagocytic lymphohistiocytosis
(HLH), 325, 341
FEV
1
/FVC ratio, 43, 44
FFP2 and FFP3masks, 307
breoptic scope, 19
brin degradation products (FDPs), increased, 299
brinogen
clotting with, DIC and, 214
level, 299, 300
brinolysis, abnormal thromboelastography, 276
ne needle aspiration, CT‐guided, necrotising
pancreatitis, 70
re (house), 280–292
airway management after, 280, 281–282, 287
burns see burns injuries
causes, 281
explosions in, injuries due to, 280, 281
inhalational burns injuries, mechanism, 286
main concerns after, 280–281
management/monitoring/investigations, 282–283
soot in mouth, implications, 280, 285
toxin exposure, 281
Fisher grading system, 194
xed‐rate intravenous insulin infusion (FRIII), 64
ail chest, 72
ow rate (Q), ventilation, 105
ow–volume loop, 43, 44
ucytosine, 223, 223
udrocortisone, 199
uid overload, massive transfusion complication, 102
uid responsiveness, assessment
focused echocardiography, 170
focused ultrasonography, 27–28, 28
Frank–Starling curve and, 33, 33
stroke volume variation predicting, 32–33, 33, 34
uid resuscitation/therapy
in acute pancreatitis, 69
in diabetic ketoacidosis, 63
in re/burns patient, 283, 286, 290
in haematemesis, 95
in haemothorax after road accident, 75
in hypotension due to aortic stenosis, 177
in hypotension due to sepsis, 171, 173
in obstetric patient, 262
requirements, calculation in burns patient, 283
in rhabdomyolysis, 88
in severe hyponatraemia, 144, 145, 146
after subarachnoid haemorrhage treatment, 195
in urosepsis, 330, 345
see also crystalloid solution; hypertonic
saline solution
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Index
362
focused assessment with sonography in trauma
(FAST), 73
focused echocardiography
cardiac arrest, 132–133
in obstetric patient, 258
LV impairment/hypertrophy, 178
obstetric patient, cardiogenic shock, 331, 346
pulmonary embolism, 124
shock, dierentiating causes/types, 170–171
in urosepsis, 173, 330
see also echocardiography
focused ultrasonography
assessment of uid responsiveness, 27–28
diculty, with intra‐abdominal pathology, 28–29
indications, 27–28
lung
bedside, after road trac accident, 72, 73–74, 74
pleural eusion, 74, 74
in trauma (FAST), advantages/disadvantages, 73
foetus
delivery, 255, 257
legal status, 254
foramen magnum, 190, 207, 208
forced expiratory volume in rst second
(FEV
1
), 43, 44
forced vital capacity (FVC), 43, 44
4Hs and 4Ts, 131, 256
4T score, 297, 298, 299
Fournier’s gangrene, 330, 345
frailty
ARDS in re/burns patient, 289
scoring (Rockwood), 43, 289
Frank–Starling mechanism/curve, 33, 33,
169, 181, 182
free radical toxicity, 87
fresh frozen plasma (FFP), 102
front of neck access, 20
full blood count (FBC)
polymorphic ventricular tachycardia, 227
functional residual capacity (FRC), 44
intubation method and, 16, 17
in pregnancy, 258, 259
reduced, in acute pancreatitis, 69
fungal infections, 218
candidiasis see candidiasis
community‐acquired pneumonia, 37
investigations, in HIV infection, 220
opportunistic, 219
furosemide, 141
acute heart failure, 184
severe hyponatraemia associated, 139, 141
fusion inhibitors, 221
G
gag reex, absent in brainstem death, 209
galactomannan, 220
gallstone disease, 65, 66, 82
gammahydroxybutyrate (GHB), 82
gamma waves, EEG, 163
gas exchange
intubation for, 13
ventilator setting, 22
gastric erosions, 96
gastric lavage, 247
gastric mucosa, stress‐related injury, bleeding, 96
gastritis, erosive, 96
gentamicin, 170, 213, 215, 216
Glasgow Coma Scale (GCS)
after acute thrombotic stroke, 204
in drug overdose case, 238, 240
grading SAH severity, 193
intracranial pressure elevation, 197
low, 187–200
causes, 187–189
dierential diagnosis, 189
initial concerns/management, 189
SAH see subarachnoid haemorrhage (SAH)
severe hyponatraemia case, 144, 145
Glasgow–Imrie score, 67, 68
gliozins, 61–62
glioblastoma multiforme, 156
gliomas, 187
global end‐diastolic volume (GEDV), 30
glomerular ltration rate (GFR)
low, uraemic encephalopathy, 188
in pregnancy, 259
glucagon, 322, 336
in bradycardia, 324, 338
glucocorticoids see corticosteroids
gluconeogenesis, 232, 322, 336
glucose
hepatic production, 61
renal threshold for handling, 61
glucose, blood
in collapse case (anorexia nervosa), 227
levels in diabetic ketoacidosis, 61, 64
in overdose cases, 241
glucose transporter type 4, insulin‐dependent, 61
GLUT4 receptors, 61
glutamine, 232
glutathione, 242, 243, 245
reduced stores, 245
glyceryl trinitrate (GTN), 185
GOLDMARK (acronym), 63
GPICS V2 standards, 7, 8, 10
GRADE system, 11
gram‐negative bacteria
antibiotics for, 170
bacilli, sepsis, 173, 174
gram‐negative sepsis, chest pain with a rash, 213, 216
ground glass opacities (GGO), 310
Guedel airway, for intubation, 19
Guillain–Barré syndrome, 48, 334
clinical course, 50, 51
clinical presentation, 48
dierential diagnosis, 49–50
investigations, 51–52
management options, 53
ongoing care, 58
outcome/prognosis, 58
pathophysiology, 52–53
plasmapheresis, 53
post‐intensive care syndrome (PICS), 58–59
progression/deterioration, 50
respiratory weaning plan, 57
scoring systems for, 58
tracheostomy indications, 54
see also tracheostomy
treatment plan, 53–54
variants, 49–50
gut failure, in re/burns injury patient, 289, 290
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363
H
H
2
‐receptor antagonists, 95, 196
HAART (highly active ART), 222
haematemesis, 94–103
ABCDE assessment, 94
bleeding severity assessment (bedside), 95
bleeding sources, 98
categories (mild, moderate, severe), 95
haematocrit and usefulness, 95
massive, management, 100–101
INR and impact on endoscopy, 102
massive transfusion, 101–102
oesophageal variceal rupture causing, 98
treatment options, 98–100
see also varices
upper vs lower GI bleeding, 96
see also upper gastrointestinal bleeding (UGIB)
haematochezia, 96, 165
haematocrit, 95
haematological causes, of low GCS, 188–189
haematological complications, of CPB, 268
haematoma
burns injury and, 287
cerebral, 77
head, 156, 157
haemodialtration, 91, 326, 341
haemodialysis, 90–91, 326, 341
intermittent (IHD), 90, 91
haemodynamic collapse, in pulmonary
embolism, 128
haemodynamic instability, 16, 26
in aortic stenosis, 177, 184
continuous RRT in recreational drug use, 92
in high‐risk pulmonary embolism, 119, 122,
124, 125, 126
in tension pneumothorax, 72
haemoltration, 90, 91, 91, 115, 326, 341
haemoglobin, level for transfusion in variceal
bleeding, 98
haemolysis
indirect bilirubin test, 300
MAHA, case history (case 23), 299, 300
in thrombotic microangiopathy, 301
haemolytic anaemia
acquired, 300
microangiopathic see microangiopathic haemolytic
anaemia (MAHA)
in thrombotic thrombocytopenic purpura, 302
haemolytic‐uraemic syndrome (HUS), 189, 296,
301–302, 322, 335
atypical (aHUS), 301, 302, 304, 322, 335
clinical features, 301, 322, 335
description, 301
diagnostic algorithm, 304
STEC, 301, 304, 322, 335
treatment, 301–302
haemophagocytic lymphohistiocytosis (HLH),
325, 340–341
Haemophilus inuenzae, 175
Haemophilus inuenzae type b, 159
haemorrhage
antepartum, 260
major
declaring, in massive haematemesis, 100
massive haematemesis, 100–101
obstetric see under obstetric patient
maternal, 260–261
causes, 260
management, 261
peripartum, 256
postpartum (PPH), 260
primary, secondary, 260
see also bleeding; haematemesis
haemothorax
bedside focused lung ultrasonography, 73–74
management, 75, 78
massive, 72, 75
road trac accident case, 76
Hagen–Poiseuille Law, 105, 287
hallucinations, 149, 150
haloperidol, 153
HALT‐IT study, 98
hand hygiene, 307
handover, after CABG and AV replacement, 279
‘happy hypoxia’, 312
Harris–Benedict formula, 235
headache
obstetric patient, 256, 257
subarachnoid haemorrhage, 187, 195
head trauma, 77, 156, 157
CT scan, 159
healthcare assistants, on critical care team, 8
healthcare‐associated infection (HCAI), 10
heart
blood volume, estimation, 30
contusions, 80
heart block, after ‘on‐pump’ CABG, prevention, 269
heart failure
acute see acute heart failure
in anorexia/starvation, 230
chronic, 185
CPB complication, 268
pregnancy‐associated, 347
with preserved ejection fraction (HRpEF), 184
with reduced ejection fraction (HRrEF), 184
heart rate
in pregnancy, 258
see also bradycardia; tachycardia
heat exchanger, in cardiopulmonary bypass
circuit, 267, 267
heat moisture exchange lter (HMEF), 105
heavy metal intoxication, 49
Helicobacter pylori, 96
helium, 322, 335
HELLP syndrome, 256, 258
helmet CPAP, COVID‐19, 308
hemicolectomy, anastomotic leakage after, 25, 26
hemispheric infarction, 205
heparin
after acute episode of HIT, 298
in CABG and AV replacement, 269
complications, 297
in continuous RRT, 92
low molecular weight, 79, 297, 309
rebound, after cardiac surgery, 269
heparin‐induced thrombocytopenia (HIT),
295, 296
description, 297
heparin administration after acute episode, 298
mortality rate, 298
rapid‐onset or delayed‐onset types, 297
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thrombosis association, 297, 298
timing of development, 297, 298
types I and II, 297
heparin‐induced thrombocytopenia and thrombosis
(HITT), 297
causes and diagnosis, 297, 298
heparin‐platelet factor 4 (PF4) antibody, 297
hepatic artery thrombosis, 252
hepatic encephalopathy, 94, 247
drug treatments, 244
general ICU care, 245
low GCS due to, 188
management, 244
prevention, rifamixin action, 244
West Haven grading of severity, 250
hepatic failure see liver failure
hepatic venous pressure gradient (HVPG), 97
varices development, and bleeding, 97
hepatitis, 324, 338–339
drug‐induced, 247
MDMA overdose, 84
viral, 324, 339
chronic liver disease due to, 248
hepatitis C, 324, 339
hepatocellular damage, drugs causing, 247
hepatopulmonary syndrome (HPS), 17, 325, 339
hepatorenal syndrome (HRS), 250
categorisation/diagnosis, 250
high‐dependency facility, anorexia nervosa
management, 229, 231, 234
high‐ow nasal oxygen (HFNO), 17, 308
in COVID‐19, 308, 309, 310, 311
in haematemesis, 94
high‐frequency oscillatory ventilation (HFOV), 114
HIV‐1, 221
HIV‐2, 221
HIV infection, 214, 219
advanced (Stage 3), 221
condentiality and, 220–221
drug therapy, 221–222
investigations, 220
mortality, 224
prevalence, 221
primary, 221
testing, in XDR‐TB, 327, 342
viral load, interpretation, 220, 222
virus characteristics and life cycle, 221
HIV‐related encephalopathy, 220
HMGB1intracellular proteins, 324, 338
homelessness, 161, 164
‘hour‐1’ bundle, 169–170
signicance, 170
house res see re (house)
4Hs and 4Ts, 131, 256
human herpes virus 8, 217, 220
Hunt and Hess grading system, 193
hydrocephalus, after subarachnoid haemorrhage, 197
hydrocortisone
in myasthenia gravis, 321, 334
in septic shock, 114
hydrostatic pressure, 90, 91
hyperammonaemia, 240
hyperbaric oxygen therapy, 285
hypercapnia, 22, 327, 341
hypercarbia, 133
hypercoagulation, abnormal
thromboelastography in, 276
hyperglycaemia, 60, 61
in diabetic ketoacidosis, 60, 61
diabetic ketoacidosis without, 61–62
hyperosmolar hyperglycaemic state (HHS), 62
hyperination, dynamic pulmonary, 313, 313
hyperkalaemia
diabetic ketoacidosis complication, 64
in obstetric patient, 256
hypermetabolism, in burns injuries, 287
hyperosmolar hyperglycaemic state (HHS), 62
hyperoxaemia
intra‐arrest, mortality, 134
after out‐of‐hospital cardiac arrest, 133–134
postarrest, mortality, 134
hyperoxia, 192
hyperpyrexia, in recreational drug use,
82, 83–84, 85
further management, 86
initial management, 85–86
MDMA adverse eects, 83–84
hypersensitivity reactions, type 1, 38
hypersplenism, 297
hypertension
management in cerebral vasospasm, 198
pre‐eclampsia, 257
recreational drug use, 82
MDMA mechanism of action, 84
hyperthermia
in burns injuries, 286, 287
in serotonin toxicity, 85
see also hyperpyrexia, in recreational drug use
hypertonic saline solution
in hepatic encephalopathy, 244
in malignant MCA syndrome, 206
in severe hyponatraemia, 144, 145, 146
hypnotic drugs, intubation and, 17–18, 21
hypocapnia, 38
hypoglycaemia, 165
in anorexia nervosa case, 232
in burns injury, 290, 291
in diabetic ketoacidosis treatment, 64
in drug overdose case, 240
refractory, 291
hypokalaemia
in anorexia nervosa case, 232
diabetic ketoacidosis complication, 64
in obstetric patient, 256
hyponatraemia, 139–154
in anorexia nervosa case, 232
causes, 141, 147–149
urinary tests in diagnosis, 147–149
classication, 139–140, 140
by symptom severity, 139–140, 140
denition, 139
diagnostic algorithm, 148
dilutional, 86–87
diuretics causing, 148, 149
in elderly, 139
hyperglycaemic, 142
hypotonic, 142, 144
management, 144, 145
based on symptoms, 140
heparin‐induced thrombocytopenia (HIT) (cont’d)
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moderately severe, 140
non‐hypotonic, 142
profound, 141
recreational drug use, 86–87
severe, 139, 140, 141, 144
delayed management, concerns, 146
failure to improve symptoms, 145, 146
immediate treatment guidance, 144
management, algorithm, 144, 145, 146
overly rapid management, 146, 147
sodium levels (serum), 139, 140, 149
sodium levels (urinary), 148, 148–149
after subarachnoid haemorrhage, 199
symptoms, 140
urinary osmolality, 147, 148, 148
hypophosphataemia, 233
hypotension, 165–176
ADH release and, 144
case history (after CABG, AV replacement) (case
21), 265, 270, 271–272
causes, 265–266
case history (rising vasopressor needs) (case
1), 25, 26
see also vasopressor(s)
case history (road trac collision) (case 5), 71, 75
case history (sepsis) (case 13), 165, 166, 169,
170, 171, 173
sudden deterioration, 165, 166
intermittent RRT, 91, 92
in malignancy, focused echocardiography, 171
management
blood transfusion, 75
uids see uid resuscitation/therapy
vasopressors see noradrenaline; vasopressor(s)
in massive haemothorax, 75
persistent
acute high‐risk pulmonary embolism, 119, 124
despite noradrenaline, causes, 177
severe aortic stenosis, 177, 178
postural (orthostatic), 50, 230
propofol causing, 17
pulmonary embolism, 124, 125
acute high‐risk, 119, 124
outcome prediction, 124
qSOFA score, 167
reduced risk with CRRT, 92
in sepsis/septic shock, 112, 165, 166
mechanisms, 169
in severe bleeding, 75, 95
hypothermia
induction, in traumatic brain injury, 78
massive transfusion complication, 102
in obstetric patient, 256
targeted, in OHCA survivors, 134
hypothyroidism, 227
hypoventilation, decreased alveolar oxygenation, 40
hypovolaemia
cardiac arrest, 131, 256
management, 131, 133
hypotension after CABG due to, 265
intravascular, in burns injury, 287
massive haemothorax, 72, 75
peripartum, 256
in sepsis, hypotension due to, 169
hypoxaemia, 44
in ARDS, 111
in COPD, 44
critical, in severe ARDS, rescue methods, 114
prone positioning, 114, 115
pulmonary embolism, 119–120, 125
hypoxia
acute, 37, 39
anaemic, 40, 41
in burns injury patients, 286, 288
in carbon monoxide poisoning, 285
chest pain with, causes, 213, 214
chronic, 44
in cyanide poisoning, 284
‘happy’, in COVID‐19, 312
histotoxic/cytotoxic, 40, 41
hypoxic, 40–41
in inhalational burns injury, 286
management, 40–41
see also oxygen therapy; positive end‐expiratory
pressure (PEEP)
myocardial dysfunction induced by, 215
in obstetric patient, 256
out‐of‐hospital cardiac arrest, 131
after postpartum haemorrhage, 261, 262
regional, 41
stagnant/ischaemic, 40, 41
in status epilepticus, 157
types, 40–41
hypoxic ischaemic encephalopathy, 159, 160, 163
hysteresis, 314
I
ICOPER study, 124
ICU Liberation bundle, 59, 153
IDEAL‐ICU trial, 113
idiosyncratic drug reactions, 247
illegal drugs see recreational drug use
imdevimab, 312–313
immune activating pathogens, identication, 51
immune reconstitutional inammatory syndrome
(IRIS), 219
diagnostic criteria, 219–220
mortality, 224
tuberculosis associated, 220
immunocompromised patients
HIV infection, 218
Kaposi sarcoma, 217
meningitis, 159
oral candidiasis, 218
see also immunosuppression
immunomodulation, Guillain–Barré syndrome, 53
immunosuppression
causes, in chest sepsis, 106–107
massive transfusion complication, 101
oral candidiasis in, 218
immunosuppressive medication
after liver transplant, 252
long‐term, complications, 253
Impella device, 273–274
inborn errors of metabolism, 156–157
incident reporting, systems, 11
independent mental capacity advocate (IMCA), 162,
163, 328–329, 343
indirect antiglobulin test (IAT), 300
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indirect bilirubin test, 299, 300
infection(s)
bacterial see bacterial infections
in burns injury, 287
control, 10–11
fungal see candidiasis; fungal infections
massive transfusion complication, 101
opportunistic, 219
postcardiac surgery, 278
viral see virus infections
see also sepsis
inferior vena cava (IVC)
collapsed, hypovolaemia, cardiac arrest, 133
collapsing, in hypotension in sepsis, 170
distended non‐collapsible, 123
inferior vena cava (IVC) collapsibility index, 27, 28
inferior vena cava (IVC) distensibility index, 27, 28
inferior vena cava (IVC) index, 27, 28
inammation/inammatory response
acute, due to sepsis, 26
in burns injury, renal failure due to, 288
inammatory mediators, 112, 169, 286, 288
inuenza A virus, 106
inuenza virus, 106
inhalational burns injuries, 280, 286
AIS score, 288, 290
bronchoscopy, 288–289
mortality/outcomes, 291
inhalational smoke injury, 280
Injury Severity Score (ISS), 290
innate immune system, 338
inotropic drugs
in acute heart failure, 185
failure to wean from CPB and, 272
inotropy, stroke volume depending on, 112, 112
inspiratory reserve volume, 44
insulin
deciency
absolute, 60
diabetic ketoacidosis, 60, 61, 64
relative, 60, 64
resistance, relative, in pregnancy, 259
therapy, in diabetic ketoacidosis, 63, 64
integrase inhibitors, 221
intensive care, 3
Intensive Care Delirium Screening Checklist
(ICDSC), 152
Intensive Care National Audit and Research Centre
(ICNARC), 11
Intensive Care Society (ICS), 7
intensive care unit (ICU), 3
bed capacity, 5, 6
communication with patient/relatives, 9–10
COVID‐19 challenges, 4
infection control, 10–11
infection susceptibility, 10, 11
interface with hospital, 6–7
levels of care, 4–5
mortality, 4
open and closed units, 7
psychological/psychiatric issues in, 9
referral systems, 7
role within hospital, 4–6
size, 6
sta, psychological issues, 10
standards for, 11
team working on, 7–9
techniques oered, 6
temporary, 5
venous thromboembolism risk factors, 119
see also critical care
intercostal drain, 75
interleukin‐1 (IL‐1), 112
interleukin‐1‐beta (IL‐1β), 324, 338
interleukin‐6 (IL‐6), 112
interleukin‐18 (IL‐18), 324, 338
intermittent haemodialysis (IHD), 90–91, 91
intermittent positive pressure ventilation
(IPPV), 33–34
intermittent renal replacement therapy see renal
replacement therapy (RRT)
International Ascites Club, 250
International League Against Epilepsy (ILAE), 158
international normalised ratio (INR), 102
burns injury with organ failure, 290, 291
impact, endoscopy in massive haematemesis, 102
liver transplant referral criteria, 246
in massive haematemesis, 101, 102
intoxications
carbon monoxide see carbon monoxide
cyanide, 281, 282, 284–285
information resources (UK), 83, 241
multiple drugs, overdose case, 238, 240
see also drug overdose; recreational drug use
intra‐aortic balloon pump (IABP), 272, 274,
277, 322, 335
evidence for use, 276–277
siting, 322, 335
theoretical basis for use, 274–275
triggering, 322, 335
weaning from, 322, 335
intracranial abscesses, 188
intracranial events, 165
GCS decrease after overdose, 240
motor weakness due to, 50
intracranial haemorrhage, 187
seizures, 156
intracranial hypertension see intracranial pressure
(ICP), elevated
intracranial pressure (ICP)
cerebral perfusion pressure and, 190–191
elevated, 188, 189, 191
blood volume increase causing, 190, 191
cerebral oedema in hepatic encephalopathy, 244
eect of, brain herniation, 190, 207–208
eye examination importance, 207
false localising signs, 190, 207
malignant MCA syndrome, 205, 206, 207
mild/severe, pressure levels, 191
nerves susceptible to damage, 207
after subarachnoid haemorrhage, 197
Lundberg waves (A, B, C waves), 197, 198
maintenance, 190, 191
monitoring, methods, 197, 206
normal range, 191
intracranial pressure (ICP) bolt, 197
intracranial tumours, 156
intraparenchymal microsensor, 197
intrathoracic blood volume (ITBV), 30
intratubular casts, 88
intravascular hypovolaemia, renal failure after
burns, 287
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intravenous access
in drug overdose, 240–241
before intubation, 16
see also cannulae/cannulation
intravenous catheters, risks associated, 235
intravenous immunoglobulin (IVIg), 53
intraventricular haemorrhage, 195
intubation, of critically unwell patient, 13–22
cervical spine stabilisation with, 17, 157,
280, 281
COVID‐19, 312, 313
preparation, 309, 312
DAS ICU guidelines, 16
delaying, reasons for, 14
deprivation of liberty and, 92, 93
deterioration after, 177–186
in acute heart failure see acute heart failure
in severe aortic stenosis see aortic stenosis
dicult, 15, 16, 280
burns patient, 281–282
emergency, 14, 16
equipment for, 19–20
failed, 20
in burns patient, prepare for, 282
following, management, 21
indications, 13, 51
in life‐threatening haematemesis, 100, 101
method (how?), 15–20
assessment, 16
call for help, 17
drugs, 17–19
in massive haematemesis, 100, 101
modied RSI approach, 15, 41, 241, 281–282
oxygen, 17
positioning, 16–17
rapid‐sequence induction (RSI), 15
setting up, 16
in pregnancy, 259
prolonged, adverse eects, 57
in pulmonary embolism, 124, 125
‘remote site’, 125
respiratory distress type I, 41, 45
role allocation for, 15
in seizures, 159
when? (timing of), 14
where? (location), 14–15
who? (sta), 15
why? (reasons for), 13
why not? (reasons for not intubating), 14
intubators, rst and second, 15
invasive monitoring, after intubation, 21
ions, 323, 337
ISAT (International Subarachnoid Aneurysm
Trial), 195
ischaemia reperfusion injury, 272
isolation rooms/areas, 10, 11
obstetric patient, after overseas travel, 262
XDR‐TB, 327, 342
isoprenaline, in bradycardia, 324, 338
J
Japanese system, acute liver failure, 248
jaundice, 247
JC virus, 220
Jervell Lange–Neilsen syndrome, 226
journal clubs, 11
justice, 239
K
Kaposi sarcoma, 217, 220
KDIGO staging, 87, 88, 250
ketamine, 18
ketonaemia, 61
ketone bodies, 61, 232
ketones, 60, 62
in collapse case (eating disorder/ventricular
tachycardia), 227, 228
in diabetic ketoacidosis, 60, 61, 62
production impaired in sepsis, 232
starvation phases, 232
use by brain, 232, 233
ketonuria, 60, 61
ketosis, 61
raised anion gap due to, 228
rebound, 64
ketosis, starvation, 229, 230
Kidney Disease Improving Global Outcomes
(KDIGO), 87, 88
King’s College classication, acute liver failure, 248
King’s College Criteria (KCC), 245–246
modied KCC, 246
‘kissing’ ventricle, 27
Klebsiella, 175
Kussmaul breathing (‘air hunger’), 39
L
lactate, 322, 334
anastomotic leak and septic shock, 26
anorexia nervosa, raised anion gap, 228
burns injury, with organ failure, 284, 290
cardiac arrest in obstetric patient, 261, 262
diabetic ketoacidosis and pancreatitis, 62, 65
liver transplant referral criteria, 246
metabolic acidosis, 227, 228
out‐of‐hospital cardiac arrest, 133
paracetamol toxicity, 246
post‐intubation deterioration, aortic stenosis, 177
raised anion gap, 63, 228
in septic shock, 26, 166, 169, 171
in tonic‐clonic seizures, 157, 334
D‐lactate, 63, 334
L‐lactate, 63, 322, 334
lactate dehydrogenase (LDH), 68, 220, 299, 300
lactic acidosis, 322, 334
lactulose, 244
Lambert–Easton myasthenic syndrome (LEMS), 49
LaPlace principle/equation, 181
laryngoscopes, types, 19
laryngoscopy
failure (rst attempt), 20
before intubation, 19
laxative misuse, 228
learning disabilities team, 329, 343
left ventricle (LV)
in aortic stenosis
low‐gradient, 179–180
severe, changes in, 179, 181
appearance, focused ultrasonography, 27
diastolic volume, 181
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failure, CPB complication, 268
lling pressures, increased in hypertrophy, 181
focused echocardiography, in shock, 170
free wall rupture, 266
hypertrophy, 177, 178
compensatory, in severe aortic stenosis, 181
physiological role, 181
problems due to, 181
impairment, severe aortic stenosis, 178, 179
increased pressure overload, 181
mass, decrease in anorexia, 230
during passive mechanical ventilation, 34
pressure–volume loop, 182, 182
in aortic stenosis, 182, 182
systolic function, 181, 182
impaired, 178, 179
systolic pressure, 182
wall stress, 181
wall thickness, increase, 181
left ventricle ejection fraction (LVEF), 178, 179
left ventricle end‐diastolic pressure, 181
left ventricle end‐diastolic volume (LVEDV),
33, 181, 182
left ventricular outow tract (LVOT)
AV velocity ratio, 178
surrogate measure of stroke volume, 34, 35
velocity–time integral (LVOT
VTI
), 31, 31, 32, 34
Legionella, 213
levels of care (in NHS), 4–5
levetiracetam, 163
levosimendan, 272
lidocaine, 18
lipase, serum, 66
‘liquid ecstasy’, 82
Listeria, 159
Listeria monocytogenes, 216
lithium, transpulmonary lithium dilution, 30
liver
cirrhosis see cirrhosis of liver
impairment, coagulopathy from, after
overdose, 244
injury, drugs causing, mechanism, 247
liver disease, chronic, 247, 248
causes, 248–249
liver failure
acute, 188, 247–248
categorisation, 247–248
causes, 247
in paracetamol overdose, 240, 242
see also hepatic encephalopathy
acute on chronic, 247
bleeding risk, viscoelastic testing, 331, 346
ammonia elevation and hepatic
encephalopathy, 244
assessment, scoring systems, 249–250
burns injury with organ failure, 291
categorisation, 247–248
chronic, 247
causes, 248–249
fulminant, causes, 247
MDMA overdose, 84
liver function tests, in chest pain and rash case, 214
liver transplantation, 98
complications (early/delayed), 252–253
criteria for referral, 245–246
non‐paracetamol toxicity, 246
paracetamol toxicity, 245–246
in hepatopulmonary syndrome, 325, 339
on list, outcome, 251
management after, 251–252
medication after, 252
number per annum, 249, 251
super‐urgent, 249, 251
waiting time (UK), 251
‘living will’, 238–239
local anaesthesia, pain management, 332, 346–347
LOLA (L‐ornithine L‐aspartate), 244, 245
long QT, in anorexia/starvation, 228, 229, 230
long QT syndromes, congenital, 226
lorazepam, 151, 155
lower gastrointestinal bleeding, 96
lower limb
oedema, in pregnancy, 258
weakness, Guillain–Barré syndrome, 48
lower respiratory tract infection, 37, 40
after chest trauma, road trac accident, 79
seizure case and, 159, 160
sepsis due to see chest sepsis
ventilation diculties, 104, 105
see also community‐acquired pneumonia (CAP)
lumbar puncture
in chest pain and rash (HIV) case, 214, 215
complications, 52
contraindications, 52, 215
indications, 52
platelet count threshold, 295
in respiratory distress type II case, 51
after subarachnoid haemorrhage, 196
Lundberg waves, 197, 198
Lund–Browder chart, 283
lung
collapsed, partial, 71, 74
uid accumulation, septic shock, 112
protection, ventilation setting, 21–22
volumes, 43, 44
lung‐associated injury, massive transfusion
complication, 102
lung cancer, 39
lung compliance, 41–42
curve, 42, 314–315, 315
decreased, causes, 41–42
low, peak/plateau pressures high, 109
lower/upper inexion points, 314, 315, 315
normal, 315
poor, respiratory distress type I case, 41–42
static, 315
lung disease
irreversible, scale and frailty, 289
pre‐existing, burns injury and, 287
lung function testing, 50–51
in collapse case (anorexia nervosa, VT), 227
Lung Injury Severity Score (LISS, Murray score), 111
lung point, 74, 173, 329, 344
lung pulse, 74
lung sliding, 73, 74, 173, 325, 340
absence, 73, 74, 344
lung ultrasonography, 28, 325, 339–341
A‐lines (reverberation artefacts), 28, 29,
173, 325, 339
bedside focused, after road accident, 73–74, 74
B‐lines (‘comet tails’) see B‐lines
left ventricle (LV) (cont’d)
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