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Index
369
cardiogenic pulmonary oedema, 173
central line insertion complications, 173
COVID pneumonia, pneumothorax, 329, 344
focused, 73–74, 74
lung point, 74, 173, 329, 344
lung pulse, 74
lung sliding see lung sliding
pleural eusion, 74, 74
Lyme disease, 49–50
lymphadenopathy
axillary, bilateral, 217
causes, 218
lymphoma, in HIV, 220
M
MACOCHA score, 16, 16
magnesium, administration
acute asthma, 331, 346
seizure prevention in obstetric patient, 257, 264
torsade de pointes, 226
magnetic resonance angiography (MRA), in
stroke, 324, 338
magnetic resonance cholangiopancreatography
(MRCP), 67
magnetic resonance imaging (MRI)
DWI, in stroke, 324, 338
in Guillain–Barré syndrome, 50, 52
intracranial events, 50
in OHCA survivors, 136, 137
prognostication after ROSC, 328, 342
tonsillar herniation, 208
malabsorption, refeeding syndrome risk, 234
maldigestion, refeeding syndrome risk, 234
malignancy
brain see brain tumours
lung cancer, 39
pericardial eusion with, 329, 344
malignant MCA syndrome, 204, 205, 205
management, 205–206
see also decompressive
hemicraniectomy (DHC)
pathophysiology, 205
prognosis, 205
Mallory–Weiss tear, 96–97
malnutrition, 227, 230
severe
cardiovascular complications, 230
non‐cardiac complications, 236
see also anorexia nervosa
mannitol
in hepatic encephalopathy, 244
in malignant MCA syndrome, 206
in rhabdomyolysis, 88
MARS (molecular adsorbent recirculating
system), 243
MARSIPAN guidelines, 231
mask(s)
facemask, 17
FFP2 and FFP3, 307
non‐rebreathe, 41, 189
surgical, air‐borne transmission reduction, 307
mass transfer, haemoltration, 90
maternal death, 255
MBRRACE, maternal death frequency, 255
McConnell’s sign, 123, 123
MCQs, 321–326, 333–341
MDMA (3,4‐methylenedi-oxymethamphetamine),
82, 83
biochemical tests, 86
cause of death, 83–84
clinical toxicity, patterns, 83–84
concentration variations, 83
hyperpyrexia management, 85–86
mechanism of action, 83
mortality associated, 84, 86
muscular hyperactivity, treatment, 86
signs/symptoms associated, 83
subjective/physiological/adverse eects, 83
mean arterial pressure (MAP)
cerebral blood ow relationship, 192
cerebral perfusion pressure and,190–191,
323, 336, 337
target, in hypotension in sepsis case, 171
targeting, in OHCA survivors, 134
vasopressors for
noradrenaline, 128, 172
peripheral access, in urosepsis, 330, 345
in septic shock/sepsis, 166, 168
vasopressin after noradrenaline, 172, 330, 344
see also noradrenaline; vasopressor(s)
mechanical ventilation see ventilation, mechanical
medical history, obtaining on ICU, 10
in drug overdose case, 242
in polymorphic ventricular tachycardia, 227
medico‐legal aspects, drug overdose
management, 238–239
megakaryoblasts, 295
megakaryocytes, 295, 299
mEGOS (modied Erasmus Guillain‐Barré Outcome
Score), 58
melaena, 96, 165
MELD (Model for End‐stage Liver Disease), 249
meningiomas, 188
meningitis
cardiac arrest in obstetric patient, 257
low GCS due to, 188, 240
meningococcal, 213
pathogens causing, 159, 162
seizures, 156, 159
steroids in, 160
meningococcaemia, 217
meningococcal meningitis, 213
meningococcal septicaemia, 216
Mental Capacity Act 2005 (UK), 239, 343
Mental Health Act 2007 (England), 230
meropenem, 216 174
metabolic acidosis, 13, 113, 227, 228
anion gap, diabetic ketoacidosis, 61, 62, 63
in aspirin/salicylate overdose, 246
in dehydration, 227
due to renal impairment, 39, 227
in eating disorders, 227, 228, 230
hyperchloraemic, 65
lactic acidosis, 322, 334
mixed, after cardiac arrest, 133
in septic shock case, 113
starvation ketosis causing, 228, 230
metabolic alkalosis, 227, 228
metabolic disorders, 165
low GCS due to, 188
seizures due to, 156–157
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370
metabolic encephalopathy, 162
metaraminol, intubation, 18–19
methaemoglobin‐forming antidotes, 285
methamphetamine, 83
methicillin‐resistant Staphylococcus aureus (MRSA),
10, 175, 216
methotrexate, 54
methylprednisolone, 211, 321
microangiopathic haemolytic anaemia
(MAHA), 188, 299
in thrombotic microangiopathy, 301
microbiological tests
gram‐negative bacilli, sepsis, 173, 174
midazolam, 18, 21
middle cerebral artery (MCA)
infarction, 203, 203
occlusion, neurological decit, 204
see also malignant MCA syndrome
middle meningeal artery, damage, 77
Miller Fisher syndrome, 49
milrinone, 185
mnemonics and acronyms, 63, 66
ABCDEF (acronym), 153
ATOM‐FC, 73
BURNS, 283
CCHASM (acronym), 146–147
FAST (Face, Arm, Speech, Test), 202
GOLDMARK (acronym), 63
4Hs and 4Ts, 131, 256
I GET SMASHED, 66
OOHCAS (acronym), 131
PANCREAS, 68
Modied Maastricht classication, 211
modied Rankin Scale (mRS), 137
monitoring, pre‐intubation, 16
monobactams, 175
Monro–Kellie doctrine, 190, 191, 205
morphine, after intubation, 21
mortality, 4
see also specic conditions
mother, precedence over foetus (UK), 254
motor weakness, Guillain–Barré syndrome, 48
MRSA (methicillin‐resistant Staphylococcus aureus),
10, 175, 216
multidisciplinary team (MDT), 8, 9
anorexia nervosa case, 229
COVID‐19management, 309–310
debrieng, 10
Guillain–Barré syndrome management, 54, 58
post‐liver transplant management, 251
respiratory distress type I case, 46
multiple organ dysfunction score (MODS), 289–290
multiple organ failure
burns injury, 289–290, 291
chest sepsis and, 110, 116
hyperpyrexia and, 85
metabolic acidosis in, after overdose, 246
scoring systems, severity grading, 289–290
severe acute pancreatitis, 69
severe community‐acquired pneumonia, 116
Murray score, 111
muscle relaxants, non‐depolarising, 18
mu waves, EEG, 163
myasthenia gravis (MG), 48–49, 321, 334
corticosteroids, 54, 321, 334
grading, 321, 334
treatment plan, 53–54
Mycobacterium chimaera, 269
Mycobacterium tuberculosis, 220
mycophenolate mofetil, 54
myocardial depression, after burns injury, 287
myocardial dysfunction, in sepsis,
hypotension from, 169
myocardial infarction (MI)
after CABG, 266
chest pain and shortness of breath, 214
after coronary artery injury, 80
failure to wean from CPB due to, 272
silent, 39
ST segment elevation, 132
torsade de pointes due to, 226
troponin levels, 215
see also cardiac arrest
myocardial injury, patterns in blunt cardiac injury, 80
myocardial ischaemia, acute, 272
myocardial oxygen demand
in acute heart failure, inotropic drugs, 185
in LV hypertrophy, 181
myoclonus, status, after cardiac arrest, 135
myoglobin, 87, 88
myoglobin‐induced renal failure, 86, 87
myopathy, critical illness (CIM), 325, 340
N
N‐acetylcysteine (NAC), 241, 242–243, 245
naloxone, drug overdose (opioids), 241
NAPQI, 242, 243, 245
nasogastric feeding, in anorexia nervosa,
233, 234, 235
nasogastric tube (NG), intubation and, 20
National Early Warning System (NEWS), 7
National Liver Oering Scheme (UK), 250
National Outreach Forum, 8
National Poisons Information Service (NPIS),
83, 241, 285
necrotising fasciitis, 330, 345
types, 345
needle decompression, tension pneumothorax, 72
Neisseria meningitidis, 156, 159
neomycin, 244
neonates, meningitis, 159
neostigmine, 53
nephrotoxicity, burns injury patients, 288
nerve conduction studies, Guillain–Barré syndrome, 52
neurally adjusted ventilatory assist (NAVA), 57
neurolament light chain (NFL), 136
neuroleptic malignant syndrome (NMS), 84, 85
neurological complications, cardiopulmonary
bypass, 268
neurological management, seizure cases, 162
neurological outcome/status
prediction, in OHCA survivors, 135–136
after traumatic brain injury, 76–78
neuromuscular blockers/blockade
in ARDS, 111–112
intubation, 18
ventilator dyssynchrony and, 104, 110
neuromuscular disorders
intubation for, 13
see also myasthenia gravis (MG)
neuron‐specic enolase (NSE), 134, 136
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371
neuropathic pain, 53
neuroprotection
after acute thrombotic stroke, 204, 206
after decompressive hemicraniectomy, 206
in re/burns cases, 286
in low GCS, 189, 192
after overdose and hepatic encephalopathy, 244
after subarachnoid haemorrhage, 192
neurosurgeons, 7, 192, 196, 204, 205, 206
neurosurgery
complications, 207
neurocritical care management after, 206
neurotransmission, dysregulation in status
epilepticus, 158
neurotransmitters, in status epilepticus, 156, 158
NEWS2, 167, 167–168, 169
next of kin, relatives
acute thrombotic stroke case, 204, 208
brainstem death and treatment withdrawal, 208,
210, 211, 212
communicating with, 9–10
COVID‐19 patient, 310, 312
delirium management, 152, 153
re/burns injury patient, 282, 286, 291
pulmonary embolism case, 125
respiratory distress type I case, 43, 46
seeing patient before intubation, 14, 282, 310
severe community‐acquired pneumonia case, 116
NHS
bed capacity, critical care, 5, 6
levels of care, 4–5
NHS England, NEWS2 recommendation, in
sepsis, 168
NICE guidance
COVID‐19management, 309, 312
eating disorder management, 231, 234
ischaemic stroke treatment, 202, 338
non‐alcoholic fatty liver disease, 249
outreach services, 8
refeeding syndrome risk, 233
status epilepticus management, 158
thromboprophylaxis in COVID‐19, 309
thrombotic stroke management, 202, 338
upper gastrointestinal bleeding prevention, 95
nimodipine, 195, 197–198
nitric oxide
exhaled, cirrhosis, 325, 339
inhaled, 114
non‐alcoholic fatty liver disease (NAFLD), 249
non‐alcoholic‐related steatohepatitis
(NASH), 248–249
non‐cardiac events (NCEs), 131
non‐convulsive status epilepticus (NCSE), 161,
162, 163, 189
non‐invasive ventilation (NIV)
acute cardiogenic pulmonary oedema, 185
acute heart failure, 185
COVID‐19, 308
after extubation, respiratory distress I, 45
non‐malecence, 239
non‐nucleoside analogue reverse transcriptase
inhibitors (NNRTI), 221
non‐steroidal anti‐inammatory drugs (NSAIDs)
bleeding peptic ulcers
cessation of NSAIDs, 96
options for continuing NSAIDs, 97
upper GI bleeding due to, 96
noradrenaline
in acute heart failure, 185
in burns injury with organ failure, 290
circulated, increased, MDMA use, 83, 84
rst‐line vasopressor in sepsis, 114, 171–172
increased requirement, after CABG, 265
mechanism of action as vasopressor, 172
persistent hypotension despite, causes, 177
in respiratory distress type I, 42
in septic shock, 112, 114, 171–172
in tamponade, after CABG, 265
nosocomial infections, 10
NSAIDs see non‐steroidal anti‐inammatory
drugs (NSAIDs)
N‐terminal (NT)‐proBNP, pulmonary
embolism, 120
nucleoside analogue(s), 223, 223
nucleoside analogue reverse transcriptase inhibitors
(NRTI), 221, 222
nurses, ICU, 7
nutritional intake, minimal, refeeding
syndrome risk, 233
nutritional management
acute pancreatitis, 69
anorexia nervosa, 235
burns injury, 290
nutritional requirements
for adults, 235, 236
anorexia nervosa management, 235
burns injury, 290
nutritional status, assessment, 227
O
obstetric patient, 254–265
breathing diculty, 332, 347
cardiac arrest, 254
frequency, 255
ischaemia after, 262
management priorities, 257–258
possible causes, 257
reversible causes (4Hs and 4Ts), 256
cardiogenic shock, 331, 346
cardiopulmonary resuscitation, 254–255
cardiovascular changes, 258
echocardiography, shortness of breath, 332, 347
4Hs and 4Ts, 256
major obstetric haemorrhage, 260
concerns after, 262, 263
management, 261, 262–263
massive pulmonary embolism, 331, 346
maternal death, frequency, 255
mortality, co‐morbidities, 255
non‐cardiovascular changes, 258–259
PRES, 263, 264
professionals involved in care, 259–260
pulmonary oedema, 263, 264
unconscious, immediate management, 254
obstructive lung disease
FEV
1
/FVC ratio, 43, 44
ow–volume loop, 43, 44
see also chronic obstructive pulmonary
disease (COPD)
octreotide, variceal bleeding treatment, 99
oculomotor nerve (III), 207
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372
oedema
cerebral see cerebral oedema
cytotoxic, after hemispheric infarction, 205
orofacial, in burns patient, 281
pulmonary see pulmonary oedema
supraglottic airway, 282
vasogenic, 264
oesophageal candidiasis, 219
oesophageal varices, rupture/bleeding, 98
treatment options, 98–100, 103
see also haematemesis; varices
oesophagitis, 96
Ogilvy and Carter scoring system, 194
O’Grady classication, acute liver failure, 248
oliguria, renal replacement therapy initiation, 89
OOHCAS (acronym), 131
open heart surgery
complications, 268, 269
tamponade, 270, 271
epicardial pacing wires use, 269–270
see also cardiopulmonary bypass (CPB)
opioids
in burns injury, 288
after intubation, 21
intubation and, co‐induction, 17, 18
overdose, 241
opportunistic infections, 219
oral candidiasis, 217, 218, 219
organ allocation, 250
organ donation, 211
‘DBD’ (after brainstem death), 211, 251
‘DCD’ (after circulatory death), 211, 251
investigations, 211
liver, 251
medications/management strategies, 211–212
Modied Maastricht classication, 211
number per annum, 249
OrganOx machine, 251
organs donated, 212
organ dysfunction, grading of severity, 289–290
OrganOx machine, 251
L‐ornithine L‐aspartate (LOLA), 244, 245
orofacial oedema, in burns patient, 281
oropharyngeal airway (Guedel), for intubation, 19
osmolality, 142
renal medulla, 142
serum see serum osmolality (P
osm
)
temperature independent, 142
urine, 147, 148, 148
osmolarity, 142
temperature dependence, 142
osmoles, 142
osmoreceptors, 143
osmotic demyelination syndrome (OMS), 146
risk factors, 146–147
osmotic diuresis, in HHS, 62
osmotic therapy
in hepatic encephalopathy, 244
in malignant MCA syndrome, 206
in rhabdomyolysis, 88
out‐of‐hospital cardiac arrest (OHCA), 130–138
arterial blood gas results after, 133
causes, 131
reversible (4Hs and 4Ts), 131, 256
chain of survival, 130
hyperoxaemia association, 133–134
management, 132
coronary angiography after, 132
focused echocardiography, 132–133
resuscitation, 132, 133
thrombolysis, evidence for/against, 131–132
neurological outcome
Cerebral Performance Category Scale, 137, 137
good, tests suggesting, 137
poor, predictive tests, 135–136
prognosis/outcome, 131
disadvantages of CPC/mRS measures, 138
long‐term, 137
modied Rankin Scale (mRS), 137
ST segment elevation, 132
survival rates, 131
targeting hypothermia in survivors, 134
targeting MAP in survivors, 134
see also cardiac arrest
overdose see drug overdose
oxygen
alveolar, 40
alveolar‐arterial gradient (A‐a), increased, 120
consumption, cerebral, in drowning, 321, 333
delivery
equation, 41, 112, 112
impaired, respiratory tract infection, 40
improving, 40, 41
demand, increased
lower respiratory tract infection, 40
myocardial, 181, 185
in pregnancy, 258, 259
fraction of inspired (F
i
O
2
), 40, 111
ARDS in burns injury, 289
partial pressure (PaO
2
)
cerebral blood ow relationship, 192
in re/burns cases, 286
hepatic encephalopathy after overdose, 244
in obstetric patient, 259
pulmonary embolism, 119–120
secondary brain injury prevention, 192
P:F ratio (PaO
2
:FiO
2
), 111, 262, 289
preoxygenation, before intubation, 17
saturation/oxygenation
apnoeic, 17
improvement with prone positioning, 115
intubation method and, 15, 17
see also arterial blood gas (ABG)
oxygenator, cardiopulmonary bypass circuit, 267, 268
oxygen free radicals, 87
oxygen therapy
burns/re patient, 282
carbon monoxide poisoning, 285
cyanide poisoning, 282, 285
high‐ow nasal see high‐ow nasal oxygen (HFNO)
home, respiratory distress case, 42
home/long‐term, re/burns injury after,
286, 287, 289
smoking risk, 289, 291
respiratory distress type I, 41
oxyhaemoglobin dissociation curve, left
shift, 327, 341
P
pacemaker and pacing wires, 323, 337
after CABG and AV replacement, 269–270, 270, 277
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pain
abdominal see abdominal pain
chest see chest pain
‘ghting the ventilator’ and, 105
management after pelvic exenteration,
332, 346–347
relief see analgesia
rib fractures, after road trac accident, 79
sources in critical care, 105
sternal fracture, 79, 80
transmission and perception, 288
pancreatic necrosis, 69
pancreatic phospholipase A2, 69
pancreatitis, acute, 65
alcohol‐induced, 66
biochemical tests, 66
causes, 66
complications, 69–70
grading systems, 67–68, 68
usefulness/reason for, 68
imaging, diagnostic, 67
management strategies, 69
outcome, 70
severity, 68
pancreatitis, necrotising, 69–70
diagnosis, and surgery role, 70
outcome, 70
pandemics
COVID‐19 see COVID‐19 pandemic
impacts on routine healthcare delivery, 311–312
planning, considerations, 311
pan‐dysautonomia, 49
papilloedema, 197, 208
paracetamol
in burns injury, 288
hepatotoxicity, stages, 242
metabolism, 242, 243
overdose, 238, 240, 241, 242
liver transplant, referral criteria, 245–246
pathophysiology, 242, 243
risk factors for toxicity, 245
staggered/unknown timing, 243, 245
treatments, 241, 242–243
see also liver failure, acute
paralysis, after intubation, 21, 86, 282
parenteral nutrition
anorexia nervosa case, 234
burns injury, 290
risks, 235
total see total parenteral nutrition (TPN)
Parinaud syndrome, 207
Parkland formula, 283
PARTNER study, 183
patent foramen ovale (PFO), 128
pathogen‐associated molecular patterns
(PAMPs), 324, 338
peak end‐expiratory pressure (PEEP), 109
peak inspiratory pressure (PIP), 109
peak pressure, ventilation, 109
PELD (paediatric version of MELD), 249
pelvic exenteration, pain management, 332,
346–347
pemphigus vulgaris, 217
penicillins, 175
peptic ulcers, bleeding, 96, 97
NSAIDs continuation, options, 97
prevention, 96
pericardial eusion, 72, 133, 265
after cardiac surgery, 265, 270, 271
malignant and, 329, 344
management, 133, 271
see also tamponade
pericardial space, uid, 270
pericardial tamponade see tamponade
pericardiocentesis, 133
perioperative risk assessment
CR‐POSSUM, 36
P‐POSSUM, 35–36
peritoneal dialysis (PD), 91
peritonism, 26
personal protective equipment (PPE), 115, 213, 220
communication with next of kin, 310
COVID‐19, 306
description/characteristics, 306, 307
personal relationships, after ICU, 59
P:F ratio (PaO
2
:FiO
2
), 111, 262, 289
pH
arterial
anorexia nervosa, 228
diabetic ketoacidosis, 61, 62, 65
metabolic acidosis, 89, 133, 246
paracetamol toxicity, 245, 246
respiratory distress I, 37
urine, 88
pharmacists, on critical care team, 8
pharyngeal‐cervical‐brachial variant, 49
phenylephrine, intubation, 18–19
phenylketonuria, 157
phenytoin, 159, 161, 163
phosphate, prognosis after liver transplant, 246
phosphodiesterase‐3inhibitor, 185
physician’s associates, 8–9
physiotherapists, on critical care team, 8
pigmenturia, 288
piperacillin/tazobactam (‘pip‐taz’), 170, 213,
215, 216
plasma exchange (PEX), 303–304
thrombotic thrombocytopenic purpura,
303–304, 305
plasma osmolality see serum osmolality (P
osm
)
plasmapheresis, Guillain–Barré syndrome, 53
PLASMIC score, 302–303, 303
plateau pressure, ventilator, 22, 109
platelet(s)
aggregation, 297
count
bleeding risk, 294
low see thrombocytopenia
normal, 293
in sepsis, 298–299
threshold for lumbar puncture, 295
decreased production, causes, 296
in disseminated intravascular coagulation, 299
formation/development, 295
functional quality, 294
increased destruction, 296, 299
immune‐mediated, 296
normal lifespan, 295
sequestration, 297
platelet transfusion, 102, 295, 296
complications, 295
platypnoea, 339
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pleural eusion, 74, 74
re/burns injury and, 287
after road trac accident, 74, 75
treatment goals, 75
pleural space, uid within, 74
Pneumocystis jirovecii, 219, 223
pneumonia
after chest trauma in road trac accident, 79
community‐acquired see community‐acquired
pneumonia (CAP)
COVID, pneumothorax, 329, 344
non‐fatal drowning and, 321, 333
pneumothorax, 38
A‐lines and B‐lines, 74, 329, 344
bedside focused lung ultrasonography, 73–74, 340
chest pain and shortness of breath, 214
in COVID‐19, 316, 329, 344
diagnosis, 73–74
re/burns injury and, 287
iatrogenic, 173
lung point diagnostic of, 74, 173, 329, 344
open (sucking), 72
spontaneous, 38
tension see tension pneumothorax
poisoning
carbon monoxide see carbon monoxide
cyanide, 281, 282, 284–285
encephalopathy due to, 160
information resources (UK), 83, 241
see also drug overdose; intoxications
POLAR‐RCT trial, 78
polyenes, 223, 223
portal hypertension, 97
portosystemic shunt, transjugular intrahepatic, 99
positive end‐expiratory pressure (PEEP)
COVID‐19, 313, 313, 314
cu herniation, 105
driving pressure, 314
‘ghting the ventilator’
chest sepsis, ARDS, 110, 113, 115
causes, 105
in re/burns cases, 285–286
in hypoxic hypoxia, 40–41
preoxygenation, before intubation, 17
positive pressure ventilation, stroke volume changes
during, 33–34
POSSUM scores, 35–36
postcardiac arrest ischaemia, in obstetric patient, 262
posterior inferior cerebellar artery (PICA),
occlusion, 204
posterior reversible encephalopathy syndrome
(PRES), 263, 264
postictal state, 240
post‐intensive care syndrome (PICS), 58–59
management approach to reduce, 59
postoperative patients, refeeding syndrome risk, 234
postural hypotension, 50
potassium, 323, 337
levels in diabetic ketoacidosis, 62, 64
PPE see personal protective equipment (PPE)
P‐POSSUM, 35–36
prednisolone, myasthenia gravis, 321, 334
pre‐eclampsia, 257, 262
complications, 262–263
pregnancy
cardiovascular changes during, 258
non‐cardiovascular changes, 258–259
see also obstetric patient
pregnancy test, 227, 241
preload, 181
in aortic stenosis, 182
denition, 181
noradrenaline increasing, 172
during passive mechanical ventilation, 34
stroke volume depending on, 112, 112
preoxygenation, aims and method, 17
PREPARE (outreach core elements), 8
PRES (posterior reversible encephalopathy
syndrome), 263, 264
pressure and ow curves, chest sepsis withventilator
dyssynchrony, 107, 107
primary survey
as rst action in trauma, 329, 343–344
goals, 71
procalcitonin, 70
progesterone, 259
progressive multifocal leucoencephalopathy
(PML), 220
proinammatory cytokines, 112, 169, 286, 288
prone positioning, 115
awake (APP), 309, 310
COVID‐19, 309, 310, 313
in immune reconstitutional inammatory
syndrome, 224
method, 115
oxygenation improvement, method, 115
septic shock and severe ARDS, 114, 115–116
propofol, 17, 21
PROSEVA trial, 114
prostacyclin, aerosolised, 114
prostaglandins, 184
protamine, 268, 269
protease inhibitors (PI), 221, 222
proteolysis, 232
proton pump inhibitors (PPI), 95, 96, 97, 196
Pseudomonas, 216
Pseudomonas aeruginosa, 175
pseudoseizures, 155
psychiatric diagnoses, pre‐existing, before ICU
admission, 9
psychiatric issues
after ICU, 58–59
in ICU, 9
psychological issues
amongst ICU sta, 10
after ICU, 58–59
in ICU, 9
psychologists, on critical care team, 8
psychosocial problems, burn injury survivors, 291
pulmonary compliance see lung compliance
pulmonary contusions, 79, 287
pulmonary embolism (PE), 39
acute, 119
high‐risk, 119
management principles, 118–119
thrombolysis see below
cardiac arrest due to, 133
in obstetric patient, 256, 258, 332, 347
deterioration, management, 124, 125, 128
catheter‐directed thrombus removal, 126
chest pain, 118, 214
complications, early/late, 128–129
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CTPA in, 121, 125–126
diagnostic blood tests, 119–120
diagnostic imaging, ‘gold standard’ (CTPA), 121
ECG abnormalities, 120
echocardiography, 122–123, 123, 347
focused, obstetric patient, 331, 346
embolectomy, 126
haemodynamically stable, 119
haemodynamically unstable, 119, 122,
124, 125, 126
massive, 39, 125, 165, 171
CTPA in, 125–126, 331, 346
obstetric patient, 331, 346
treatment priorities, 126–127
mortality, 124, 129
multiple small, 39
pretest probability scores, 121–122, 122
prognosis
clinical feature predicting, 124
ECG abnormalities, 120
poor, prognostic factors, 124
right ventricle dysfunction, 124
pulmonary vasodilators, 128
recurrence, 128
thrombolysis, 126–127
advantages/disadvantages, 127–128
choice of agent, 127
contraindications, 126–127
troponin levels, 215
Wells/modied Wells criteria, 121–122, 122
pulmonary hypertension, chronic thromboembolic
(CTEPH), 129
pulmonary oedema, 28
cardiogenic (CPO), 173, 185
in diabetic ketoacidosis, 65
in obstetric patient, 263, 264
respiratory distress, 38
risk, rhabdomyolysis management, 88
surrogate measure for, 30
pulmonary thrombosis, in obstetric patient, 256
pulmonary vasoconstriction, hypoxic, inhalational
burns injury, 286
pulmonary vasodilators, in pulmonary
embolism, 128
pulmonary venous embolism, in obstetric
patient, 257
pulse, monitoring during intubation, 15, 125
pulse check, 10‐second, 132
pulse contour analysis, 30
stroke volume variation measurement, 34
pulsed wave Doppler techniques, cardiac output
measurement, 31, 31, 32
pumps, cardiopulmonary bypass circuit, 267, 267
pupil(s)
absence of response, 207, 209
in raised ICP, 207
pupillary light reex (PLR), 135
PVL‐MRSA, 216
PVL toxin, 216
pyridostigmine, 53
pyroptosis, 324, 338
Q
qSOFA score, 167
quality assurance, 11–12
quality‐of‐care indicators, 11
quality of life, after cardiac arrest, 137
quarantine areas, COVID‐19, 306
quick Sequential Organ Failure Assessment (qSOFA)
score, 167
quinolones in variceal bleeding, 100
R
radiograph trauma series, 282
radiography, chest see chest radiography
radiology
in subarachnoid haemorrhage, 194, 195
see also specic modalities
Rankin Scale, modied (mRS), 137
Ranson’s criteria, 67
rapid‐sequence induction (RSI) method, 15
rapid shallow breathing index (RSBI), 45, 332, 347
rash
darker red/purple lesions, causes, 217
diuse macular erythematous, 217
erythematous, in anorexia nervosa case, 235
history‐taking, 218–219
investigations, 214–215
non‐blanching, 217
RASS (Richmond Agitation‐Sedation Scale),
149, 149, 152
recombinant tissue‐type plasminogen activator
(rtPA), 127, 132
RECOVERY trial, 309
recreational drug use, 82–93
acute kidney injury, 87
CRRT, 89, 92
deprivation of liberty, 92, 93
drug group used, 82
hyperpyrexia due to see hyperpyrexia
liver injury due to, 247
low serum sodium, 86–87
multiple, serotonin syndrome, 84
rhabdomyolysis in, 87
management, 88
seizures associated, 156
toxic eects, 82
see also MDMA (3,4‐
methylenedioxymethamphetamine)
recruitment manoeuvres, in severe ARDS, 114
recumbent position, intubation, 17
red blood cells (RBCs)
fragmented (schistocytes), 299
immune‐mediated destruction, 300
refeeding syndrome, 161, 233
risk, patients at, 233–234
referral systems, 7
refusal for critical care admission, 230
regional wall motion abnormalities (RMWAs), 80
reintubation, 45
relatives see next of kin, relatives
remdesivir, 313
remifentanil, after intubation, 21
remote location, intubating in, 14–15
renal failure
in burns injury patients, 286, 287–288, 290
in drug overdose case, 240
MDMA overdose and, 84, 86
myoglobin‐associated, 86, 87
see also acute kidney injury (AKI)
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376
renal impairment, 39
in anorexia nervosa, 228, 229
drug overdose causing, 240
renal perfusion, 87, 88
renal replacement therapy (RRT), 326, 341
access, 90
case study (recreational drug use), 92
characteristics, 89–90
continuous see continuous renal replacement
therapy (CRRT)
‘early’ vs ‘late’, 113
indications in critical care, 88, 89
intermittent, 89, 90
CRRT preferred over in critical care, 89, 92
method of removing solutes, 90, 91, 91
methods, 90–91, 91
haemodialtration, 91, 326, 341
haemodialysis, 90–91, 91, 326, 341
haemoltration, 90, 91, 91, 115, 326, 341
peritoneal dialysis, 91
slow low‐eciency dialysis, 91
optimal timing of initiation, 89
principles, 326, 341
rhabdomyolysis management, 88, 92
RENAL study, 92
renal tubular cells, ADH eect, 143, 143
renal vasoconstriction, rhabdomyolysis, of acute
kidney injury, 87
reservoir, cardiopulmonary bypass circuit, 267, 267
residual volume, lung, 44
resistance to ow (R), 105
ReSPECT form, 46
respirators
air‐borne transmission reduction, 307
FFP2 and FFP3, 307
respiratory acidosis, mixed, 133, 157
respiratory alkalosis
aspirin/salicylate overdose, 246
obstetric patient, 258
respiratory care, techniques in ICU, 6
respiratory compliance see lung compliance;
respiratory system compliance (C
RS
)
respiratory complications, cardiopulmonary
bypass, 268
respiratory depression, low GCS due to, 240
respiratory distress, type I, 37–47
action/management, 41, 42
poor premorbid state, 42–43
analysis, 40–41
causes, 37–40
COVID‐19, 308
discussions with next of kin, 43, 46
extubation to NIV, 45, 46
intubation and reintubation, 41, 45
investigations and specialist review, 43
lung function test results, 43, 44
MDT discussion, 46
outcome (likely), 43
pre‐existing COPD, 40, 41, 42, 43, 44, 45
spontaneous breathing trial (SBT), 45
terminal phase and death, 46–47
tracheostomy, 46
respiratory distress, type II, 48–59
deterioration, 51
examination/assessment, 50–51
investigations, 51–52
respiratory function assessment, 50–51
see also Guillain–Barré syndrome
respiratory failure
acute hypoxaemic, HFNO for, 308
complication after road trac accident, 79
management, in acute pancreatitis, 69
respiratory function, assessment, in respiratory
distress, 50–51
respiratory physician reviews, 43
respiratory rate, raised, 25, 95
chest pain, pulmonary embolism, 118
COVID‐19, 308, 310, 312, 313
re/burns, 280
qSOFA score, 167
respiratory distress I, 37, 38, 40
after road trac accident, 71
septic shock, 166
ventilator dyssynchrony, 109
respiratory system compliance (C
RS
)
curve, 43, 314–315, 315
denition, 314
normal, 315
static, 315
see also lung compliance
respiratory tract
infection see lower respiratory tract infection
inhalational injury and, 280
respiratory weaning plan see under ventilation,
mechanical
restrictive lung disease
FEV
1
/FVC ratio, 43, 44
ow–volume loop, 43, 44
resuscitation
cardiac arrest after CABG, protocol, 271
obstetric patient, 254
in septic shock/sepsis, 169, 170
see also cardiopulmonary resuscitation (CPR)
Resuscitation Council UK, 132, 225, 254, 323–324,
337–338
retroviruses, 221
return of spontaneous circulation (ROSC), 130,
131, 133, 135
obstetric patient, 255, 256
prognosis of poor outcomes after, 328, 342
‘reversibility’ of patient’s condition, 3
rhabdomyolysis, 87
acute kidney injury due to, 87
burns injury patients, 288
mechanism, 87–88
causes, 87
management, 88
see also renal replacement therapy (RRT)
post‐traumatic, 88
sequelae, 87
Rhesus system, 75, 76
rheumatic fever, 347
rheumatic heart disease, 180
rib fracture, 72, 78, 79
Richmond Agitation‐Sedation Scale (RASS),
149, 149, 152
rifamixin, 244
right heart failure, ARDS with, management, 327, 341
right ventricle (RV)
dysfunction, 129
COPD, 44–45
pulmonary embolism, 122, 123, 123, 124, 126, 133
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echocardiography, 325, 340
failure
ARDS with, management, 327, 341
cardiopulmonary bypass complication, 268
overload, pulmonary embolism, 122
during passive mechanical ventilation, 34
in pericardial tamponade, 72
right ventricular outow tract (RVOT),
acceleration time, 123
rilpivirine, 222
risk–benet assessment, 3
rituximab, 303
rivastigmine, 53
road trac collision, 71–81
blood transfusion, 75–76
blunt cardiac injury, 79–80
complications after, monitoring, 79
diagnostic imaging after primary survey, 76, 78
haemothorax after, 74, 75–76
life‐threatening conditions, 72–73, 75
neurological status change, 76–78
primary survey, goals, 71
secondary survey, 79
sternal fracture, 78, 79, 80
traumatic brain injury, 76–79, 80
Rockwood frailty score
ARDS in re/burns injury, 289
respiratory distress type I case, 43
rocuronium, intubation, 18, 21
burns patient, 282
Romano–Ward syndrome, 226
ROSE Trial, 111
ROSIER (recognition of stroke in emergency
room), 202
ROTEM® system, 274, 275
RSBI (rapid shallow breathing index), 45, 332, 347
Rumack–Matthew nomogram, 242–243
runner, for intubation, 15
S
saccular (‘berry’) aneurysms, 193
safeguarding
deprivation of liberty, 92, 93, 230
independent mental capacity advocate, 162, 163,
328–329, 343
seizure case, 162, 163, 164
salbutamol, intravenous, 346
salicylates
actions, 246
levels of concern/life‐threatening, 246
overdose/toxicity, 238, 246
treatment, 247
see also aspirin
saline infusion
hypertonic see hypertonic saline solution
after subarachnoid haemorrhage treatment, 195
SALT team, 8
SAPSII score, respiratory distress type I case, 43
sarilumab, 312
SARS‐CoVs, 308
SARS‐CoV‐2 see COVID‐19
SARS epidemic, 308
SBAs, 327–332, 341–347
schistocytes, 299
sclerotherapy, variceal bleeding control, 100
sedation
for burst suppression, 163, 164
after decompressive hemicraniectomy, 206
inadequate, ‘ghting the ventilator’, 105
increasing sedation, 110
after intubation, 21
required for ventilation, 105
secondary brain injury prevention, 192
seizure(s)
breakthrough, 257
burst suppression, 162–164
causes, 155–157, 158–159
establishing, 157
after decompressive hemicraniectomy, 206
EEG in intensive care, 162–163
epileptic, 155
factitious, 155
follow‐up on discharge to ward, 164
investigations, 161, 162
isolated, new‐onset epilepsy, 155
life‐threatening issues, 157
low GCS due to, 240
management (next steps), 162–163
management plan, in ICU, 160–161
management priorities, 157
non‐epileptic, 155
in obstetric patient, 256, 257, 263
prevention, in obstetric patient, 257
secondary brain injury, 192
slow neurological progress, 161, 163
thrombocytopenia, 293
tonic‐clonic, 157
types, 158
see also status epilepticus
Seldinger method, 56–57
self‐harm, risk, 229
Sellick manoeuvre, 20
Sengstaken–Blakemore tube, 99
sepsis, 324, 338
anastomotic leakage (case 1), 26
cardiac arrest in obstetric patient (case 20), 257
causes, pathogens, 173, 174
chest see chest sepsis
chest pain with rash (HIV) (case 17), 213, 216
denition, 166
deterioration, NEWS2 to detect, 167, 167–168, 169
disseminated intravascular coagulation in, 214, 299
ESICM guidelines, vasopressin in, 330, 344
gram‐negative bacilli, 173, 174
hypotension in/due to, mechanisms, 169
sudden deterioration, 165, 166
vasopressors for, 171–172
ketone production, 232
low GCS due to, 188
management
antibiotics, 170, 216
corticosteroids, 172–173
‘hour‐1’ bundle, 169–170
vasopressors, 171–172
as medical emergency, 170
mortality, 328, 342–343
in obstetric patient, 257, 259, 347
organ dysfunction identication, 168
outcome, qSOFA score, 167
risk in burns injury, 287
screening, in obstetric patient, 263
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screening tools, scoring, 167, 167–168
severe, redundancy of term, 328, 343
steroid use, 113–114
thrombocytopenia due to, 295, 298–299
urosepsis see urosepsis
Sepsis‐3, 166, 167
septic shock, 112, 166
anastomotic leak and, 26
antibiotics, 169, 170
community‐acquired pneumonia, 112, 116
denition and identication, 166
management, 171, 321, 334
‘hour‐1’ bundle, 169–170
vasopressors, 171–172
as medical emergency, 170
refractory, steroid use, 114
screening tools, scoring, 167, 167–168
see also sepsis
Sequential (Sepsis‐related) Organ Failure Assessment
(SOFA), 116, 168, 168, 328, 342–343
serotonin (5‐HT), 84
excess see serotonin syndrome
toxicity, treatment, 85
serotonin syndrome, 84
neuroleptic malignant syndrome comparison, 85
risk factors, 84
treatment, 85
serum osmolality (P
osm
), 141, 142, 323, 336
ADH release and, 143, 144
changes, osmoreceptors sensing, 143
estimation, formula, 141
hyperosmolar hyperglycaemic state, 62
hyponatraemia classication, 140, 142
maintaining (physiological), 142–144
measured, hypotonic hyponatraemia, 142
normal reference range, 141
osmolarity vs, 142
Shiga toxin 1 and Shiga toxin 2, 301
Shiga toxin‐producing Escherichia coli (STEC), 301
shock
cardiogenic see cardiogenic shock
denition, 165
distributive, 166, 169, 170
hypovolaemic, 166, 170
obstructive, 166, 171, 270
in acute high‐risk pulmonary embolism, 119
septic see septic shock
in severe bleeding, 95
types, 166
focused echocardiography to
dierentiate, 170–171
short‐latency somatosensory evoked potentials
(SSEPs), 135–136
SHOT (Serious Hazards of Transfusion), UK, 102
sinus tachycardia, 241
SIRS criteria, 68, 328, 342–343
skin, integrity, loss in burns injury, 287
slow low‐eciency dialysis (SLED), 91
smoke inhalation injury, 280
social isolation, after ICU, 59
sodium, 323, 337
disorders, aetiology, 147
elevated, diabetes insipidus, 199
homeostasis, disturbances and
pathophysiology, 141
low see hyponatraemia
monitoring, after decompressive
hemicraniectomy, 206
regulation disorders, after SAH, 199, 200
serum level
increase, hyponatraemia treatment, 144, 145
overly rapid correction, 146, 147
serum osmolality estimation, 141
in urine, concentration, 147–149, 148
sodium bicarbonate, in tricyclic antidepressant
overdose, 247
sodium‐glucose co‐transporter‐2inhibitors
(SGLT‐2), 61–62
sodium nitroprusside, 185
SOFA score, 116, 168, 168, 328, 342–343
somatosensory evoked potentials (SSEPs), 328, 342
somatostatin, variceal bleeding treatment, 99
space‐occupying lesion
low GCS due to, 187–188
seizures due to, 156
special care baby unit, 263, 264
specialists, on critical care team, 9
speech and language therapists, 8
spinal cord pathology, 50
spirometry, 50
spleen, platelet sequestration, 297
spontaneous breathing trial (SBT), 45
sta
in critical care team, 7–9
pandemic planning, 311
ICU, psychological issues amongst, 10
infection exposure, managing, 11
for intubation, 14, 15
PPE for, 306, 307
trained assistant, for intubation, 15
staircase recruitment manoeuvre, 114
standards, for critical care, 11
Staphylococcus aureus, 106
methicillin‐resistant (MRSA), 10, 175, 216
starvation, 232
cardiovascular complications, 230
hypothyroidism due to, 227
non‐cardiac complications, 227, 236
phases, 232, 232
prolonged, 232, 233
refeeding syndrome, 233
see also anorexia nervosa
starvation ketosis, 229, 230
status epilepticus, 155–164
basic intensive care management, 161
causes, 156
denition, 158
intensive care plan, 160–161
non‐convulsive, 161, 162, 163, 189
refractory, burst suppression, 163–164
pathophysiology, 158
refractory convulsive, drug management, 158
see also seizure(s)
stenting, variceal bleeding control, 100
sternal fracture, 78, 79, 80
steroids, 113–114
in acute asthma, 331, 346
in bacterial meningitis, 160
in COVID‐19, 309
in myasthenia gravis, 54, 321, 334
oral candidiasis with, 218
sepsis (cont’d)
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