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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3080_Библиотеки_им_академика_М_И_Перельмана
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Index
379
in sepsis, 172–173
in severe community‐acquired pneumonia, 113–
114, 330, 344–345
see also corticosteroids
Streptococcus, group A, 213, 217
invasive (iGAS), 216
Streptococcus pneumoniae, 106, 159
meningitis, 159, 160
streptokinase, 127
stress ulcer, prevention, 196
stridor, 280
stroke, haemorrhagic, 187
stroke, ischaemic, 187, 201–212, 324, 338
causes, 201
deterioration after, 204, 205
management priorities, 204
diagnosis and investigations, 202
embolic, 201
extension or haemorrhage into, 204
imaging, 324, 338
incidence, 187
lacunar, 201
low GCS due to, 187
malignant MCA syndrome after see malignant
MCA syndrome
middle cerebral artery, 203, 204
neurological decit patterns, 203–204
in obstetric patient, 256, 257
postcardiac surgery, 278
risk factors, 201–202
thrombotic, 187, 188, 201
acute, management options, 202–203
in obstetric patient, 256
stroke volume (SV), 112, 112
calculation by echocardiography, 31, 31
changes during passive mechanical
ventilation, 33–34
indexed (SVi), 180, 182, 185
low, aortic stenosis, 180
measurement methods, 34, 35
noradrenaline increasing, mechanism, 172
in pregnancy, 258
pulmonary embolism complication, 128
surrogate measures for, 34, 35
stroke volume variation (SVV), 32
measurement methods, 34, 35
prediction of uid responsiveness, 32–33, 33, 34
in septic shock, 113
in severe community‐acquired
pneumonia, 330, 344
stylet, 20
subarachnoid haemorrhage (SAH), 189
aneurysmal, 193
treatment options, 194–195
causes, 193
cerebral vasospasm after, 196, 197, 199
critical care management after, 195–196
CT scan, 189, 190
deterioration after treatment, causes, 196–197
diabetes insipidus after, 199
follow‐up investigations, 196
hydrocephalus after, 197
incidence, 192, 193
intracranial pressure elevation after, 197
Monro–Kellie doctrine and, 190
prophylactic medication after, 196
rebleeding, 196
recovery period problems, 200
risk factors, 193
severity, grading (scoring systems), 193–194
sodium regulation disorders after, 199, 200
spontaneous, 193
traumatic, 77, 193
subdural haematoma (SDH), 76–77, 77, 78
subdural screw, 197
subglottic airway device (SAD), 20
subglottic secretion drainage ports, 20
substance P, 286, 288
suction, intubation and, 20
sudden cardiac death, 226
sugammadex, 18
suicide letter, 238–239
support sta, 8
supraglottic airway oedema, 282
‘surge capacity’, 5
surgical aortic valve replacement (SAVR), 183
surgical masks, 307
Surviving Sepsis Campaign (SSC), 169–170
Surviving Sepsis Guidelines (2021), 114
suxamethonium (succinylcholine), 18, 282
synchronised intermittent mandatory ventilation
(SIMV), 107, 108, 109
syndrome of inappropriate antidiuretic hormone
(SIADH), 199, 200
systemic inammatory response syndrome (SIRS)
after cardiopulmonary bypass, 268, 269
criteria, 68, 328, 342–343
systemic vascular resistance (SVR), increase, 92
T
4T score, 297, 298, 299
tachycardia
cardiogenic pulmonary oedema, 173
chest pain, 118
in haematemesis, 94, 98
pulmonary embolism, 120
recreational drug use, toxic eects, 82
respiratory distress I, 37, 40
respiratory distress II, 51
tachyphylaxis, 185
tachypnoea see respiratory rate, raised
tacrolimus, 54
Tamm–Horsfall protein, 88
tamponade, 72, 133, 171
after CABG and AV replacement, 265, 270, 271
management, 271, 272
early, after cardiac surgery, 270
echocardiogram ndings, 270, 325, 340
in obstetric patient, 256
postcardiac surgery, presentation, 270–271
Targeted Temperature Management 2 (TTM 2)
trial, 134
tazobactam, 213, 215
temperature
control
diculties after re/burns injury, 286, 287
in malignant MCA syndrome, 205–206
after subarachnoid haemorrhage treatment, 196
elevated (case 6), 82–93
see also hyperpyrexia; hyperthermia;
recreational drug use
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Index
380
reducing
continuous RRT, 92
further management, 86
initial management, 85–86
temporary pacing, 269–270, 270
tenecteplase, 132
tension pneumothorax, 72
in COVID‐19, 316
emergency management, 316–317
in obstetric patient, 256
terbinane, 223, 223
terbutaline, nebulised, 331, 345–346
terlipressin, 98–99
terminal phase of life, 4, 292
burns injury with organ failure, 290, 291
discussions with patient/next of kin, 46–47, 291
T‐helper cells (CD4
+
), 220, 221, 222
thermal injury see burns injuries
theta waves, EEG, 163
thiamine, 233, 234
thinking, disorganised, 151
thiopentone, intubation technique, 18, 159
thirst, 143
thoracic aortic injury, 79
thoracic electrical impedance, 32
thrombectomy
in acute thrombotic stroke, 202–203
suitability and transfer time, 203
thrombocytopenia, 293–305
bleeding risk, platelet levels, 294
causes, 295, 296, 300
DIC, 296, 299
haemolytic‐uraemic syndrome, 296, 301
HIT see heparin‐induced
thrombocytopenia (HIT)
MAHA, 296, 299, 300
sepsis, 214, 295, 298–299
thrombotic microangiopathy, 300, 301
TTP, 296, 302, 305
see also thrombotic thrombocytopenic
purpura (TTP)
denition, 293
frequency in critical care, 295
heparin‐induced see heparin‐induced
thrombocytopenia (HIT)
mechanisms, 295–296
mortality risk, 295
platelet count, 293, 294
platelet destruction causing, 296
platelet production decrease causing, 296
platelet sequestration causing, 296, 297
risks associated, 294–295
severity, levels, 293
thrombosis risk, 296, 297
see also heparin‐induced
thrombocytopenia (HIT)
see also platelet(s)
thromboelastography (TEG), 102
description, 274, 275
normal and abnormal traces, 276
after tamponade in CABG case, 271–272, 274
thrombolysis, 324, 338
in acute ischaemic stroke, 202, 324, 338
thrombotic stroke, 202
advantages/disadvantages, 127–128
in cardiac arrest, evidence for/against, 131–132
contraindications (absolute/relative), 126–127
in massive pulmonary embolism, 126–127
choice of agent and dosage, 127
Thrombolysis in Cardiac Arrest Trial (TROICA,
2008), 132
thrombopoietin (TPO), 295
thromboprophylaxis
after subarachnoid haemorrhage treatment, 196
venous see under venous
thromboembolism (VTE)
thrombosis
cerebral venous sinus, 189
in obstetric patient, 256
risk in COVID‐19, 309
stroke see stroke, ischaemic
in thrombocytopenia, risk, 296, 297
in thrombotic microangiopathy, 301
venous drainage of brain, 189
thrombotic microangiopathy (TMA), 300, 301
diagnostic algorithm, 304
disorders included/causing, 301
see also haemolytic‐uraemic syndrome
(HUS); thrombotic thrombocytopenic
purpura (TTP)
thrombotic thrombocytopenic purpura (TTP), 302
causes (ADAMTS13 activity level), 302
clinical presentation, 302
description, 302
diagnostic algorithm, 304
increased destruction of platelets, 296
low GCS due to, 188
mortality, 302
PLASMIC scoring for ADAMTS13 activity,
302–303, 303
thrombocytopenia in, 296, 302
treatment, 303–304
thrush, oral, 218
thymectomy, 54
thyroid function tests, 227
thyroid hormones, 212, 259
tick‐borne Lyme borreliosis, 49
tidal volume, 44, 259
V
T
:C
RS
, in ARDS/COVID‐19, 314
Tieneau–Pinelli index, 43
tissue‐type plasminogen activator (tPA), 132
recombinant (rtPA), 127, 132
tocilizumab, 312
tonsillar herniation (‘coning’), 190, 207–208
torsade de pointes, 225
advanced life support, 225–226
causes, 226
rhythm strip, 225, 226
total airow resistance, 109
total lung capacity, 44
total lung compliance, 41–42
total parenteral nutrition (TPN)
avoidance in acute pancreatitis, 69
risks, 235
TOXBASE, 241, 285
toxicology screen, 228
toxic shock syndrome, 283, 345
toxins
acute/fulminant liver failure due to, 248
cardiac arrest in obstetric patient, 257
Guillain–Barré type features due to, 49
temperature (cont’d)
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Index
381
in obstetric patient, 256, 257
risk after house re, 281
management, 282
tracheostomy
consent for, 55–56
early, indications/arguments to support, 54
elective, indications, 55
emergency, indications, 54
equipment, and drugs, 56
indications, 54–55, 55–56
performing, procedure, 55–57
personnel, 56
postprocedure management, 57
preparation, 56
respiratory distress type I case, 46
risks, 55
TrachMan study, 54
tranexamic acid (TXA)
in haemothorax, 75
in maternal haemorrhage, 261
in traumatic brain injury, 78
in upper GI bleeding, 98
transcalvarial herniation, 207
transcatheter aortic valve replacement (TAVR), 183
transcranial Doppler (TCD), cerebral
vasospasm, 197
transient ischaemic attacks (TIAs), 202, 324, 338
transjugular intrahepatic portosystemic shunt
(TIPS), 99, 249
transoesophageal aortic Doppler, 31–32
transoesophageal echocardiography (TOE), 31, 31
blunt cardiac injury diagnosis, 80
hypotension after CABG and AV replacement, 265,
266, 270, 271
transplantation, organ
liver see liver transplantation
number per annum, 249
organ donation see organ donation
Transplant Benet Score (TBS), 250
transpulmonary lithium dilution, 30
transpulmonary pressure, 41
transpulmonary thermodilution, 29–30
transtentorial herniation, 207
transthoracic echocardiography (TTE), 31, 31
pulmonary embolism, 122–123, 123
respiratory distress type I, 43
trauma
brain see traumatic brain injury (TBI)
in re/burns patient, 280
see also burns injuries
head, 77, 156, 157, 159
primary survey as rst action, 329, 343–344
road trac see road trac collision
traumatic brain injury (TBI), 76–78
antibrinolytic agent, role, 78
case study (road trac accident, case 5), 76, 78, 80
cooling in, evidence for, 78
CT scan, 76–77, 77
GCS decrease, overdose case, 240
seizures due to, 156
see also brain injury
treatment against patient’s will, 228
tricuspid annulus plane systolic excursion (TAPSE),
123, 325, 340
tricuspid regurgitation, 123
tricyclic antidepressants (TCA)
dysrhythmias due to, 247
overdose
management, 247
trigeminal nerve (V), 207
triglyceride, serum, 66
haemophagocytic lymphohistiocytosis, 325, 341
tri‐iodothyronine, 212
troponin, in chest pain and rash case, 215
troponin C, 272
troponin I, 120
troponin T, 80, 120
trypsinogen‐2, urinary, 66
4T score, 297, 298, 299
tuberculosis, 214
extensive drug‐resistant (XDR‐TB), 220, 327, 342
in HIV infection, 220, 222
multidrug‐resistant (MDR‐TB), 220
treatment, 222–223
U
UK Department of Health (DoH), 11
UKELD (UK model for End‐Stage Liver Disease), 250
UKOSS (UK obstetric surveillance system), 255
UK Resuscitation Council, 130, 131, 132
ulcer prophylaxis, 196, 252
ultrasonography
acute pancreatitis diagnosis, 67
chest, after road trac accident, 73
endoscopic (EUS), 67
focused see focused ultrasonography
lung see lung ultrasonography
uncal herniation (transtentorial herniation), 207
upper gastrointestinal bleeding (UGIB)
haemoglobin level for transfusion, 98
lower GI bleeding vs, 96
non‐variceal, sources, 96–97
prophylaxis in acutely unwell critical care
patients, 95
risk of death, factors increasing, 102
tranexamic acid use, 98
variceal see varices
see also haematemesis
uraemic encephalopathy, low GCS due to, 188, 240
urea, 141
in malnutrition/anorexia nervosa, 227,
228, 229, 232
raised serum levels
acute kidney injury, 89, 90, 90, 214
acute pancreatitis, 68
in GI bleeding, 96
overdose causing renal impairment,
240, 245, 249
removal, renal replacement therapy, 90
in sepsis, 214
in thrombocytopenia case, 293, 294
urea and electrolytes (U&E), 214, 227, 294
urinary stasis, in pregnancy, 259
urinary tract infection (UTI)
sudden deterioration, 165
see also urosepsis
urine
alkalinisation, 88
concentration
changes with plasma osmolality, 143, 144
reduced, diabetes insipidus after SAH, 199
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Index
382
osmolality, 144, 147, 148, 148
sodium concentration, 147, 148, 148–149
tests to diagnose hyponatraemia cause,
147–149, 148
urine output
electrolyte concentration and, 147
increased
diabetes insipidus after SAH, 199
recreational drug use case, 87, 88, 89
KDIGO classication, acute kidney injury, 88
monitoring, after decompressive
hemicraniectomy, 206
reduced, in sepsis/septic shock, 107, 112, 113
urokinase, 127
urosepsis, 165, 174
gram‐negative bacilli, antibiotics, 174
mortality, 328, 342
in obstetric patient, 259
scoring, 328, 342–343
vasopressor and uid resuscitation, 330, 345
urticaria, 217
uterotonic drugs, 261
V
valvular heart disease, cause, 180
VA/NIH Acute Renal Failure Trial Network
(ATN) study, 92
varices
cirrhosis contributing to, 97
pathogenesis, 97
rupture, bleeding due to, 98
balloon tamponade, 99
endoscopic treatment, 99–100
haemoglobin level for transfusion, 98
non‐endoscopic treatment, 98–99
prophylactic antibiotics, 100
transjugular intrahepatic
portosystemic shunt, 99
treatment options, 98–100
see also haematemesis
VasCath™, 89, 113, 242
vascular disease, aortic sclerosis suggesting, 180–181
vasoactive drugs, intubation, 18–19
vasoconstriction, noradrenaline action, 171, 172
vasodilation, in sepsis, hypotension from, 169
vasodilators
acute heart failure treatment, 185
inhaled pulmonary, 114
levosimendan action, 272
in severe aortic stenosis, 185
vasogenic oedema, 264
vasogenic waves, 198
vasopressin, 172
administration, as vasopressor in sepsis, 172
community‐acquired pneumonia, 330, 344
mechanism of action as vasopressor, 172
see also antidiuretic hormone (ADH)
vasopressin receptors (V2R), 143, 172, 323, 336
antagonists, 199
vasopressor(s), 15, 171–172
in acute heart failure, 185
adrenaline, 19, 172
in cerebral vasospasm, 198
mechanism of action, 172
peripheral access for, starting, 330, 345
in pulmonary embolism, 124
rising requirements (anastomotic leak,
case 1), 25–36
cardiac output measurement, 29–32
uid responsiveness see uid responsiveness,
assessment
focused ultrasonography, 27–29
immediate concerns for CT transfer, 35
initial management, 25–26
investigations/diagnosis, 26
perioperative risk assessment, 35–36
surgery outcome, 36
see also anastomotic leakage
in sepsis/septic shock, 26, 166, 169, 171–172
mechanism of action, 172
recommended agents, 171–172, 330, 344–345
in tamponade after CABG, 265
in urosepsis and hypotension, 330, 345
see also noradrenaline; vasopressin
vasospasm, cerebral see cerebral vasospasm
VASST study, 172
velocity–time integral (VTI), 31, 31
venous drainage of brain, thrombus/
obstruction, 189
venous sinuses
damage, 77
thrombosis, 189
venous thromboembolism (VTE)
antiphospholipid syndrome and, 119
in diabetic ketoacidosis, 65
prophylaxis
in COVID‐19, 309
after decompressive hemicraniectomy, 206
after liver transplant, 252
after subarachnoid haemorrhage treatment, 196
risk factors, 119
ventilation, mechanical, 283, 286
airway pressure release ventilation (APRV), 114,
115, 328, 342
in ARDS, 287, 289, 328, 342
barotrauma, in COVID‐19, 310
breath stacking, 313, 313, 314
in burns/re cases
ARDS, 287, 289
diculties and reasons, 286–287
ventilator settings, 285–286
in COVID‐19, 313, 313, 314
driving pressure/tidal volume, 313, 314, 315
preparation, 309, 312
dicult, ‘ghting the ventilator’, 104–117
causes of lack of synchrony, 104–106
chest sepsis, 104, 106–107, 116
management if patient deteriorating, 110
new pathology with chest sepsis, 106
options to combat, 109–110
pain, distress, inadequate sedation, 105
septic shock, 111, 114
ventilator problems, 105
driving pressure, 22, 313, 314, 315
expiratory time, too short, 313, 313
failure to wean, CIP and MIP, 325, 340
ow‐time curve, COVID‐19, 313, 313
in hyperpyrexia due to recreational drug use, 86
in life‐threatening haematemesis, 100
low tidal volume, 109
urine (cont’d)
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Index
383
lung‐protective strategy, 285–286, 327
modes, 104
adaptive, 108
biphasic, 108
categorisation, 108
changing, 109–110
conventional, 108
mandatory, 104, 107, 108
spontaneous, 104, 108
synchronised intermittent mandatory (SIMV),
107, 108, 109
passive, denition and stroke volume
changes, 32, 33–34
peak pressure, 109
PEEP see positive end‐expiratory pressure (PEEP)
plateau pressure, 22, 109, 314, 315
positive pressure, stroke volume changes
during, 33–34
pressure‐ventilation curve, 314, 315, 315
prolonged, tracheostomy indication, 55
protocols to reduce time on, 57
in pulmonary embolism (haemodynamically
unstable), 124, 125
in respiratory distress type I, 42
respiratory tract infections due to, 79
risks, in Guillain–Barré syndrome, 54
setting ventilator, 21–22
in ARDS, 328, 342
in burns injuries, 285–286
strategy, volumes/pressures, 21–22
stroke volume changes during, 32, 33–34
after subarachnoid haemorrhage treatment, 196
weaning from, 110
failure, CIP and MIP, 325, 340
principles, 57
successful, predicting, RSBI, 332, 347
ventilator, settings see under ventilation,
mechanical
ventilator dyssynchrony, 107
autotriggering, 109
causes/mechanism, 104
double triggering, 109
early and delayed cycling, 108, 109
ow asynchrony, 109
options to combat, 109–110
pressure and ow curves, 107, 107
termination asynchrony, 109
trigger asynchronies, 108–109
types, 108–109
ventricular assist device (VAD), 273
ventricular brillation (VF), 130, 132
ventricular pseudoaneurysm, 266
ventricular tachycardia, polymorphic
advanced life support, 225–226
causes, 226
immediate concerns, 227, 229
investigations, 227–228
management, 229
vertebral artery, occlusion, neurological decit, 204
virus infections
acute/fulminant liver failure due to, 248
air‐borne transmission reduction methods, 307
chest sepsis, 106
community‐acquired pneumonia, 37, 106
haemolytic‐uraemic syndrome, 322, 335
meningitis, 159, 162
opportunistic, 219
viscoelastic haemostatic assay (ROTEM), 274, 275
viscoelastic testing, 331, 346
visual disturbances
in obstetric patient, 256, 257
see also eyes
vital capacity, 44
vitamin D deciency, 234
volume status, hyponatraemia classication, 140
vomiting
abdominal pain with see under abdominal pain
after acute thrombotic stroke, 204
coee grounds, 96
hypokalaemia due to, in obstetric patient, 256
low GCS with (case 15), 187, 188
after overdose, 238
von Willebrand factor (vWF), 302
antibodies, 303
V/Q mismatch, inhalational burns injury, 286
W
waking, failure, postcardiac surgery and atrial
brillation, 278
Wallace rule of nines, 283
Wallenburg syndrome, 204
warfarin, 102
warm agglutinins, 300
warm ischaemic time (WIT), 211, 212, 251
water
free, loss, electrolyte concentrations and, 147
homeostasis, 323, 336
Waters breathing circuit, 17
weakness
Guillain–Barré syndrome, 48, 50
intubation in/for, 13
weight
gain, goal in anorexia nervosa, 235
healthy, for young woman, 231
loss, refeeding syndrome risk, 233, 234
Wells criteria, 121–122, 122
West Haven scoring system, 250
WFNS (World Federation of Neurosurgeons)
score, 189, 193
WHO ‘Five Moments for Hand Hygiene’, 10
withdrawal of treatment, 210, 211
World Health Organization (WHO)
air‐borne particles, denition, 307
CNS tumour classication, 156
healthcare‐associated infection rate, 10
postpartum haemorrhage, 260
Z
zinc deciency, 235
zopiclone, 240
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