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TitleAdult Critical Care Medicine: A Clinical Casebook
Author
LanguageEnglish
File Size4.1 MB
Total Pages401
Table of Contents
                            Preface
Contents
Contributors
Chapter 1: Management of Intracranial Hypertension and Status Epilepticus
	Case #1: Intracranial Hypertension
	Case #2: Status Epilepticus
	References
Chapter 2: Overcoming Conflicts in ICU Care of Surgical Patients
	Case Presentation
	Introduction
	Surgeon-Patient Relationship
	Communication
	Surgical vs. Medical Intensivist
	Conflict Between Surgeon and Intensivist
	Closed vs. Open ICU
	Discussion
	References
Chapter 3: Perioperative Management of the Heart Transplant and Mechanical Circulatory Support Device Patient
	Introduction
	Case Presentation
	Initial Considerations
	Post-operative Considerations
	Anticoagulation Considerations
	Additional Considerations
	Post-readmission Considerations
	Posttransplant Considerations
	Posttransplant Arrhythmias
	Allograft Dysfunction
	Conclusion
	References
Chapter 4: Damage Control in the Trauma ICU
	Prehospital Course
	Emergency Room Course
	Past Medical/Surgical History
	Home Medications
	Social History
	Admission Laboratory Results
	Operating Room Course
	Trauma ICU Course
		Hypothermia
		Acidosis/Circulatory Support
		Coagulopathy
	Second Operating Room Course
	Subsequent Trauma ICU Course and Abdominal Closure
	Epilogue
	Summary
	References
Chapter 5: Liver Failure in the ICU
	Case 1
		History of Present Illness
		Past Medical History
		Physical Exam
		Laboratory Parameters and Diagnostic Testing
		Differential Diagnosis
		Case Summary
	Case 2
		History of Present Illness
		Past Medical History
		Physical Exam
		Laboratory Parameters
		Diagnostic Considerations
		Case Summary
	Case 3
		History of Present Illness
		Past Medical History
		Physical Exam
		Laboratory Parameters and Diagnostic Testing
		Differential Diagnosis
		Case Summary
	Case 4
		History of Present Illness
		Past Medical History
		Physical Exam
		Laboratory Parameters
		Differential Diagnosis
		Case Summary
	Suggested Reading
Chapter 6: Harm and Quality in the ICU
	Case Study
	Differential Diagnoses
	Introduction
	Reportable Metrics
	Quality: Six Sigma, CUSP, and Just Culture
		Six Sigma
		CUSP
		Communication and Culture
	Summary
	References
Chapter 7: Surveillance and Prevention of Hospital-Acquired Infections
	Case 1
		Reporting of Ventilator-Associated Events (VAE)
		VAE
		Avoidance of Intubation If Possible
		Minimize Sedation
		Maintain and Improve Physical Conditioning
		Minimize Pooling of Secretions Above the Endotracheal Tube Cuff
		Elevate the Head of the Bed
		Maintain Ventilator Circuits
		Summary of VAE
	Case 2
		Reporting of Catheter-Associated Urinary Tract Infections
		Symptomatic Catheter-Associated UTI [27]
		Asymptomatic Catheter-Associated UTI [27]
		CAUTI
		Prevention of CAUTI
		Summary of CAUTI
	Case 3
		Reporting of a Hospital-Acquired Central-Line Bloodstream Infection (CLABSI)
		CLABSI
		Prevention of CLABSI
		Summary of CLABSI
	Case 4
		Reporting of Hospital-Acquired Clostridium difficile Infection
		CDI
		Prevention of Hospital-Acquired Clostridium difficile Infections
		Summary of CDI
	References
Chapter 8: Sepsis and Septic Shock
	Case Study
	Diagnosis
	Management
		Early Antimicrobials
		Hemodynamic Management
		Source Control
		Adjunctive Therapies
		De-escalation
	Case Conclusion
	References
Chapter 9: Advanced Practice Providers in the ICU: Models for a Successful Multiprofessional Team
	Case Presentation
	Discussion
	References
Chapter 10: Critical Care Billing, Coding, and Documentation
	Case Presentation
		Day 1
		Day 2
		Day 3
		Days 4–13
		Days 14–28
		Overview
	Critical Care Billing, Coding, and Documentation: Case Discussion
		Day 1
		Day 2
		Day 3
		Day 4–13
		Day 14–28
	Summary
	References
Chapter 11: Shock and Vasopressors: State-of-the-Art Update
	Introduction
	Case Presentation
	Future Aims
	References
Chapter 12: Brain Death
	Introduction
	Case Presentation
	Assessment and Diagnosis
	Law
	Ethics
	Management
	References
Chapter 13: Nutrition Support Therapy During Critical Illness
	Case Study
	Our Diagnoses and Initial Management
	What Is the Role of Nutrition in Critical Illness?
	How Much Nutrition Should I Start (If Any)?
	What Is Nutritional Risk?
	Should I Start Enteral or Parenteral Nutrition (or Both)?
	What Is the Optimal Macronutrient?
	Our Assessment of Nutritional Risk in Our Patient
	Our Management Strategy for Nutrition in Our Patient
	References
Chapter 14: Advanced and Difficult Airway Management in the ICU
	Introduction
	Case Presentation
	Recognizing the Difficult Airway
	Independent Risk Factors for Difficult Mask Ventilation
	Airway Management
	The Difficult Airway Response Team
	A Reasonable Approach
	Summary
	References
Chapter 15: Hemodynamic Monitoring: What’s Out There? What’s Best for You?
	Case Summary
	Differential Diagnosis
	Treatment and Management I
	Clinical Parameters for Assessing for Volume Responsiveness
	Bedside and Biomarker Assessment of Volume Responsiveness
	Central Catheter-Based Hemodynamic Monitoring
	Ultrasonography
	Arterial Pressure Waveform Analysis
	Bioreactance
	Fingertip Monitoring Devices
	Treatment and Management II
	Conclusion
	References
Chapter 16: Bleeding and Thrombosis in the ICU
	Part A: Case Presentation
		Differential Diagnosis and Assessment
		Management of Bleeding
	Part B: Case Presentation, Continued
		Differential Diagnosis and Assessment
		Management of Thrombosis
		Outcome
	References
Chapter 17: Diagnosis and Management of Pulmonary Embolism in Pregnancy
	Case Presentation
		History of Present Illness (HPI)
		Past Medical and Surgical History
		Family and Social History
		Physical Examination
		Ancillary Studies
	Differential Diagnosis
		Dyspnea of Normal Pregnancy
		Asthma
		Pneumonia and Respiratory Infections
		Pre-eclampsia
		Acute Coronary and Vascular Syndromes
		Peripartum Cardiomyopathy (PPCM)
		Amniotic Fluid Embolism (AFE)
		Pulmonary Embolism (PE)
	Diagnosis
		Blood and Serum Testing
		Electrocardiogram (ECG)
		Duplex Ultrasound (US)
		CT Angiogram (CTA)
		Ventilation-Perfusion (VQ) Scan
		Transthoracic Echocardiogram (TTE)
		Further Diagnostic Patient Data
	Treatment and Management
		Standard Therapies
			Supportive Critical Care in the Obstetric Patient
			Anticoagulation
			Massive Pulmonary Embolism
		Future Directions
			Catheter-Directed Thrombolysis (CDT)
			Extracorporeal Membrane Oxygenation (ECMO)
	Case Summary
	References
Chapter 18: Challenges in Oxygenation and Ventilation
	Case Part 1
	Case Part 2
	Summary
	References
Chapter 19: Poisoning and Toxicity: The New Age
	Introduction
	Case Study
		Digoxin
		Alpha-2 Agonists
		Opioids
		Sedative/Hypnotics
		Organophosphates/Carbamates
		Plants, Herbs, and Animals
		Management of the Acutely Ill, Hypotensive, Bradycardic Patient
		Case Conclusion
	References
Index
                        
Document Text Contents
Page 200

196

Will you delay vasopressor initiation for central venous
catheter placement?

Does this patient require arterial line placement?

The Surviving Sepsis Campaign (SSC) has issued recom-
mendations regarding vasopressors in septic shock [1]. The
choice of norepinephrine versus dopamine as the first-line
vasopressor had once been an area of staunch debate.
However, it has become standard practice to use norepineph-
rine as the first-line vasopressor to treat septic shock. When
compared to dopamine, norepinephrine has demonstrated
increased potency in achieving a MAP goal [4]. The superior-
ity of norepinephrine is due primarily to its relatively limited
side effect profile without sacrificing efficacy when compared
to alternative vasopressors. Norepinephrine typically does
not produce significant tachycardia as its venoconstriction
effect and associated stimulation of right atrial baroreceptors
neutralize the beta-1 chronotropic stimulation. When com-
pared to dopamine, norepinephrine has a lower incidence of
arrhythmic events [5, 6]. In a single meta-analysis, dopamine
may have an increased relative risk of death when compared
to norepinephrine [7]. This information has pushed norepi-
nephrine to the forefront as the preferred vasopressor.
Dopamine has been relegated to a niche role as a vasopressor
which will be discussed later.

Despite no head-to-head trials showing that norepineph-
rine is superior to epinephrine for the treatment of septic
shock, norepinephrine is, in general, considered to have a
more preferable side effect profile. Epinephrine has been
associated with tachycardia, transient increase in insulin
requirements, and elevated lactic acid levels as displayed in
Fig. 11.1 [8]. Epinephrine, along with low-dose vasopressin, is
considered the next drug of choice in septic shock patients
that do not respond to norepinephrine.

Studies in septic shock have revealed low levels of circulat-
ing vasopressin, an unexpected finding as increased levels
would be expected with hypotension, a stimulus for vasopres-
sin release [9, 24]. This argument for a relative vasopressin

M. Kouch and R. P. Dellinger

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