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• Cover
• Title Page
• Copyright Page
• Dedication
• Contents
• Contents in Detail
• Acknowledgments
• Contributors
• Reviewers
• Preface
• Section I. The Essentials
• 1. Assessment of Critically Ill Patients and Their Families
• Assessment Framework
• Prearrival Assessment
• Admission Quick Check
• Comprehensive Initial Assessment
• Ongoing Assessment
• Patient Safety Considerations in Admission Assessments
• Prearrival Assessment: Before the Action Begins
• Admission Quick Check Assessment: the First Few Minutes
• Airway and Breathing
• Circulation and Cerebral Perfusion
• Chief Complaint
• Drugs and Diagnostic Tests
• Equipment
• Comprehensive Initial Assessment
• Past Medical History
• Social History
• Physical Assessment by Body System
• Psychosocial Assessment
• Ongoing Assessment
• Principles of Management
• Selected Bibliography
• Critical Care Assessment
• Evidence-Based Practice
• 2. Planning Care for Critically Ill Patients and Their Families
• Interprofessional Plan of Care
• Planning Care Through Staffing Considerations
• Patient Safety Considerations in Planning Care
• Prevention of Common Complications
• Physiologic Instability
• Venous Thromboembolism
• Hospital-Acquired Infections
• Pressure Injury
• Sleep Pattern Disturbance
• Psychosocial Impact
• Patient and Family Education
• Assessment of Learning Readiness
• Strategies to Address Patient and Family Education
• Principles for Educational Outcome Monitoring
• Family-Centered Care
• Transporting the Critically Ill Patient
• Assessment of Risk for Complications
• Level of Care Required During Transport
• Preparation
• Transport
• Interfacility Transfers
• Transitioning to the Next Stage of Care
• Supporting Patients and Families During the Dying Process
• Principles of Management
• Selected Bibliography
• Patient and Family Needs
• Infection Control
• Patient and Family Education
• Psychological Problems
• Sleep Deprivation
• Transport of Critically Ill Patients
• Evidence-Based Practice
• 3. Interpretation and Management of Basic Cardiac Rhythms
• Basic Electrophysiology
• ECG Waveforms, Complexes, and Intervals
• P Wave
• QRS Complex
• T Wave
• U Wave
• PR Interval
• ST Segment
• QT Interval
• Basic Electrocardiography
• Cardiac Monitoring
• Determination of the Heart Rate
• Determination of Cardiac Rhythm
• Common Dysrhythmias
• Rhythms Originating in the Sinus Node
• Normal Sinus Rhythm
• Sinus Bradycardia
• Sinus Tachycardia
• Sinus Dysrhythmia
• Sinus Arrest
• Dysrhythmias Originating in the Atria
• Premature Atrial Complexes
• Wandering Atrial Pacemaker and Multifocal Atrial Tachycardia
• Atrial Tachycardia
• Atrial Flutter
• Atrial Fibrillation
• Supraventricular Tachycardia (SVT)
• Dysrhythmias Originating in the Atrioventricular Junction
• Premature Junctional Complexes
• Junctional Rhythm, Accelerated Junctional Rhythm, and Junctional Tachycardia
• Dysrhythmias Originating in the Ventricles
• Premature Ventricular Complexes
• Idioventricular Rhythm and Accelerated Idioventricular Rhythm (AIVR)
• Ventricular Tachycardia
• Ventricular Fibrillation
• Ventricular Asystole
• Atrioventricular Blocks
• First-Degree Atrioventricular Block
• Second-Degree Atrioventricular Block
• High-Grade Atrioventricular Block
• Third-Degree Atrioventricular Block (Complete Block)
• Temporary Pacing
• Indications
• Transvenous Pacing
• Epicardial Pacing
• Components of a Pacing System
• Basics of Pacemaker Operation
• Initiating Transvenous Ventricular Pacing
• Initiating Epicardial Pacing
• External (Transcutaneous) Pacemakers
• Defibrillation and Cardioversion
• Defibrillation
• Automatic External Defibrillators
• Cardioversion
• Selected Bibliography
• Evidence-Based Practice
• 4. Hemodynamic Monitoring
• Hemodynamic Parameters
• Cardiac Output
• Components of Cardiac Output/Cardiac Index
• Stroke Volume and Stroke Volume Index
• Ejection Fraction
• Factors Affecting Stroke Volume/Stroke Volume Index
• Basic Components of Hemodynamic Monitoring Systems
• Pulmonary Artery Catheter
• Arterial Catheter
• Pressure Tubing
• Pressure Transducer
• Pressure Amplifier
• Pressure Bag and Flush Device
• Alarms
• Obtaining Accurate Hemodynamic Values
• Zeroing the Transducer
• Leveling the Transducer to the Catheter Tip
• Ensuring Accurate Waveform Transmission
• Insertion and Removal of Catheters
• Pulmonary Artery Catheters
• Arterial Catheters
• Obtaining and Interpreting Hemodynamic Waveforms
• Patient Positioning
• Interpretation
• Artifacts in Hemodynamic Waveforms: Respiratory Influence
• Cardiac Output
• Continuous Mixed and Central Venous Oxygen Monitoring
• Monitoring Principles
• Selected Examples of Clinical Applications
• Minimally Invasive Hemodynamic Monitoring
• Thoracic Bioimpedance/Bioreactance
• Esophageal Doppler Cardiac Output
• Carbon Dioxide Rebreathing
• Pulse Contour Measurement
• Passive Leg Raise Maneuver
• Application of Hemodynamic Parameters
• Low Cardiac Output States
• Left Ventricular Dysfunction
• Hypovolemia
• High Cardiac Output States
• Selected Bibliography
• Hemodynamic Monitoring
• Minimally Invasive Hemodynamic Monitoring
• Therapeutics
• Evidence-Based Practice Guidelines
• 5. Airway and Ventilatory Management
• Diagnostic Tests, Monitoring Systems, and Respiratory Assessment Techniques
• Arterial Blood Gas Monitoring
• Venous Blood Gas Monitoring
• Pulse Oximetry
• Assessing Pulmonary Function
• Airway Management
• Oropharyngeal Airway
• Nasopharyngeal Airway
• Artificial Airways
• Endotracheal Suctioning
• Oxygen Therapy
• Complications
• Oxygen Delivery
• Basic Ventilatory Management
• Indications
• General Principles
• Modes
• Complications of Mechanical Ventilation
• Weaning from Short-Term Mechanical Ventilation
• Weaning From Long-Term Mechanical Ventilation
• Respiratory Fatigue, Rest, and Conditioning
• Wean Trial Protocols
• Other Protocols for Use
• Critical Pathways
• Systematic Institutional Initiatives for the Management of the LTMV Patient Population
• Troubleshooting Ventilators
• Communication
• Principles of Management
• Selected Bibliography
• General Critical Care
• Ventilator Management
• Weaning From Mechanical Ventilation
• Communication
• Evidence-Based Resources
• 6. Pain, Sedation, and Neuromuscular Blockade Management
• Physiologic Mechanisms of Pain
• Peripheral Mechanisms
• Spinal Cord Integration
• Central Processing
• Responses to Pain
• Pain Assessment
• A Multimodal Approach to Pain Management
• Nonsteroidal Anti-Inflammatory Drugs
• Side Effects
• Opioids
• Side Effects
• Intravenous Opioids
• Patient-Controlled Analgesia
• Switching From IV to Oral Opioid Analgesia
• Epidural Analgesia
• Epidural Opioids
• Epidural Local Anesthetics
• Cutaneous Stimulation
• Distraction
• Imagery
• Relaxation Techniques
• Deep Breathing and Progressive Relaxation
• Presence
• Special Considerations for Pain Management in Older Adults
• Assessment
• Interventions
• Principles of Pain Management
• Sedation
• Reasons for Sedation
• Sedatives
• Medications for Delirium
• Goals of Sedation, Monitoring, and Management
• Neuromuscular Blockade
• Neuromuscular Blocking Agents
• Monitoring and Management
• Principles of Management for the Use of Sedatives and Neuromuscular Blocking Agents
• Selected Bibliography
• Pain Management
• Sedation and Neuromuscular Blockade
• Evidence-Based Practice Guidelines
• 7. Pharmacology
• Medication Safety
• Medication Administration Methods
• Intravenous
• Intramuscular or Subcutaneous
• Oral
• Sublingual
• Intranasal
• Transdermal
• Central Nervous System Pharmacology
• Sedatives
• Analgesics
• Neuromuscular Blocking Agents
• Anticonvulsants
• Cardiovascular System Pharmacology
• Miscellaneous Agents
• Parenteral Vasodilators
• Antiarrhythmics
• Vasodilators and Remodeling Agents
• Vasopressor Agents
• Inotropic Agents
• Antibiotic Pharmacology
• Aminoglycosides
• Vancomycin
• Pulmonary Pharmacology
• Albuterol
• Levalbuterol
• Ipratropium
• Gastrointestinal Pharmacology
• Stress Ulcer Prophylaxis
• Acute Peptic Ulcer Bleeding
• Variceal Hemorrhage
• Renal Pharmacology
• Diuretics
• Hematologic Pharmacology
• Anticoagulants
• Factor Xa Inhibitors
• Direct Thrombin Inhibitors
• Glycoprotein IIb/IIIa Inhibitor
• Thrombolytic Agents
• Immunosuppressive Agents
• Cyclosporine
• Tacrolimus (FK506)
• Sirolimus (Rapamycin)
• Special Dosing Considerations
• Continuous Renal Replacement Therapy
• Drug Disposition in Older adults
• Therapeutic Drug Monitoring
• Selected Bibliography
• General
• Evidence-Based Practice Guidelines
• 8. Ethical and Legal Considerations
• Types of Ethical Problems
• The Foundation for Ethical Decision Making
• Professional Codes and Standards
• Institutional Policies
• Legal Standards
• Principles of Ethics
• Paternalism
• Frameworks for Ethical Analysis
• Ethic of Care
• Patient Advocacy
• The Process of Ethical Analysis
• Assessment
• Plan
• Implementation
• Evaluation
• Contemporary Ethical Issues
• Informed Consent
• End-of-Life Issues
• Resuscitation Decisions
• Evolving Technology
• Building An Ethical Environment
• Healthy Work Environments
• Selected Bibliography
• General
• Professional Codes, Standards, and Position Statements
• Evidence-Based Guidelines
• Online References of Interest: Related to Legal and Ethical Considerations
• Section II. Pathologic Conditions
• 9. Cardiovascular System
• Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
• Assessment of Chest Pain
• Coronary Angiography
• Percutaneous Coronary Interventions
• Other Percutaneous Coronary Interventions
• Pathologic Conditions
• Acute Ischemic Heart Disease
• Heart Failure
• Shock
• Hypertension
• Selected Bibliography
• General Cardiovascular
• Coronary Revascularization
• Acute Ischemic Heart Disease
• Heart Failure
• Hypertension
• Evidence-Based Practice Guidelines
• 10. Respiratory System
• Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
• Chest X-Rays
• Computed Tomography, Magnetic Resonance Imaging, and Bedside Ultrasonography
• CTPA and Ventilation-Perfusion Scans
• Chest Tubes
• Thoracic Surgery and Procedures
• Principles of Management for Thoracic Surgery and Procedures
• Pathologic Conditions
• Acute Respiratory Failure
• Acute Respiratory Distress Syndrome
• Acute Respiratory Failure in the Patient with Chronic Obstructive Pulmonary Disease (also called COPD exacerbation)
• Acute Respiratory Failure in the Patient With Asthma (also called acute severe asthma)
• Principles of Management for Acute Severe Asthma and Asthma Exacerbations
• Interstitial Lung Disease
• Pulmonary Arterial Hypertension
• Pneumonia
• Pulmonary Embolism
• Selected Bibliography
• Critical Care Management of Respiratory Problems
• Chest X-Ray Interpretation
• Evidence-Based Practice Resources
• 11. Multisystem Problems
• Sepsis and Septic Shock
• Etiology, Risk Factors, and Pathogenesis
• Clinical Presentation
• Principles of Management of Sepsis and Septic Shock
• Overdoses
• Etiology, Risk Factors, and Pathophysiology
• Principles of Management for Overdose
• Pressure Injury
• Pressure Injury Stages
• Principles of Management of Pressure Injury
• Healthcare-Associated Infections
• Selected Infectious Diseases
• Selected Bibliography
• Sepsis and Septic shock
• Overdoses
• Pressure Injuries
• Healthcare-Associated Infections
• Selected Infectious Diseases
• 12. Neurologic System
• Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
• Level of Consciousness
• Glasgow Coma Scale (GCS) and the Full Outline of Unresponsiveness (FOUR) Score
• Mental Status
• Motor Assessment
• Sensation
• Cranial Nerve Assessment and Assessment of Brain Stem Function
• Vital Sign Alterations in Neurologic Dysfunction
• Death by Neurologic Criteria
• Diagnostic Testing
• Computed Tomography (CT)
• Magnetic Resonance Imaging
• Cerebral (Catheter) Angiography
• Transcranial Doppler Ultrasound
• Lumbar Puncture
• Electroencephalography
• Electromyography/Nerve Conduction Studies
• Intracranial Pressure: Concepts and Monitoring
• Causes of Increased Intracranial Pressure
• Cerebral Blood Flow
• Clinical Presentation
• Invasive Monitoring of ICP
• Principles of Management of Increased ICP
• Acute Ischemic Stroke
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Tests
• Principles of Management of Acute Ischemic Stroke
• Hemorrhagic Stroke
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Tests
• Principles of Management of Intracerebral Hemorrhage
• Seizures
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Testing
• Principles of Management of Seizures
• Infections of the Central Nervous System
• Meningitis
• Encephalitis
• Intracranial Abscess
• Neuromuscular Diseases
• Myasthenia Gravis
• Multiple Sclerosis
• Guillain-Barré Syndrome
• Selected Bibliography
• Assessment and Diagnostic Testing
• Intracranial Pressure
• Acute Ischemic Stroke and Hemorrhagic Stroke
• Seizures
• Infections of the Central Nervous System
• Neuromuscular Diseases
• Evidence-Based Practice
• 13. Hematologic and Immune Systems
• Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
• Complete Blood Count
• Red Blood Cell Count
• Hemoglobin
• Hematocrit
• Red Blood Cell Indices
• Total White Blood Cell Count
• White Blood Cell Differential
• Platelet Count
• Coagulation Studies
• Additional Tests and Procedures
• Pathologic Conditions
• Anemia
• Immunocompromise
• Coagulopathies
• Selected Bibliography
• Anemia
• Immunocompromised Patient
• Coagulopathy
• 14. Gastrointestinal System
• Pathologic Conditions
• Acute Gastrointestinal Bleeding
• Liver Failure
• Acute Pancreatitis
• Intestinal Ischemia
• Bowel Obstruction
• Bariatric (Weight Reduction) Surgery
• Surgical Procedure
• Nutritional Support for Critically Ill Patients
• Nutritional Requirements
• Nutritional Case: Special Populations
• Gastric Residual Volume
• Aspiration
• Bowel Sounds
• Nausea, Vomiting, and Diarrhea
• Osmolality or Hypertonicity of Formula
• Diarrhea
• Flow Rates and Hours of Infusion
• Formula Selection
• Selected Bibliography
• Upper GI Bleeding
• Liver Failure
• Acute Pancreatitis
• Intestinal Ischemia/Bowel Obstruction
• Nutrition
• On-line References of Interest
• Bariatric (Gastric Bypass) Surgery
• 15. Renal System
• Acute Kidney Injury
• Etiology, Risk Factors, and Pathophysiology
• Clinical Phases
• Clinical Presentation
• Principles of Management for Acute Kidney Injury
• Electrolyte Imbalances
• Sodium Imbalance: Hyperosmolar Disorders
• Sodium Imbalance: Hypo-osmolar Disorders
• Potassium Imbalance: Hyperkalemia
• Potassium Imbalance: Hypokalemia
• Calcium Imbalance: Hypercalcemia
• Calcium Imbalance: Hypocalcemia
• Magnesium Imbalance: Hypermagnesemia
• Magnesium Imbalance: Hypomagnesemia
• Phosphate Imbalance: Hyperphosphatemia
• Phosphate Imbalance: Hypophosphatemia
• Principles of Management for Electrolyte Imbalances
• Renal Replacement Therapy
• Access
• Dialyzer/Hemofilters/Dialysate
• Procedures
• Indications for and Efficacy of Renal Replacement Therapy Modes
• General Renal Replacement Therapy Interventions
• Selected Bibliography
• General Renal and Electrolytes
• Acute Kidney Injury
• Renal Replacement Therapy
• Web Resources
• 16. Endocrine System
• Pathologic Conditions
• Hyperglycemic States
• Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar
• Acute Hypoglycemia
• Summary: Hyperglycemia and Hypoglycemia
• Pituitary Gland Function and Associated Disorders
• Syndrome of Inappropriate Antidiuretic Hormone Secretion
• Diabetes Insipidus
• Summary: Pituitary Gland and DI/SIADH
• Thyroid Gland Function and Associated Disorders
• Hyperthyroidism and Thyroid Storm
• Hypothyroidism and Myxedema Coma
• Summary: Hyperthyroidism and Thyroid Storm, Hypothyroidism and Myxedema Coma
• Adrenal Gland Function and Associated Disorders
• Cushing Syndrome
• Aldosteronism
• Addison Disease and Crisis
• Critical Illness-Related Corticosteroid Insufficiency
• Pheochromocytoma and Catecholamine Crisis
• Summary: Adrenal Gland Dysfunction
• Selected Bibliography
• Blood Glucose Monitoring
• Hyperglycemia, DKA, and HHS
• SIADH and Diabetes Insipidus
• Hyperthyroidism and Thyroid Storm
• Hypothyroidism and Myxedema Coma
• Adrenal Gland, Cushing Disease, and Pheochromocytoma
• Critical Illness-Related Corticosteroid Insufficiency
• 17. Trauma
• Specialized Assessment
• Primary, Secondary, and Tertiary Trauma Surveys
• Diagnostic Studies
• Mechanism of Injury
• Physiologic Consequences of Trauma
• Common Injuries in the Trauma Patient
• Thoracic Trauma
• Abdominal Trauma
• Musculoskeletal Trauma
• Complications of Traumatic Injury in Severe Multisystem Trauma
• General Concepts
• Infection, Systemic Inflammatory Response Syndrome, Sepsis/Septic Shock, and Multiple Organ Dysfunction
• Acute Respiratory Distress Syndrome
• Psychological Consequences of Trauma
• Selected Bibliography
• General Trauma
• Section III. Advanced Concepts
• 18. Advanced ECG Concepts
• The 12-Lead Electrocardiogram
• Axis Determination
• Bundle Branch Block
• Acute Coronary Syndrome
• Preexcitation Syndromes
• Advanced Dysrhythmia Interpretation
• Supraventricular Tachycardias
• Polymorphic Ventricular Tachycardias
• Differentiating Wide QRS Beats and Rhythms
• St-Segment Monitoring
• Measuring the ST Segment
• Choosing the Best Leads for ST-Segment Monitoring
• Cardiac Pacemakers
• Evaluating Pacemaker Function
• VVI Pacemaker Evaluation
• DDD Pacemaker Evaluation
• Selected Bibliography
• Electrocardiography
• Acute Coronary Syndrome
• Long QT Syndrome and Brugada Syndrome
• Dysrhythmias
• Pacemakers
• Evidence Based Practice
• 19. Advanced Cardiovascular Concepts
• Pathologic Conditions
• Cardiomyopathy
• Valvular Heart Disease
• Pericarditis
• Aortic Aneurysm
• Cardiac Transplantation
• Intra-Aortic Balloon Pump Therapy
• Ventricular Assist Devices
• Selected Bibliography
• General Cardiovascular
• Cardiomyopathy
• Heart Transplantation
• Valvular Disorders
• Pericarditis
• Thoraco-Abdominal Aneurysms
• Intra-aortic Balloon Pump Therapy
• Ventricular Assist Devices
• Evidence-Based Practice/Guidelines
• 20. Advanced Respiratory Concepts: Modes of Ventilation
• Advanced Modes of Mechanical Ventilation
• New Concepts: Mechanical Ventilation
• Volume Versus Pressure Ventilation
• Advanced Modes: What Do We Know?
• Selected Bibliography
• Mechanical Ventilation: Modes
• Selected Vendor Web Pages
• Evidence-Based Practice
• Additional Readings
• 21. Advanced Neurologic Concepts
• Subarachnoid Hemorrhage
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Tests
• Principles of Management of Aneurysmal Subarachnoid Hemorrhage
• Traumatic Brain Injury
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Tests
• Principles of Management of Traumatic Brain Injury
• Traumatic Spinal Cord Injury
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Tests
• Principles of Management of Acute Spinal Cord Injury
• Future Spinal Cord Injury Treatment
• Brain Tumors
• Etiology, Risk Factors, and Pathophysiology
• Clinical Presentation
• Diagnostic Tests
• Principles of Management of Intracranial Tumors
• Trans-Sphenoidal Resection of Pituitary Tumors
• Advanced Technology
• Selected Bibliography
• Subarachnoid Hemorrhage
• Traumatic Brain Injury
• Spinal Cord Injury
• Brain Tumors
• Advanced Technology: Multimodal Monitoring
• Evidence-Based Guidelines
• Section IV. Key Reference Information
• 22. Normal Laboratory Reference Values
• 23. Pharmacology Tables
• 24. Hemodynamic Monitoring Troubleshooting Guide
• 25. Cardiac Rhythms, ECG Characteristics, and Treatment Guide
• Index