Download The Beginner’s Guide to Intensive Care : a Handbook for Junior Doctors and Allied Professionals PDF

TitleThe Beginner’s Guide to Intensive Care : a Handbook for Junior Doctors and Allied Professionals
File Size4.4 MB
Total Pages485
Table of Contents
                            Cover
Half Title
Title Page
Copyright Page
Contents
Foreword
Acknowledgements
Editors
Contributors
Introduction
Part 1: Basics
	Chapter 1: Your first day and what to expect
		The ‘usual’ day
			Who to ask for help
		ICU terminology
	Chapter 2: The daily review of a patient
		Primary diagnosis
		Background and progress
		Issues over the last 24 hours
		Respiratory system
		Cardiovascular system
		Renal system
		Gastrointestinal system
		Haematology
		Neurological system
		Microbiology
		Lines
		General
		Summary of issues
		Treatment plan
	Chapter 3: Communication
		Why is communication so important?
		Who will I be communicating with?
			On the intensive care unit
			In the hospital
			Outside the hospital
		How can I communicate effectively within the multi-disciplinary team?
			Always
			Never
		How can I communicate effectively with patients and relatives?
			Always
			Never
		How do I break bad news?
			Spikes model
			Always
			Never
		Conclusion
		Further reading
	Chapter 4: Capacity and consent
		Consent
		Capacity
		Lack of capacity
		Deprivation of liberty safeguards
		Restraint
		Mental Health Act 1983
		Children
		Answer to clinical scenario
		Further reading
	Chapter 5: FOAMed and social media as an aid to education in intensive care
		Free open access medical education (FOAMed)
			Twitter
			Podcasts
			Blogs/websites
		Not all that glitters is gold
		Further reading
	Chapter 6: Research in intensive care
		Why is research important?
		Common types of research in ICU
			Translational science
			Early phase clinical studies
			Observational studies
			Randomised controlled trials (RCTs)
		Practical aspects of research in ICU
			Who carries out the research?
		Consent
		Ethical aspects of research in ICU
		How to get involved in research in ICU
		Further reading
	Chapter 7: Stress and burnout in intensive care medicine: Looking after yourself
		What is ‘burnout’?
		How common is burnout?
		Who gets burnout?
		Individual factors
		Organisational/work-related factors
		What are the signs of burnout?
		What are the effects of burnout?
		How is burnout diagnosed?
		Are there any treatments for burnout?
		I am feeling burnt out. what should I do?
		Can burnout be prevented?
		What about our case? An idealised outcome
		Further reading
Part 2: Staffing on the Intensive Care Unit: The multidisciplinary team
	Chapter 8: The intensive care nurse
		What training do critical care nurses have?
	Chapter 9: Speech and language therapists
		Communication difficulties
			Swallowing difficulties
		Further reading
	Chapter 10: The critical care physiotherapist
		Respiratory treatment
		Rehabilitation
		What we need from you
		Further reading
	Chapter 11: Advanced critical care practitioners (ACCP)
		Background
		Recognition by the Faculty of Intensive Care Medicine
		What are the typical backgrounds of ACCPs?
		Current roles of the critical care practitioners within critical care services
		Additional advantages of ACCPs
		Further reading
	Chapter 12: The critical care pharmacist
		Further reading
Part 3: Initial assessment: The first hour
	Chapter 13: Assessing ICU referrals on the ward
		Using a systematic approach to assess referrals
			Airway
			Breathing
			Circulation
			Disability
			Exposure
		Additional information
		Making a plan
		Immediate plan for the ward
		The need for ICU
		Further reading
	Chapter 14: Assessment and management of major trauma patients
		Introduction
		The emergency department
		Patient arrival
		Cervical spine control
		Primary survey
		Catastrophic haemorrhage
		Airway
		Breathing
		Circulation
		Rapid sequence intubation in the emergency department
		Where do they go next?
		Case review
		Further reading
	Chapter 15: Management of the head-injured patient
		Basic principles
			What should you do in response to the nurse’s question?
			Initial assessment and management (first hours)
		Ongoing critical care management in severe traumatic brain injury (hours to days)
			Cerebral perfusion and intracranial pressure
		Further reading
	Chapter 16: Initial management of the patient with burns
		The basics of burns
		Assessment
		Airway and breathing
		Thermal injury
		Respiratory injury
		Toxic injury
		Circulation
			Fluid resuscitation and maintenance
		Circumferential burns
		Disability
		Exposure
		Ongoing management
		Further reading
Part 4: Drugs
	Chapter 17: Analgesia, sedation and muscle relaxation
		Introduction
		Analgesia
		Context-sensitive half-life
		Sedation
		Titration of analgesia and sedation
		Muscle relaxation
		Managing sedation for Mrs Smith
		Further reading
	Chapter 18: Drugs that work on the heart
		Blood pressure
			Increasing blood pressure
				Drugs
			Decreasing blood pressure
				Drugs
		How to use these medications in a clinical setting
			What do you do in response to the nurse’s question?
		Further reading
	Chapter 19: Nutrition and fluids in intensive care
		Summary of nutritional assessment
		Requirements
			Not severely ill or injured patients without risk of refeeding
		Seriously ill or injured patients
		Refeeding syndrome
		Risk for refeeding syndrome
		Prescription for people at high risk of developing refeeding problems
		Intravenous fluids
		Further reading
Part 5: Equipment and investigations
	Chapter 20: Face masks, continuous positive airway pressure (CPAP) and airways
		Introduction
		Oxygen delivery without airway or respiratory support
			Nasal cannulae
			Simple (Hudson) face mask
			Venturi face mask
			Face mask with reservoir bag
		Oxygen delivery with respiratory support
			High-flow nasal cannula (HFNC)
			Continuous positive airway pressure (CPAP)
			Non-invasive positive pressure ventilation (NIPPV/BiPAP/NIV)
		Oxygen delivering with airway support
			Endotracheal tube (ETT)
			Tracheostomy
			Clinical scenario management plan
	Chapter 21: The ventilator
		Why do we need to ventilate?
			Extra-pulmonary
				Central nervous system
				Neuromuscular
				Musculoskeletal
			Pulmonary
		How to set up the ventilator
		Common pitfalls and complications
		Weaning
		Further reading
	Chapter 22: Monitoring the critical care patient
		Airway
			End tidal capnometry (ETCO2)
		Breathing
			Respiratory rate
			Oxygen saturation
			Ventilator values
			Arterial blood gas
		Circulation
			Heart rate
			Electrocardiogram (ECG)
			Blood pressure and mean arterial blood pressure (MAP)
			Central lines and central venous Pressure (CVP)
			Cardiac output monitoring
			Echocardiogram
		Disability
			Glasgow Coma Scale (GCS)
			Capillary blood glucose
			Intracranial pressure (ICP)
		Exposure
			Temperature
			Urine output
		Which of these parameters are important for your clinical review of Mrs Moffat?
		Further reading
	Chapter 23: Ultrasound in intensive care
		What is ultrasound?
		How can ultrasound help in intensive care?
		Echocardiography
		Lung ultrasound
		Abdominal ultrasound
		Vascular ultrasound
		How would ultrasound help our patient?
		Further reading
	Chapter 24: Renal replacement therapy in intensive care
		Types of renal replacement therapy
			Dialysis
			Filtration
		Intermittent RRT
		Continuous RRT (CRRT)
		Sustained low efficiency dialysis (SLED) (or SLEDD: Slow low efficiency daily dialysis)
		So how do we pick?
		Vascular access
		Anticoagulation
		Concepts in prescribing CRRT
			Anticoagulation
			Exchange rate
			Fluid replacement and balance
			Replacement fluid choice
			Pre- and Post-dilution
		What are you going to do for Mr Smith?
		Further reading
	Chapter 25: Interpreting arterial blood gases (ABGs)
		What is an ABG?
		Normal values for arterial blood Gas (ABG)
		Definitions
			Other components
		Alternative approaches to blood gas analysis
		How to interpret an ABG
			What is the pO2?
			What is the pH?
			Is the pH change due to a primary respiratory or metabolic disturbance? check the PaCO2 and HCO3-
			What is the base excess and anion gap?
			Is there evidence of compensation?
		What should we do?
			Immediate management
		Further reading
Part 6: Airway and respiratory emergencies
	Chapter 26: Maintaining an airway
		Causes of airway obstruction
		Recognising an obstructed airway
		Basic airway opening manoeuvres
		Head tilt and Chin lift
		Jaw thrust
		Airway adjuncts
		Ventilation
		Advanced airways
		Approaching the above clinical problem
	Chapter 27: Rapid sequence induction
		Indications
		Risk of procedure
		How to do an RSI
		Minimizing aspiration risk
			Cricoid pressure
			Tracheal intubation
			Optimizing oxygenation prior to intubation
				Adequate preoxygenation
				Increase FiO2
				Positive pressure
				Apnoeic oxygenation
			Positioning for preoxygenation
				Suction equipment and tilting trolley
		Drugs in RSI
			Induction agent
			Neuromuscular blocking agent
		Opioids
		Ventilation
		Planned Preparation with Checklist for RSI
		Management of Failure – DAS Guidelines
		Further reading
	Chapter 28: Endotracheal tube and tracheostomy problems
		When do airway problems occur?
		How will I know it is an airway problem?
		What should I do?
		Suspected airway problem with the endotracheal tube still in the mouth
			Actions
		What to do if the endotracheal tube is completely displaced
		Tracheostomy basics
			Surgical tracheostomies
			Percutaneous tracheostomies
			Laryngectomy patients
			Mini-tracheostomy
		Managing tracheostomy emergencies
		Expert tips
		Further reading
	Chapter 29: ‘Fighting the ventilator’
		Questions
		Introduction
		Initial assessment
		Identification of the problem
			Airway or breathing circuit issues
			Breathing or circulatory problems
		Inappropriate ventilator settings
		Inadequate sedation or paralysis
		Conclusion
		Further reading
	Chapter 30: Pneumothorax
		Definition
		Causes
		Recognition
		Tip
		Tension pneumothorax
		Management – What do you need to do?
		Chest drain insertion
		Technique
		Further reading
Part 7: Other emergencies
	Chapter 31: Cardiac arrhythmias
		Supraventricular arrhythmias
			Supraventricular tachycardia (SVT)
			Atrial fibrillation
				Treatment
			Atrial tachycardia
				Treatment
		Supraventricular bradycardias
			Heart block
				Treatment
		Ventricular arrhythmias
			Ventricular extrasystoles
				Treatment
			Ventricular fibrillation
		Asystole
	Chapter 32: ICU delirium and the agitated patient
		What is critical care delirium?
		Causes and impact of critical care delirium and agitation
		Detecting delirium
		Management of critical care delirium and agitation
			Non-pharmacological management
			Pharmacological management
		Case resolution
		Further reading
	Chapter 33: Status epilepticus
		Definition
		Causes
			Acute
			Chronic
		Management
			Airway and Breathing
			Circulation
			Disability
			Examination
		Drug treatment
		Further investigations
		Clinical case
		Further reading
	Chapter 34: The critically ill or injured child in a non-paediatric hospital
		What do critically ill children present to district general hospitals with?
			Respiratory conditions
			Cardiac conditions
			Sepsis
			Neurological conditions
			Non-accidental injury (NAI)
		Recognition of the critically ill child
		Investigations
			Bloods
			Urine
			Other investigations
		What do you do in this emergency situation? (Management of critically ill child)
		Airway considerations
		Sedative and muscle relaxation drugs and doses
		Ventilation
		Supporting the circulation
		Human factors
		Further reading
	Chapter 35: Management of hyperglycaemic emergencies
		What is diabetic ketoacidosis?
		Epidemiology
		What causes DKA?
		What are the clinical features?
		How can a diagnosis of DKA be confirmed in Mr Evans?
		How should Mr Evans be managed?
			Fluid resuscitation
			Hyperglycaemia
			Administration of electrolytes
		How should Mr Evans’ fluid regimen be prescribed?
			Other considerations
		Does Mr Evans require admission to critical care?
		Complications of DKA
			Cerebral oedema
			Pulmonary oedema
			Hypoglycaemia
		Important points for consideration
		Following treatment
		How is DKA different from hyperosmolar hyperglycaemic state (HHS)?
		Further reading
	Chapter 36: Poisoning
		General measures
		Paracetamol
		Salicylates
		Sedatives
			Tricyclic antidepressants
			Beta-blockers
Part 8: Management
	Chapter 37: Pneumonia
		Introduction
		Community-acquired pneumonia (CAP)
			Typical organisms
			Atypicals
			Investigations
			Treatment
		Hospital-acquired pneumonia (HAP)
			Treatment of HAP
			Aspiration pneumonia
		Ventilator-associated Pneumonia (VAP)
			Diagnosis
				The Clinical Pulmonary Infection Score (CPIS) for VAP
			Prevention of VAP
			Treatment
		What do you do in response to the nurse’s question?
		Further reading
	Chapter 38: Acute severe asthma
		What causes asthma?
		Diagnosis of acute severe asthma
		Investigations
			Peak expiratory flow (PEF) or FEV1
			Pulse oximetry
			Arterial blood gases (ABGS)
		Management
			Initial treatment
				Oxygen
				Beta-2 agonist bronchodilator
				Ipratropium bromide
				Steroids
				Intravenous fluids
		Treatment initiated after consultation with senior staff
			Magnesium sulphate
			Aminophylline infusion
			Adrenaline
			Anaesthetic inhalational agents
			Ketamine
		Ventilation
			Non-invasive
			Invasive
		What is the prognosis of asthma and how do I prevent it?
		Further reading
	Chapter 39: The COPD patient in intensive care
		Introduction
		Pharmacological management of an exacerbation of COPD
		Ventilator support for patients with COPD
			Non-invasive ventilation for patients with COPD
				Where should NIV be delivered?
				How is NIV provided?
			Invasive ventilation for patients with COPD
		What about Mr Evans?
		Further reading
	Chapter 40: Acute respiratory distress syndrome
		What is ARDS?
		Diagnosis
		Treatment
		Ventilation strategies
		Positioning
			Prone ventilation
		Pharmacological approaches
			Sedation
			Muscle relaxants
			Steroids
			Pulmonary vasodilators
			Intravenous fluid
		Other therapies
			Extracorporeal membrane oxygenation (ECMO)
			Extracorporeal CO2 removal
		Outcome
		Clinical scenario
		Further reading
	Chapter 41: Sepsis
		What is sepsis?
		How do patients with sepsis present?
		How is sepsis managed?
			Initial resuscitation
			Antimicrobial therapy
		Some controversies in sepsis
			Paracetamol for pyrexia in sepsis
			Activated Protein C (APC)
			Glycaemic control
			What about Mr Kay?
		Further reading
	Chapter 42: Acute renal failure in intensive care (Acute kidney injury)
		What causes renal failure?
			Pre-renal (generally because of poor renal perfusion)
			Renal
			Post-renal – obstructive causes. Rarer but we do see them
		Diagnosis of acute renal failure/acute kidney injury (AKI)
			Staging
		How do I prevent renal failure?
		Investigations
			Bloods
			Urine
			Other investigations
		What do you do in response to the nurse’s question? (Treatment of acute renal failure)
			Initial treatment (Within six hours)
				Remember your ABC
				Lines
				Drugs
		Renal replacement therapy
			Concomitant medication
		Long-term prognosis
		Further reading
	Chapter 43: Management of severe acute pancreatitis
		Symptoms/signs
		Causes
		Investigations
		Scoring systems
			Ranson’s criteria
				Non-gallstone pancreatitis
				Gallstone pancreatitis
			‘GLASCOW’ Criteria
		Back to the patient
			Respiratory
			Cardiovascular
			Renal
			Nutrition
		Management of pseudocysts and infection
			Surgical management
		Further reading
	Chapter 44: Hepatic failure
		Physiology of liver
		Causes of liver failure
			Drug-related hepatotoxicity
			Hepatic failure in pregnancy
			Toxin-related hepatotoxicity
			Vascular causes
			Metabolic causes
			Malignancies
		Presentation
			History
			Physical examination
			Complications
		Management
			Prothrombin time
			Hepatic enzymes
			Serum bilirubin
			Serum ammonia
			Serum glucose
			Serum lactate
			Other useful tests
			Diagnosis
			Management of acute liver failure
			Management of encephalopathy and cerebral oedema
			Infection
			Coagulation
			N-acetylcysteine
			Liver transplantation
			Diet
			Prognosis
			Clinical scenario – continued
		Further reading
	Chapter 45: Non-traumatic brain injuries
		What is a subarachnoid haemorrhage and what causes it?
		Diagnosis of SAH
		Classification of SAH
		Complications
			Disease-associated events
			Treatment-associated events
			Complications associated with prolonged bed rest
		Management
			Critical care
			Neurosurgical and neuroradiological intervention
		Intracerebral haemorrhage
		Ischaemic stroke in neurocritical care
		Decompressive hemicraniectomy
		What do you do in response to the nurse’s question? (Assessment of patient with deteriorating conscious level after diagnosis of Grade I SAH)
			Immediate management
		Further reading
	Chapter 46: Ongoing management of the patient with burns
		Systemic considerations
			Cardiovascular
			Respiratory
			Genitourinary tract
			Renal
			Neurological
			Musculoskeletal
			Electrolyte
			Metabolism
			Haematological
			Immune
			Psychological
		Specific considerations
			Smoke inhalation injury
			Burn shock, fluid resuscitation and management
			Temperature regulation
			Wound infection/sepsis
	Chapter 47: Ageing and frailty
		The ageing population
		The elderly – the challenges
		Physiological and pathological changes associated with the elderly
			Cardiovascular
			Respiratory
			Renal
			Neurological
			Haematological
			Musculoskeletal
			Nutrition
			Pharmacological
			Functional decline
		Frailty and frailty assessment
		Prognostic implications
			Therapeutic implications
		Back to the case
		Further reading
	Chapter 48: Transfer of the critically ill patient
		Introduction
		Preparation for transfer
			Airway (with cervical spine immobilisation if indicated)
			Breathing
			Circulation
			Disability
			Everything else
		Special circumstances
			Aeromedical transfers
			MRI
		Case answer
			Airway
			Breathing
			Circulation
			Disability
			Everything else
		Summary
		Further reading
	Chapter 49: The critically ill obstetric patient
		Differential diagnoses
			Shortness of breath (SOB)
			Asthma
			Pulmonary embolus
			Pneumonia
				Bacterial pneumonia
				Viral pneumonia
			Pulmonary oedema
			Pulmonary arterial hypertension (PAH)
			Abdominal pain or diarrhoea and vomiting
				Pre-conception
				In early pregnancy
				Later in pregnancy or post-delivery
			Headache
		Cardiac disease
		Sepsis
		Embolism
			Thrombosis and thromboembolism
				Management
			Amniotic fluid embolism (AFE)
		Pre-eclampsia, eclampsia and HELLP
			Pre-eclampsia
				Management
			Eclampsia
		Haemorrhage
			Causes of obstetric haemorrhage
				Management
		Important physiological alterations in pregnant women
			Respiratory
			Cardiovascular
			Haematology
			Renal
			Gastrointestinal
		Conclusion
		Further reading
	Chapter 50: The bariatric patient in intensive care
		Definition
		Respiratory system
			Unfavourable respiratory mechanics in the face of increased oxygen consumption
			Obstructive sleep apnoea
			Obesity hypoventilation syndrome
			Management principles relevant to respiratory care
				Positioning
				CPAP/NIV
				Invasive mechanical ventilation
		Cardiovascular system
			Physiology
			Risk of cardiovascular comorbidity
		Renal system
		Nutritional support
		Immune system changes and nosocomial infections
		Thromboembolic risk
		Pharmacology/drug dosing
		Technical and organisational issues
			Blood pressure monitoring
			Placement of vascular access
			Airway management
			Organisational issues
		How about steve?
		Further reading
	Chapter 51: Post-ICU syndrome
		What is Post-ICU syndrome?
			Physical consequences
			Non-physical consequences
		Who is likely to get it?
		What can we do to manage it?
			Before admission to ICU
			During ICU stay
			Following discharge from ICU
		Further reading
	Chapter 52: End of life care in ICU
		What is palliative care?
		Identifying patients
		Symptom control
			Pain
			Anxiety
			Secretions
		Nausea and vomiting
			Dyspnoea
		End of life prescribing
		Anticipatory prescribing
		Palliative care emergencies
			Hypercalcaemia
			SVC obstruction
			Major haemorrhage
			Metastatic spinal cord compression
		Case review
		Further reading
	Chapter 53: Brain stem death and organ donation
		Donors after brain stem death (DBD)
		What is coning?
		Brain stem death testing
			Pre-conditions
			Clinical examination
				Apnoea test
			Donation after circulatory death (DCD)
			Assessment for organ donation suitability
		Clinical priorities
		Donor optimisation
		How do you respond to the nurse’s question?
		Further reading
Index
                        

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