說明教案醫(yī)學(xué)叢書oxford desk reference critical care

1、OXFORD MEDICAL PUBLICATIONSOxford Desk ReferenceCritical CareOxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. ers must therefore always check the product informa- tion and clinical procedures with the most up-to-date pub- lished pro

2、duct information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.2 Except

3、where otherwise stated, drug doses and recom- mendations are for the non-pregnant adult who is not breast-feeding.Oxford Desk ReferenceCritical CareCarl WaldmannConsult n Anaesthesia and Intensive Care Royal BerkshiospitalingNeil SoniHonorary Clinical Senior Lecturer Division of Surgery, Oncology, R

4、eproductive Biology and Anaesthetics Imperial CollegeLondonandAndrew RhodesConsult n Intensive Care St George's Hospital London11Great Clarendon Street, Oxford OX2 6DPOxford University Press is a department of the University of Oxford.It furthers the Universitys objective of excellence in resear

5、ch, scholarship, and education by publishing worldwide inOxford New YorkAuckland Cape Town Dar es Salaam Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei TorontoWith ofces inArgentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan P

6、oland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine VietnamOxford is a registered trade mark of Oxford University Press in the UK and in certain other countriesPublished in the United Statesby Oxford University Press Inc., New York© Oxford University Press 2008The moral rig

7、hts of the author have been asserted Database right Oxford University Press (maker)First published 2008. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press,or as

8、expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproductionoutside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address aboveYou must not circulate this book in any othe

9、r binding or cover and you must impose this same condition on any acquirerBritish Library Cataloguing in Publication Data Data availableLibrary of Congress Cataloguing in Publication Data Data availableTypeset by Cepha Imaging Private ., Bangalore, India Printed in Great Britainon acid- paper by CPI

10、 Antony Rowe, Chippenham, WiltshireISBN 978019922958110 9 8 7 6 5 4 3 2 1vPrefaceIntensive care medicine is an evolving speciality in which the amount of available informa- tion is growing daily and increasingly, textbooks reect this in terms of their size. Size and immediate clinical utility are of

11、ten inversely related and bottom line practicality is drowned in compensive discussion. The natural habitat of this new textbook of critical care and emergency medicine is on the desktops of Intensive Care units, High Dependency units, acute medical or surgical wards, Accident & Emergency depart

12、ments and maybe even operating theatres where it is easily accessible with useful and relevnformation.While aimed primarily at a specialist ership including clinicians, nurses, and other allied health professionals in Critical Care, Anaesthesia and the acute specialities, we hope it will nd a niche

13、with anyone involved in care of the critically ill, whether in specialist areas or in the wards.It is intended that the key feature of this book is ease of access to up-to-date relevant evidenced-based information regarding the management of commonly encountered condi- tions, techniques, and problem

14、s in those who are critically ill. Most importantly that it is practical and useful. The content of the book is based, wherever possible and useful, upon the latest sets of guidelines from national or international bodies (e.g. Society of Critical Care Medicine, European Society of Intensive Care Me

15、dicine). We hope the book will be useful not only in the United Kingdom, but to anyone using international guidelines. , the range of invited authors incorporates a large number of countries but for all, the com- mon theme is management of the critically ill.To facilitate the key aim of rapid and ea

16、sy access to information, the book is designed such that each subject will form a self-contained topic in its own right, laid out across two (or, for larger subjects, up to four) pages. This format facilitates the use of the book as a desk reference and we envisage that it will be consulted in the c

17、linic or ward setting for information on the optimum management of a particular condition.It is the fervent wish of the editors that this book, one in a series of desk top books from Oxford University Press, becomes a valuable tool in the management of critically ill pa- tients.CW, NS, and ARThis pa

18、ge intentionally left blankBrief contentsviied Contents ix Abbreviations xiii Contributors xixRespiratory therapy techniques11Cardiovascular therapy techniques512Renal therapy techniques633Gastrointestinal therapy techniques734Nutrition815Respiratory monitoring896Cardiovascular monitoring9778 Neurol

19、ogical monitoring129 9 Fluids141 10 Respiratory drugs153 11 Cardiovascular drugs165 12 Gastrointestinal drugs193 13 Neurological drugs205 14 Haematological drugs219 15 Miscellaneous drugs227 16 Resuscitation239 viiiBRIEF CONTENTS17Respiratory disorders24718Cardiovascular disorders28319Renal disorder

20、s31120Gastrointestinal disorders31721Hepatic disorders34722Neurological disorders35923Haematological disorders38724Metabolic disorders40925Poisoning43926Shock44527Infection and inammation46128Trauma and burns48129Physical disorders49730Pain and post-operative intensive care50731Obstetric emergencies

21、51732Death and dying52933ICU organization and management541Appendix591Index 593PRELIM RUNNING HEADixed contentsAbbreviations xiiiContributors xix1 Respiratory therapy techniques 1Oxygen therapy 2Ventilatory support: indications 6 IPPVdescription of ventilators 8 IPPVmodes of ventilation 10 IPPVadjus

22、ting the ventilator 12 IPPVbarotrauma 14IPPVweaning techniques 16High-frequency ventilation 18 Positive end-respiratory pressure 22 Continuous positive airway pressure ventilation (CPAP) 24Recruitment manoeuvres 26 Prone position ventilation 28 Non-invasive positive pressure ventilation (NIPPV) 30Ex

23、tracorporeal membraneoxygenation (ECMO) for adults in respiratory failure 32Tracheostomy 34Aftercare of the patient with a tracheostomy 36Chest drain insertion 38Pleural aspiration 40Flexible bronchoscopy 42Chest physiotherapy 44Humidication 46Heartlung interactions 482 Cardiovascular therapy techni

24、ques 51Debrillation 52Temporary cardiac pacing 54Intra-aortic balloon counterpulsation pump 56Cardiac assist devices 58Therapeutic cooling 603 Renal therapy techniques 63Haemodialysis 64Haemo(dia)ltration 68Peritoneal dialysis (PD) 704 Gastrointestinal therapy techniques 73Insertion of a SengstakenB

25、lakemore tube in critical care 74Upper gastrointestinal endoscopy 76Nasojejunal feeding in critical care patients 785 Nutrition 81 Enteral nutrition 82 Parenteral nutrition 84Immune-enh ng nutrition 866 Respiratory monitoring 89Pulmonary function tests in critical illness 90End-tidal CO2 monitoring

26、92Pulse oximetry 947 Cardiovascular monitoring 97ECG monitoring 98Arterial pressure monitoring 102 Insertion of central venous catheters 104Common problems with central venous access 106Pulmonary artery catheter: indications and use 108 Pulmonary artery catheter: insertion 110Echocardiography 112Cli

27、nical application of echocardiography in the ICU 116Doppler 118Pulse pressure algorithms 120Non-invasive methods 122 Measurement of preload status 124 Detection of uid responsiveness 1268 Neurological monitoring 129 Intracranial pressure monitoring 130 Intracranial perfusion 132EEG and CFAM monitori

28、ng 134Other forms of neurological monitoring 138ED CONTENTSx9 Fluids 141 Crystalloids 142 Colloids 144Sodium bicarbonate 146Blood 15010 Respiratory drugs 153Bronchodilators 154Nitric oxide 156Mucolytics 158Surfactant 160Heliumoxygen gas mixtures 16211 Cardiovascular drugs 165B-Adrenergic agonists 16

29、6Phosphodiesterase inhibitors 168Vasodilators 170Vasopressors 174arrhythmic agents 176Chronotropes 178anginal agents 182platelet agents 184 Diuretics and the critically ill 186 Levosimendan 19012 Gastrointestinal drugs 193H2 blockers and proton pump inhibitors 194emetics 196Gut motility agents 198 d

30、iarrhoeals 200 Constipation in critical care 20213 Neurological drugs 205Opioid and non-opioid analgesics in the ICU 206Sedation management in ICU 208Muscle relaxants 210onvulsant drugs 212Cerebroprotective agents 214Mannitol and hypertonic saline 21614 Haematological drugs 219oagulants and heparin-

31、induced thrombocytopenia 220Thrombolysis 224brinolytics 22615 Miscellaneous drugs 227biotics 228fungals 230viral agents 232N-Acetylcysteine 234Activated protein C 23616 Resuscitation 239Basic and advanced resuscitation 240 Post-cardiac arrest management 242 Fluid challenge 24417 Respiratory disorder

32、s 247 Upper airway obstruction 248 Respiratory failure 250Pulmonary collapse and ateleis 252Chronic obstructive pulmonary disease (COPD) 254ARDS: diagnosis 256ARDS: general management 258 ARDS: ventilatory management 260 Asthma 262Asthma: ventilatory management 264Pneumothorax 266Empyema 268Haemopty

33、sis 270Inhalation injury 272Pulmonary embolism 274Commu -acquired pneumonia 276Hospital-acquired pneumonia 278Pulmonary hypertension 28018 Cardiovascular disorders 283Hypertension 284Tachyarrhythmias 288Bradyarrhythmias 290Myocardial infarction: diagnosis 292NSTEMI 294STEMI 296Acute heart failure: a

34、ssessment 300 Acute heart failure: management 304 Bacterial endocarditis 30819 Renal disorders 311 Prevention of acute renal failure 312 Diagnosis of acute renal failure 31420 Gastrointestinal disorders 317 Vomiting and gastric stasis/gastroparesis 318 Gastric erosions 320Diarrhoea 322Upper gastroin

35、testinal haemorrhage (non-variceal) 324ED CONTENTSxiBleeding varices 326Intestinal perforation 328Intestinal obstruction 330Lower gastrointestinal bleeding 332Colitis 334Intra-abdominal sepsis 336Pancreatitis 338Acute acalculous cholecystitis 340 Splanchnic ischaemia 342 Abdominal hypertension (IAH)

36、 andabdominal compartment syndrome 34421 Hepatic disorders 347Jaundice 348Acute liver failure 350 Hepatic encephalopathy 352 Chronic liver failure 354Abnormal liver function tests 35622 Neurological disorders 359Agitation and confusion 360Status epilepticus 362Meningitis 364Intracerebral haemorrhage

37、 366Subarachnoid haemorrhage 368Ischaemic stroke 370GuillainBarre syndrome 372Myasthenia gravis 374ICU neuromuscular disorders 376Tetanus 378Botulism 380Neuro abilitation 382Hyperthermias 38423 Haematological disorders 387Bleeding disorders 388 Anaemia in critical care 392 Sickle cell anaemia 394 Ha

38、emolysis 396Disseminated intravascular coagulation 398Neutropenic sepsis 400Haematological malignes in the ICU 404Coagulation monitoring 40624 Metabolic disorders 409Electrolyte disorders 410Hyponatraemia 414Hypernatraemia 416Categorizing metabolic acidoses 418 Metabolic acidosis aetiology 420 Metab

39、olic alkalosis 422Glycaemic control in the critically ill 426 Diabetic ketoacidosis 428 Hyperosmolar diabetic emergencies 430 Thyroid emergencies: thyroid crisis/thyrotoxic storm 432Thyroid emergencies:myxoedema coma 434Hypoadrenal crisis 43625 Poisoning 439Management of acute poisoning 44026 Shock

40、445Shock: denition and diagnosis 446Hypovolaemic shock 450Cardiogenic shock 452Anaphylactic shock 456Septic shock: pathogenesis 45827 Infection and inammation 461Pathophysiology of sepsis and multi-organ failure 462Infection controlgeneral principles 464HIV 466Severe falciparum malaria 468 Vasculiti

41、des in the ICU 470 Source control 472Selective decontamination of the digestive tract (SDD) 474 Markers of infection 476Adrenal insufciency and sepsis 47828 Trauma and burns 481Initial management of major trauma 482Head injury 484Spinal trauma 486Chest trauma 488Pelvic trauma 490Burnsuid management

42、492Burnsgeneral management 49429 Physical disorders 497Hypothermia 498Drowning and near-drowning 500Rhabdomyolysis 502Pressure sores 50430 Pain and post-operative intensive care 507Pain management in ICU 508ED CONTENTSxiiIntensive care for the high risk surgical patient 510The acute surgical abdomen

43、 in the ITU 512The medical patient with surgical problems 51431 Obstetric emergencies 517Pre-eclampsia 518Eclampsia 520HELLP syndrome 522Postpartum haemorrhage 524Amniotic uid embolism 52632 Death and dying 529Conr death using neurological criteria (brainsteth) 530 Withdrawing and withholding treatm

44、ent 532The potential heart-beating organ donor 534Non-heart-beating organ donation 53833 ICU organization and management 541Consent on the ICU 542Rationing in critical care 544ICU layout 546Medical stafng in critical care 548ICU stafng: nursing 550ICU stafng: supporting professions 554Fire safety 55

45、6Legal issues and the Coroner 560Patient safety 564Severity of illness scoring systems 568Comparison of ICUs 570Critical care disaster planning 572 Health technology assessment 574 Transfer of the critically ill patient 576 Aeromedical evacuation 580Outreach 582Medical emergency teams 584 Critical c

46、are follow-up 586 Managingbiotic 588Appendix 591Respiratory physiology 592Index 593Abbreviationsxiii±plus or minus£less than or equal to³more than or equal to- approximatley° degrees­increase¯decreasevenegative+vepositiveAACacute acalculous cholecystitisAAFBacid- and al

47、cohol-fast bacilliABGarterial blood gasABPAallergic bronchopulmonary aspergillosis ACactivated charcoalACSacute coronary syndrome ACTHadrenocorticotrophic hormone ACEangiotension-converting enzymeAChRacetylcholine receptorACTHadrenocorticotrophic hormone ADHdiuretic hormoneAECOPDacute exacerbations

48、of chronic obstructive airways diseaseAEDautomated external debrillator/ epileptic drugAFatrial brillationAFEamniotic uid embolismAGanion gapAHFacute heart failureAIacoustic impedanceAIDPacute inammatory demyelinating polyneuropathyAIDSautoimmune deciency syndromeAKIacute kidney injuryALIacute lung

49、injuryALSadvanced life supportAMANacute motor axonal neuropathy AMIacute myocardial infarctionAMSANacute motor sensory axonal neuropathy ANCabsolute neutrophil countANCAutrophil cytoplasmicbody ANPatrial natriuretic peptideAPACHEAcute Physiology and Chronic Health EvaluationAPCactivated protein CAPH

50、antepartum haemorrhageAPPabdominal perfusion pressureaPPTactivated partial prothrombin timeARaortic regurgitationARBangiotensin II receptor blockerARDSacute respiratory distress syndromeARFacute respiratory failure ARVretroviralASaortic stenosisASAacetylsalicylic acid (aspirin)aSAHaneurysmal subarac

51、hnoid haemorrhage ASTaspartate aminotransferaseATLSAdvanced Trauma Life SupportATPadenosine triphosphateAVatrioventricularAVParginine vasopressinAXRabdominal X-rayBAEbronchial artery embolizationBALbronchoalveolar lavageBAEPbrainstem auditory evoked potential BBBbloodbrain barrierbdtwice a dayBiPAPb

52、ilevel positive airway pressureBLSbasic life supportBMIbody mass indexBMPbone morphogenetic proteinBMPR2bone morphogenetic protein receptor II BMSbone marrow suppressionBPblood pressureBPFbronchopleural stulabpmbeats per minuteBNPbrain natriuretic peptideBTFBrain Trauma FoundationCABGcoronary artery

53、 bypass graftCADcoronary artery diseasecAMBconventional amphotericin BCAPcommu-acquired pneumoniaCAPDcontinuous ambulatory peritoneal dialysis CBFcerebral blood owCCBcalcium channel blockerCCCCompensive Critical CareCCritical Care Contingency PlanningCCNcritical care nurseCDADClostridium difcile-ass

54、ociated disease CDTClostridium difcile toxinCEAcost-effective analysisCEMCHCondential Enquiry into Maternal and Child HealthCFAMcerebral function analysing monitor CFMcolour ow mapCHFchronic heart failureCIcondence intervalCIMcritical illness myopathyCINcontrast-induced nephropathyABBREVIATIONSxivCINMcritical illness neuromyopathyCIPcritical i