cambridge university press 0521681014 - core cases in...

ABC algorithm, resuscitation, 3–4

abdomen

aortic aneurysm, hypotension after

repair, 1–9

compartment syndrome, 81

n-acetylcysteine

bronchoscopic lavage, 184

paracetamol poisoning, 229

acid–base balance

alkalosis, poisoning, 225, 226 (Table)

bowel fluid loss, 91–92

acidosis

see also metabolic acidosis; respiratory

acidosis

poisoning, 225, 226 (Table)

acrylate glue, oesophageal varices, 101

ACTH (adrenocorticotrophic hormone), 77

activated charcoal, 230

activated partial thromboplastin time, value

for correction, 6

activated protein C, 83

acute lung injury (ALI), 13

acute-on-chronic respiratory failure, 24

acute respiratory distress syndrome (ARDS),

13–14

burns, 156

management, 17–20

acute tubular necrosis, 41

pancreatitis, 137

pre-renal oliguria vs, 42 (Table)

adenosine antagonists, for oliguria, 46

adrenaline see epinephrine

adrenergic receptor blockers,

pre-eclampsia, 128

adrenergic receptors, TCA poisoning, 226

adrenocorticotrophic hormone (ACTH), 77

adult respiratory distress syndrome see acute

respiratory distress syndrome

adverse reactions to drugs, 63–71

afterload (cardiac), 2–3

age

blood pressure, 90

respiratory function, 86

agitation, drugs and poisons causing, 223

(Table)

airflow limitation, asthma, 177

air leaks, bronchopleural fistula, 16

airway

burns, 152, 153–154, 155

head injury, 143–144

injuries to, 16

management, 3

near-drowning, 109

neuromuscular failure, 167–168

spinal trauma, 212

alarm settings, ventilation in asthma, 182

albumin, burns, 156

alcohol

cirrhosis, 95–104

in overdoses, 228

pancreatitis, 135

aldosterone, 77

alfentanil, intubation in neuromuscular

failure, 168

INDEX

233

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alkalosis, poisoning, 225, 226 (Table)

allergies

see also anaphylaxis

tracheal intubation in asthma, 181

alveolar–arterial oxygen tension difference,

age, 86

alveolar oedema, pulmonary contusion, 13

aminophylline

asthma, 179

chronic obstructive pulmonary disease

and, 29

ammonia, portal–systemic encephalopathy,

97–99

amniotic fluid embolism, 122, 125

amphetamines, 224

amylase, 132

anaesthesia

status epilepticus, 201

tracheal intubation in asthma, 180–181

anaesthetic agents

see also inhalational anaesthetics

anaphylaxis, 64

analgesia

burns, 158

chest trauma, 20

Guillain–Barré syndrome, 170

anaphylactoid reactions, 66

anaphylaxis

defined, 65–66

from drugs, 63–71

aneurysm, abdominal aorta, hypotension

after repair, 1–9

angiography, coronary, adverse reactions,

65 (Table)

anion gap, 91–92

poisoning, 226 (Table)

antibiotics

anaphylaxis, 64

burns, 160

chronic obstructive pulmonary disease,

29

gastrointestinal haemorrhage, 102

pancreatitis, 137

after splenectomy, 20–21

anticholinergic drugs

chronic obstructive pulmonary disease

and, 28

myasthenia gravis diagnosis, 165–167

anticoagulation, haemodialysis, 55–56

anticonvulsants

pre-eclampsia, 129

status epilepticus, 200–201

antidotes, 228–229

anti-emetics, gastrointestinal haemorrhage,

102

anti-fibrinolytic agents, 127

anti-inflammatory mediators, 75 (Fig.)

anti-inflammatory response syndrome,

compensatory, 76

anti-inflammatory therapy, ARDS, 20

anxiolysis, Guillain–Barré syndrome, 169

aortic aneurysm, hypotension after repair,

1–9

ARDS see acute respiratory distress

syndrome

ARDS Network protocol, 17

arrhythmias (cardiac)


29

drugs and poisons causing, 223 (Table)

postoperative, 7

arterial blood gases

brain stem death, 114


32

near-drowning, 110

respiratory failure, 27

arterial lines, blood pressure, 4

transport of patient, 145

arteriovenous access, 54

see also venous access

aspirin see salicylate poisoning

asthma, 175–186

atracurium, tracheal intubation in asthma,

181

atrial natriuretic peptide analogues, for

oliguria, 46

atropine, 169

autonomic dysfunction, neuropathic, 164,

167–168

autonomic mass effect, spinal trauma, 216

auto-PEEP see intrinsic PEEP

auto-regulation curve, cerebral perfusion

pressure, 143

INDEX

234






AVPU scale, 224

awake fibre-optic tracheal intubation, 168

awareness, 188

axonal degeneration, Guillain–Barré

syndrome, 172

bacterial infections

from bowel, 81–82, 136

central venous catheters, 55


26–27

gram-positive, intensive care, 203

balloon tamponade

uterine haemorrhage, 128

variceal bleeding, 102

Balthazar score, pancreatitis, 135 (Table)

band ligation, oesophageal varices, 101

barbiturates, seizure control, 113–114

barotrauma

see also pneumothorax; tension

pneumothorax

PEEP, 33

base excess, renal failure, 52

Battle’s sign, 192

benzodiazepine receptors, encephalopathy, 98

benzodiazepines

antidotes, 228

seizures, 200, 225

ventilation, chronic obstructive pulmonary

disease, 34

�2-adrenergic receptor agonists, chronic

obstructive pulmonary disease

and, 28

�-adrenergic receptor agonists, asthma, 179

bicarbonate

haemofiltration, 57

levels, hypercapnia, 27, 87

loss from bowel, 88

therapy

crush injuries, 216

near-drowning, 110–111

TCA poisoning, 229

bilevel ventilation, asthma, 182

biphasic reactions, contrast media, 65

bladder

pressure, 81

spinal trauma, 210

blisters, burns, 153

blood gases see arterial blood gases

blood pressure, 1–2

age, 90

arterial lines, 4


glomerular filtration rate, 41

blood transfusion see transfusion

body surface area (BSA), burns, 151

Rule of 9s, 156

bone marrow, near-drowning, 109

botulism, 166 (Table), 167

bradycardia



spinal trauma, 209

brain damage, 142–143

asthma, 185

near-drowning, 106, 113

prevention, 141–149, 193–194


brain oedema

eclampsia, 124

encephalopathy, 98

fluid resuscitation, 127


brain stem death, 114–117

brain stem lesions, signs, 191

breathing

see also ventilation

burns, 155–156

coma, 192

Guillain–Barré syndrome, 168–169

head injury, 144

postoperative management, 4

breath stacking, asthma, 178 (Fig.)

British Trauma Society, spinal clearance, 215

(Fig.)

bronchi, asthma, 176–177

bronchodilators

asthma, 179–180

ventilation, 182–183


28–29, 35

bronchopleural fistula, 16

mechanical ventilation, 19, 184

bronchoscopic lavage, n-acetylcysteine, 184

INDEX

235






bulbar reflexes, Guillain–Barré syndrome

management, 168

burns, 151–161

buttock burns, 159

Caesarean section, obstetric haemorrhage,

121–130

calcium, intravenous, 217

Campylobacter, Guillain–Barré syndrome,

172

carbon dioxide tension


ventilation, head injury, 144

carbon monoxide poisoning, 153, 155

carboprost, 128

cardiac index

management, 80

Shoemaker’s goal, 79

cardiac output, 2

dopamine on, 46

monitoring, PEEP, 17

cardiopulmonary bypass, rewarming, 112

(Table)

cardiopulmonary resuscitation, near-

drowning, 106

cascade humidifier, 112 (Table)

cathartics, 230

catheters

see also central venous catheters;

pulmonary artery catheters

haemodialysis, 54–55

infections, 204

urinary, spinal trauma, 213

cellular energy failure, brain damage, 142

cellular hypoxia, lactate, 90

cellular poisons, 224

central nervous system

see also brain damage; brain oedema;

spine

near-drowning, 106, 113–114

central venous catheters

haemodialysis, 55

infections, 204


central venous pressure, 2, 4

obstetric haemorrhage resuscitation, 126

pre-eclampsia, 124

cephalosporins, cross-sensitivity with

penicillin, 64

cerebral blood flow, 143


cerebral hypoxia, 105–119, 142

cerebral oedema see brain oedema

cerebral perfusion pressure, 143, 193–194

cerebrospinal fluid, Guillain–Barré

syndrome, 165

filtration, 171

cervical spine

coma, 192

immobilisation, 144, 212

trauma, 208

charcoal, activated, 230

checklists, transport of patient, 147–148

chelating agents, 228

chemical burns, 154

chest

drains, asthma, 183–184

manual compression, 184

trauma, 11–22

Child’s classification, oesophageal varices,

haemorrhage risk, 96

Chlamydia pneumoniae, chronic obstructive

pulmonary disease, 27

cholangitis, pancreatitis, 137

chronic inflammatory demyelinating

polyneuropathy, 172


87

oxygen therapy, 28, 89

respiratory failure, 23–37

circulation

see also haemodynamics

burns, 156–157

coma, 192


poisoning, 223–224

resuscitation, 4


spinal trauma, 212–213

TCA poisoning, 226

circumferential burns, 153, 156

cirrhosis

alcohol, 95–104

definition, 97

INDEX

236






citrate toxicity, blood transfusion, 99, 123

(Table)

coagulation, endoscopic thermal, 43–44

coagulopathy

dilutional, 123, 124 (Table)

near-drowning, 109

obstetric haemorrhage, 122–123

treatment, 127

cockpit drill, allergic reactions, 68

cold shock, 76

collars, cervical, 144

colloids

anaphylaxis from, 64

fluid resuscitation, 6, 126

burns, 156

coma, 187–196

poisoning, 222

tricyclic antidepressants, 227

community acquired pneumonia,

203–204

compartment syndrome

abdomen, 81

crush injury, 210–211, 216

electrical burns, 154

compensatory anti-inflammatory response

syndrome, 76

complement, measurement after contrast

media reactions, 69

computed tomography

ARDS, 13–14

brain, near-drowning, 113

coma, 193

pancreatitis, 134–135

spinal trauma, 214

conduction velocity, nerves, Guillain–Barré

syndrome, 165 (Table)

confusion, 188 (Table)

consciousness, 188

AVPU scale, 224

causes of depression, 189 (Table)

Glasgow Coma Scale (GCS), 188 (Table),

191

continuous positive airways pressure (CPAP),

asthma, 180, 182

contrast media, adverse reactions, 63–71

contusion, lung, trauma, 11–22

convulsions see seizures

coronary angiography, adverse reactions, 65

(Table)

coroners, organ donation and, 115

cor pulmonale, 25–26

electrocardiography, 28

corticosteroids

see also hydrocortisone;

methylprednisolone

ARDS, 20

asthma, 179

chronic obstructive pulmonary disease, 29

myopathy, 35

HELLP syndrome, 129

long-term

postoperative care and, 73

on stress response, 77

septic shock, 80–81

spinal trauma, 213

cortisol, 77

cranial nerves, Guillain–Barré syndrome, 164

C-reactive protein, pancreatitis, 133

creatinine clearance, 53

creatinine kinase, myocardial specific, 7

critical illness neuropathy, 82

cross-sensitivity, penicillin with other drugs,

64

crush injuries, 208, 210–211, 216–217, 218

cryoprecipitate, 127

indications, 6

crystalloids, fluid resuscitation, 6

CT see computed tomography

Cullen’s sign, 132

cultures (bacteriology), catheters, 204

cyanide poisoning, 154, 156

cytokines, 75–76

cytotoxic oedema, brain, 142

DDAVP (ADH analogue), brain stem death,

116–117

debridement, 81

decision-making, patients with chronic

obstructive pulmonary disease, 30, 36

deep burns, 153

deep vein thrombosis


spinal trauma, 216

dehydration, 90

INDEX

237






delirium, 188 (Table)

demyelinating polyneuropathy, chronic

inflammatory, 172

dermal burns, 152–153

devascularisation, uterus, 128

dextrose solutions

head injury and, 145


diabetes insipidus, brain stem death,

116–117

diabetes mellitus

coma, 187–188

pancreatitis, 138

dialysis, 54–57

diazepam, status epilepticus, 200

digestive tract see gastrointestinal tract

digital ischaemia, vasopressors, 82

dilutional effects

coagulopathy, 123, 124 (Table)

massive transfusion, 100

diphtheria, neuromuscular failure, 166

(Table), 167

disseminated intravascular coagulation


laboratory findings, 124 (Table)

pre-eclampsia, 125

treatment, 127

diuresis

forced, 230–231

hypothermia, 108, 113

diuretics

see also frusemide; loop diuretics


diving reflex, 106

dobutamine

cardiac index maintenance, 80

neuromuscular failure, 168

domestic accidents, spinal injury incidence,

208

domperidone, gastrointestinal haemorrhage,

102

dopamine, 7 (Table)

for oliguria, 46

septic shock, 80

dopexamine, 7 (Table)

septic shock, 80

Doppler ultrasound, transoesophageal, 5–6

doxapram, chronic obstructive pulmonary

disease, 29–30

drowning see near-drowning

drugs

anaphylaxis from, 63–71

extra-corporeal removal, 57–58

poisoning, identification, 225–228

dynamic hyperinflation, 18, 24–26


33–34

detection, 34

dysequilibrium syndrome, haemodialysis,

58–59

dysrhythmias see arrhythmias (cardiac)

Eaton–Lambert syndrome, 166 (Table), 167

eclampsia, 122, 124

edrophonium, myasthenia gravis diagnosis,

167


heart, 157

electrocardiography


28


myocardial monitoring, 7

near-drowning, 107

TCA poisoning, 226, 227 (Fig.)

electroencephalography

coma, 193


electrophrenic ventilation, 217

embolisation (angiographic), uterine

devascularisation, 128

emesis, for poisoning, 229

emphysema, 87

encephalopathy, portal–systemic, 96, 97–99

end-expiratory occlusion, intrinsic PEEP

quantification, 34

endobronchial mucus suffocation, 176, 184

endocrine coma, 187–196

endoscopy, gastrointestinal haemorrhage,

43–44, 96, 101

prognostic features, 43 (Table)

endotracheal intubation see tracheal

intubation

energy failure, cellular, brain damage, 142

INDEX

238






enoximone, 7 (Table)

septic shock, 80

enteral nutrition

burns, 157–158


lung injury management, 20

for near-drowning, 113

pancreatitis, 137

epidural analgesia, chest trauma, 20

epilepsy

see also seizures


epinephrine (adrenaline), 7 (Table)

asthma, 179

near-drowning, 111

septic shock, 80

epithelial burns, 152

equipment

obstetric haemorrhage treatment

packs, 127

renal filtration, 56 (Fig.)

transport of patient, 145–147

ergometrine, 128

examination (clinical)

coma, 191–192

pancreatitis, 132

renal failure, 52

spinal trauma, 213

expiratory airflow

asthma, 177


extra-corporeal circulation

plasma exchange, Guillain–Barré

syndrome, 171

rewarming, 112 (Table)

extra-corporeal drug removal, 57–58

extra-corporeal membrane oxygenation, 19

extubation, asthma, 184

faecal peritonitis, 81–82

fasciotomy, 216

fentanyl, tracheal intubation in asthma, 181

fibre-optic tracheal intubation, 168

fibrinogen depletion

level for correction, 6


fibroproliferation, pulmonary, 20

filtration

see also haemofiltration

cerebrospinal fluid, Guillain–Barré

syndrome, 171

massive transfusion, 99–100

flaccid paralysis, spinal trauma, 210

flail chest, 12–13, 16

flow time corrected for heart rate (FTc), 5

fluid challenge, hypovolaemia

measurement, 4

fluid loss, gastrointestinal tract, 85–94


asthma, 180

burns, 156

fluid loss from bowel, 90–91


sepsis, 79

flumazenil, 228

Foley catheter, uterine haemorrhage, 128

foods, anaphylaxis, 64 (Table)

forced diuresis, 230–231

forced expiratory volume in 1 second

(FEV1), asthma, 177

fosphenytoin, 200

fractional excretion, sodium, 52

fractures

ribs, 12–13, 144, 145

skull, signs, 192

fresh frozen plasma (FFP), 127

frusemide

see also loop diuretics

for raised intracranial pressure, 194

full thickness burns, 153

functional residual capacity (FRC)

asthma, 178 (Fig.)

postoperative, 86

fundi, coma, 191–192

GABAA receptors, ammonia, 98

gallstones, pancreatitis, 135, 137, 138

gamma-aminobutyric acid receptors,

A type, ammonia, 98

gamma-globulin, Guillain–Barré syndrome,

171

gastric lavage, 229

gastric outflow obstruction, 88

spinal trauma, 210

INDEX

239






gastrin, 87–88

gastritis, causes, 40

gastrointestinal haemorrhage

endoscopy, 43–44, 96, 101

prognostic features, 43 (Table)

haemodialysis, 58

oesophageal varices, 95–104

oliguria, 39–48

gastrointestinal tract

fluid loss, 85–94

hypoxaemia on, 108, 113

motility, 88

postoperative, 86–87

removal of poisons, 229–230

selective decontamination (SDD), 102

translocation of bacteria, 81–82, 136

GCS (Glasgow Coma Scale), 188 (Table),

191

Glasgow Coma Scale (GCS), 188 (Table),

191

Glasgow score, pancreatitis, 133

glomerular filtration rate, renal control, 41

glucose

see also hypoglycaemia

blood levels for treatment of septic shock,

81

excess, near-drowning, 112

glutamatergic system, portal–systemic

encephalopathy, 99

glutamine, portal–systemic encephalopathy,

99

glycaemia see glucose

glyceryl trinitrate, 7 (Table)


glycopyrrolate, 169

gram-positive bacteria, intensive care,

203

Grey Turner’s sign, 132


H2-receptor antagonists, 44

burns, 154

haematemesis, 40

haemodiafiltration, poisoning, 231

haemodialysis

poisoning, 231

renal failure, 54–57

haemodynamics

see also circulation

abdominal aortic aneurysm repair, 1–9



near-drowning, 107–108, 110

PEEP on, 17, 33

pre-eclampsia, 124

sepsis, 76, 79–80

transport of trauma patient, 145

haemofiltration, 54–57

equipment, 56 (Fig.)

rewarming with, 112 (Table)

poisoning, 231

haemoglobin

carbon monoxide on, 153

levels

sepsis treatment, 79

transfusion, 6, 126

haemolysis, fresh water aspiration, 109

haemolytic anaemia, micro-angiopathic,

pre-eclampsia, 125

haemoperfusion, poisoning, 231

haemorrhage

see also gastrointestinal haemorrhage

aortic aneurysm rupture, 3

burns surgery, 159

obstetric, 121–130

treatment packs, 127

spinal trauma, 209

transfusion, 6

haemothorax, 16

head injury, transfer of patient, 141–149

heart block, Guillain–Barré syndrome, 169

heart rate, 2

heavy metal poisoning, chelating agents,

228

Heimlich manoeuvre, not in near-drowning,

109

Helicobacter pylori, eradication therapy, 45

Heliox, asthma, 184

HELLP syndrome, 125

corticosteroids, 129

mortality and recurrence risk, 129

heparin

for disseminated intravascular coagulation,

127

INDEX

240







haemodialysis, 56

high frequency oscillator ventilation, 19

high molecular weight hydroxyethyl

starches, 126

high pressure ventilation, 18–19

high tension electrical burns, 154

hip replacement, oliguria after, 49–61

history-taking

coma, 190


humidifier, cascade, 112 (Table)

hydralazine, pre-eclampsia, 128–129

hydrocortisone


septic shock, 80–81

hydrofluoric acid, burns, 154

hydrogen ions

see also acid–base balance; acidosis;

alkalosis; pH

water dissociation, 92

hydroxyethyl starches, high molecular

weight, 126

hyperbaric oxygen, carbon monoxide

poisoning, 155

hypercalcaemia, crush injury, 211

hypercapnia, 12

see also respiratory acidosis

bicarbonate levels, 27, 87


oxygen therapy, 28

hyperglycaemia, near-drowning, 112

hyperinflation see dynamic hyperinflation

hyperkalaemia, 52

effects, 51


management, 216–217

massive transfusion, 123 (Table)

near-drowning, 112

suxamethonium, 168

hypertension, drugs and poisons causing, 223

(Table)

hyperventilation


head injury, 144

hypocalcaemia, crush injury, 211

hypocapnia, 144

hypoglycaemia, 190, 192–193, 194



hyponatraemia, near-drowning, 112

hypoperfusion, 4

hypophosphataemia, haemodialysis, 59

hypotension

see also shock

after abdominal aortic aneurysm repair, 1–9




plasma exchange, 171

haemodialysis, 58

management, 225

spinal trauma, 209

hypothermia

arterial blood gases, 110


burns, 154, 158

coma, 191

diuresis, 108, 113


electrocardiography, 107


near-drowning, 106

rewarming, 111–112

treatment, 79

hypovolaemia

crush injury, 211


management, 6

measurement, 4–5


shock, 40–41

monitoring, 43

signs, 52


trauma, 145

vasoconstrictors, 6, 44

hypoxaemia, 12

gastrointestinal tract, 108, 113

haemodialysis, 59

kidney, 41

liver, 108, 113

near-drowning, 110

oxygen therapy, 89

INDEX

241






trauma, management, 15–16

ventilation for, 11–12, 16–19

hypoxia

cellular, lactate, 90

cerebral, 105–119, 142

spinal, 209

hysterectomy, obstetric haemorrhage, 128

IgE antibodies, 66

ileus

postoperative, 86–87, 88

spinal trauma, 210, 216

immediate action drill, allergic reactions, 68

immobilisation, spinal, 212

cervical, 144, 212

immunocompromise, compensatory

anti-inflammatory response

syndrome, 76

industrial accidents, spinal injury incidence, 208

infections

see also bacterial infections

burns, 155, 158, 160


26–27


intensive care, 202–205

lung, Guillain–Barré syndrome, 170


pancreatitis from, 135


inflammation

pulmonary contusion, 13

therapy, ARDS, 20

inflection points, pulmonary static

pressure–volume curve, 18

information, to patients with chronic

obstructive pulmonary disease, 30, 36

inhalational anaesthetics, asthma, 184

tracheal intubation, 181

inhalers, asthma, 183

injection therapy, endoscopic, 43

inotropes


near-drowning, 111


septic shock and, 79

insect bites and stings, anaphylaxis, 64 (Table)

inspiratory to expiratory time ratio

ARDS, 18

asthma, 182, 184

intensive care

asthma, 177–179, 185


bed occupancy rates, 24

infections, 202–205

non-invasive ventilation, 30–31

variceal haemorrhage, 103

intracranial pressure, 114, 142

coma, 194

monitoring, 141

intravenous immunoglobulin,


intravesical pressure, 81

intrinsic PEEP (PEEPi), 18, 25

asthma, 177


33–34

detection, 34

intubation see tracheal intubation

inverse ratio ventilation (IRV), 18

iodine, in contrast media, 66

ipatropium bromide, asthma, 179

ipecacuanha syrup, 229

ischaemic heart disease

abdominal aortic aneurysm repair, 3

platelet counts, 6

isoprenaline, heart block, 169

J-waves, hypothermia, 107

ketamine, 181

kidney

see also renal failure

hypoperfusion, 41

hypothermia, 108

pre-eclampsia, 124

labetalol


pre-eclampsia, 128

lactate

accumulation

haemodialysis, 59

near-drowning, 112

INDEX

242






haemofiltration replacement fluid, 57

hypoxia vs exogenous, 90

from reperfusion, 6

lactulose, gastrointestinal haemorrhage, 102

Laplace’s law, 3

laser photocoagulation, endoscopic, 44

latex, anaphylaxis, 64 (Table)

lavage, pancreatic bed, 137

lead poisoning, neuromuscular failure, 166

(Table)

leucotriene antagonists, asthma, 180

life support equipment

see also ventilators


lipase, pancreatic, 132

liver

see also cirrhosis

hypoxaemia on, 108, 113

pre-eclampsia, 124

transplantation, 103, 104

organ donation, 115–117

log rolling, 213

loop diuretics

see also frusemide

for oliguria, 45

lorazepam


ventilation, head injury, 144

low tension electrical burns, 154

lumbar puncture, coma, 193

lung

see also pulmonary oedema

contusion, trauma, 11–22

infections, Guillain–Barré syndrome, 170

near-drowning, 108

poisoning, 223

magnesium

asthma, 180

eclampsia treatment, 124, 129

normal levels, 7

magnetic resonance imaging, coma, 193

Mallory–Weiss tears, 40

mannitol

oliguria, 45–46

raised intracranial pressure, 147, 194

manual compression of chest wall, 184

massive transfusion, 99–100, 123–124

matrix, liver cirrhosis, 97

melaena, 40

metabolic acidosis

fluid loss from bowel, 91

near-drowning, 110–111, 112


renal failure, 52

from saline infusion, 126

metabolic dysfunction, coma, 187–196

metaraminol, spinal trauma, 212–213

metered dose inhalers, asthma, 183

methaemoglobinaemia, drugs and poisons

causing, 226 (Table)

methicillin-resistant Staphylococcus aureus

(MRSA), 204–205

methylhistamine, urine measurement, 69

methylprednisolone

for pulmonary fibroproliferation, 20

spinal trauma, 213

metoclopramide, gastrointestinal

haemorrhage, 102

microaggregates, massive transfusion, 99–100

micro-angiopathic haemolytic anaemia,

pre-eclampsia, 125

Miller–Fischer variant, Guillain–Barré

syndrome, 164

miosis, drugs and poisons causing, 223

(Table)

misoprostol, non-steroidal anti-inflammatory

drugs and, 45

molecular weight, extra-corporeal drug

removal, 57–58

monitoring

hypovolaemic shock, 43


montelukast, asthma, 180

morphine, tracheal intubation in asthma, 181

mortality

aortic aneurysm repair, 8

ARDS, 21

asthma, 175, 176, 185

burns, 151–152, 159–160



surgery, 44

maternal, 129

INDEX

243






organ failure, 59, 82, 93

pancreatitis, 138

renal failure, 59


TCA poisoning, 226

motor neurone disease, 166 (Table)

Guillain–Barré syndrome vs, 165

MRSA (methicillin-resistant Staphylococcus

aureus), 204–205

mucus suffocation, endobronchial, 176, 184

multiple organ dysfunction syndrome

(MODS), 74 (Table)

multiple organ failure (MOF), 81–82, 92–93

multiple trauma, burns, 158

muscle relaxants see neuromuscular blocking

drugs

muscle weakness, ventilatory failure, 163–173

myasthenia gravis, Guillain–Barré syndrome

vs, 165–167

mydriasis, drugs and poisons causing, 223

(Table)

myocardial specific creatinine kinase, 7

myocardium, 2

abdominal aortic aneurysm repair on, 3

management, 7–8

rewarming, 111

transoesophageal Doppler, 5

myoglobinuria, burns, 157

myopathy

corticosteroids, 35

non-depolarising neuromuscular blocking

agents, 181

n-acetylcysteine

bronchoscopic lavage, 184

paracetamol poisoning, 229

naloxone, 228

naso-gastric tubes

non-invasive ventilation, 90

spinal trauma, 213

National Acute Spinal Cord Injury Study

(NASCIS), trials, 213


prognosis, 117–118

nebulised drugs, asthma, 179

ventilation, 182–183

neck rigidity, coma, 192

necrosectomy, pancreatitis, 137

nerve conduction velocity, Guillain–Barré

syndrome, 165 (Table)

neurological examination, coma, 191–192

neurological failure, peripheral, 164–173

neuromuscular blocking drugs

anaphylaxis, 64

asthma, 181


34–35

Guillain–Barré syndrome, 168, 169

head injury, 144

status epilepticus and, 201

neuropathy

critical illness, 82

peripheral neurological failure, 164–173

nifedipine, Guillain–Barré syndrome, 169

nitrates, pre-eclampsia, 129

nitric oxide

ARDS, 19–20

asthma, 184

nitrites, cyanide poisoning, 156

NMDA (N-methyl-D-aspartate) stimulation,

portal–systemic encephalopathy, 99

non-bicarbonate buffer anions, 91–92

non-depolarising neuromuscular blocking

agents, myopathy, 181

non-invasive ventilation (NIV)

asthma, 180


30–31

mortality, 36

gastric inflation, 90


spinal trauma, 217

non-ionic contrast media, 66–67

non-steroidal anti-inflammatory drugs

(NSAIDs)

gastrointestinal haemorrhage, 40, 47

on renal function, 41–42

norepinephrine, 7 (Table)

septic shock, 80

norfloxacin, gastrointestinal haemorrhage, 102

nosocomial infection, pneumonia, 203–204

nutrition

see also enteral nutrition

total parenteral nutrition, burns, 157

INDEX

244







treatment packs, 127

octreotide, oesophageal varices, 102

oculovestibular reflex test, brain stem death,

115 (Table)

oedema, chronic obstructive pulmonary

disease, 26

oesophagus

Doppler ultrasound via, 5–6

pressure, asthma, 178 (Fig.)

varices, 40, 95–104

oliguria

gastrointestinal haemorrhage, 39–48

hip replacement, 49–61

hypoperfusion, 4

management, 45–46


opiates

tracheal intubation in asthma, 181

ventilation, chronic obstructive pulmonary

disease, 34

organ donation, brain stem death, 115–117

organ failure

mortality, 59, 82, 93

multiple (MOF), 81–82, 92–93

oro-gastric tubes, spinal trauma, 213

osmolality

contrast media, 67

dehydration, 90

osmolar gap, poisoning, 226 (Table)

overdoses of drugs, 221–232

oxygen consumption, Shoemaker’s goal, 79

oxygen delivery, Shoemaker’s goal, 79

oxygen dissociation curve, massive

transfusion, 123 (Table)

oxygen tension

age, 86

inspired

ARDS management, 17


oxygen therapy

asthma, 179


carbon monoxide poisoning, 155

chronic obstructive pulmonary disease, 28,

89

oxytocics, obstetric haemorrhage, 127–128

packing, uterus, 128

pain

see also analgesia

pancreatitis, 132

respiratory failure from, 12

pancreatic bed lavage, 137

pancreatitis, acute-on-chronic, 131–139

pancuronium, tracheal intubation in asthma,

181

panda eyes, 192

paracetamol

antidote, 228–229


paraldehyde, status epilepticus, 201

paralysis, spinal trauma, 210

Parkland formula, fluid resuscitation, burns,

156

peak expiratory flow rate (PEFR), asthma, 177

PEEP, 17

asthma and, 182



33–34


near-drowning, 110

PEEPi see intrinsic PEEP

penicillin, anaphylaxis, 64

peripheral neurological failure, 164–173

peritonitis, faecal, 81–82

pH

see also acidosis; alkalosis; hydrogen ions

poisoning, 225, 227

urine, manipulation, 230–231

phenobarbital, status epilepticus, 200–201

phenytoin

head injury, 144

seizures, 200, 225

phosphodiesterase inhibitors, 8

physiotherapy, spinal trauma, 216

placenta, obstetric haemorrhage and, 123

plasma exchange, Guillain–Barré

syndrome, 171

platelet counts

haemorrhage, 123–124

ischaemic heart disease, 6

for massive transfusion, 100

pre-eclampsia, 125

INDEX

245






platelet transfusions, 127

pneumonia


community acquired, 203–204


postoperative, 85

ventilator associated, 204

pneumothorax

see also tension pneumothorax

asthma

emergency treatment, 183–184

signs, 176

PEEP, 33

trauma, 15–16

poisoning, 221–232

poliomyelitis, 166 (Table), 167

polyneuropathy, post-infective, 164–167

portal hypertension, 97

portal–systemic encephalopathy, 96, 97–99

positive pressure ventilation, 13

see also PEEP


33–34

continuous positive airways pressure

(CPAP), asthma, 180, 182

post-infective polyneuropathy, 164–167

postoperative care, criteria for high risk, 78

postoperative haemorrhage, Caesarean

section, 121–130

post-partum haemorrhage see obstetric

haemorrhage

post-renal failure, 50–51

posture, management of ARDS, 20

prone position, 18

potassium, normal levels, 7

predictable drug reactions, 64

pre-eclampsia, 122, 124

prevention of complications, 128–129

recurrence risk, 129

pregnancy, thrombosis risk, 123

preload (cardiac), 2

premedication, contrast media reactions, 68

pre-renal failure, 41–42, 50

pressure control, mechanical ventilation, 17

pressure-limited ventilation, asthma, 182

pressure sores, prevention, 216

pressure–volume curve, pulmonary static, 18

pro-inflammatory mediators, 75

prone position, ARDS management, 18

propofol

anaphylaxis, 64


prostacyclin

ARDS, 20

haemodialysis, 56

prostaglandins

carboprost, 128

for obstetric haemorrhage, 127

protein binding, extra-corporeal drug

removal, 57–58

protein requirements, burns, 158

prothrombin time, value for correction, 6

protocol-driven weaning programmes, 35

proton pump inhibitors (PPIs), 44, 45

pseudostatus epilepticus, 198

pulmonary artery catheters, 4–5

infections, 204


pulmonary capillary wedge pressure, 2

monitoring, 4–5

pre-eclampsia, 124

pulmonary fibroproliferation,

methylprednisolone for, 20

pulmonary oedema

pre-eclampsia, 124

spinal trauma, 213

pulmonary static pressure–volume curve, 18

pulse oximetry, poisoning and, 225

pupils

examination, 191


purple glove syndrome, phenytoin, 200

pyrexia, 198, 199, 202–205

burns, 158

coma, 191

drugs and poisons causing, 223 (Table),

224

QTc interval, TCA poisoning, 226,

227 (Fig.)

quality of life, chronic obstructive pulmonary

disease, 36

quinolones, selective decontamination of

digestive tract (SDD), 102

INDEX

246






radiology

ARDS, 13–14

chronic obstructive pulmonary

disease, 28

coma, 193

embolisation, uterine devascularisation,

128

ileus, 92

near-drowning, 110


renal failure, 53


Ranson score, pancreatitis, 133

receptor down-regulation, septic shock, 80

reflexes, coma, 191

renal clearance, extra-corporeal drug removal

and, 57–58


burns, 157

diagnosis, 51–53

hypovolaemia, 41–42

near-drowning, 113

rhabdomyolysis, 210, 216

renal replacement therapy, 53–59

renal rescue therapy, 53

reperfusion, 6

replacement fluids, haemofiltration, 57

respiratory acidosis, 27

see also hypercapnia


disease, 32

management, 17


respiratory alkalosis, poisoning, 226 (Table)

respiratory distress syndrome see acute

respiratory distress syndrome

respiratory failure

see also ventilatory failure

chest trauma, 11–22


23–37

coma, 192

poisoning, 222

spinal trauma, 209

respiratory function

age, 86


respiratory muscles

resting, 32–33

weakness, chronic obstructive pulmonary

disease treatment, 35

respiratory rates, ventilation in asthma, 182

resuscitation

see also fluid resuscitation

ABC algorithm, 3–4

coma, 190



shock, 42


rewarming, hypothermia, 111–112

rhabdomyolysis, 210

rheumatoid arthritis, postoperative care, 73

ribs, fractures, 12–13, 144, 145

road traffic accidents, spinal injury

incidence, 208

rocuronium, tracheal intubation

asthma, 181


Rule of 9s, 156

SAGM (saline, adenine, glucose and

mannitol) solution, 99, 100

salbutamol, asthma, 179

salicylate poisoning

gastric lavage, 229

urine alkalinisation, 231

saline infusion

metabolic acidosis from, 126

see also SAGM solution

sclerotherapy, oesophageal varices, 101

sedation



ventilation


34–35

head injury, 144

seizures


eclampsia, 124

head injury and ventilation, 144

management, 194, 200–202, 225


INDEX

247







TCA poisoning, 227

selective decontamination of digestive tract

(SDD), 102

self-poisoning, 221–232

Sengstaken Blakemore tube

oesophageal varices, 102

uterine haemorrhage, 128

sepsis

near-drowning, 113

systemic, 73–84

shock

hypovolaemia, 40–41

monitoring, 43

sepsis, 76, 79–80

Shoemaker’s goals, 79

shunt, pulmonary, trauma, 12

sieving coefficient, extra-corporeal drug

removal, 58

skin, poisoning signs, 223 (Table)

skin prick testing, allergies, 69

skull fractures, signs, 192

sleep, 188 (Table)

sodium

fractional excretion, 52

retention, variceal bleeding, 102

sodium valproate, status epilepticus, 201

somatostatin, oesophageal varices, 102

spinal clearance, 213–214, 215 (Fig.)

spinal cord perfusion pressure, 213

spinal shock, 209

spine, trauma, 207–219

splenectomy, postoperative management,

20–21

sporting accidents, spinal injury incidence,

208

Staphylococcus aureus, methicillin-resistant

(MRSA), 204–205

Starling’s law, 2

static pressure–volume curve, pulmonary, 18


steroids see corticosteroids

stomach, secretion, 87–88

storage effects, red cells in SAGM, 100–101

Streptococcus pneumoniae, 203–204

stress response, burns, 154

stress ulcers, spinal trauma, 216

stroke volume, 2


strong ion difference (SID), 92

stupor, 188 (Table)

subphrenic abscess, 92

sugar see glucose

superficial burns, 152–153

surgery

burns, 159

debridement, 81

for gastrointestinal haemorrhage, 44

Guillain–Barré syndrome after, 164

postoperative care, criteria for high risk, 78

suxamethonium

asthma, 181

danger

neuromuscular failure, 168, 169

spinal trauma, 210

sympathetic nervous system, spinal trauma, 209

sympathomimetic drugs, 8

see also vasoconstrictors

synchronised intermittent mandatory

ventilation

asthma, 182

weaning, 35

syntocinon, obstetric haemorrhage, 127–128

systemic inflammation, ARDS, 13

systemic inflammatory response syndrome

(SIRS), 74–78

criteria for diagnosis, 132

systemic sepsis, 73–84

systemic vascular resistance

level for treatment of septic shock, 80


tachycardia, tachypnoea, drugs and poisons

causing, 223 (Table)

TCAs (tricyclic antidepressants), poisoning,

226–227

bicarbonate for, 229

temperature

see also hypothermia; pyrexia;

thermoregulation

peripheral vs core, 4

tension pneumothorax, 4

from mechanical ventilation, 15–16

PEEP, 33

INDEX

248






terlipressin, oesophageal varices, 101–102

thermal coagulation, endoscopic, 43–44

thermoregulation

see also hypothermia; pyrexia

spinal trauma, 210

thiopentone

anaphylaxis, 64


thiosulphate, cyanide poisoning, 156

thrombosis

prevention after obstetric haemorrhage,

128

risk, pregnancy, 123

thyroid function, brain stem death, 117

tidal volume, ventilator settings, 17

total parenteral nutrition, burns, 157

total weak acid concentration (Atot), 92

toxidromes, 222, 223 (Table)

T-piece trials, ventilator weaning, 35

trace elements, burns, 158

tracheal intubation

asthma, 180–181

burns, 155

complications, 15

head injury, 143


spinal trauma, 212

tracheostomy


35–36


tramadol, Guillain–Barré syndrome,

170

transfer

burns patient, 159

trauma patient, 141–149

transfusion

haemorrhage, 6

massive, 99–100, 123–124

transjugular intrahepatic portosystemic

shunt (TIPS), 103

translocation, bacteria from bowel, 81–82,

136

transoesophageal Doppler ultrasound, 5–6

transplantation

liver, 103, 104

organ donation, 115–117

trauma

see also fractures

chest, 11–22

crush injuries, 208, 210–211, 216–217,

218

spine, 207–219

transfer of patient, 141–149

tricyclic antidepressants see TCAs

troponin I, 7–8, 157

trypsinogen-2, 132

tryptase, 66, 69

Turner’s sign, 132

ultrasound

pancreatitis, 134

renal failure, 53

transoesophageal, 5–6

unpredictable drug reactions, 64

uraemia, 51, 52

urinary catheters, spinal trauma, 213

urine

methylhistamine measurement, 69

osmolality, vs plasma, 90

pH manipulation, 230–231

pre-renal oliguria vs acute tubular

necrosis, 42 (Table)

renal failure, 52

uterine haemorrhage, 121–130

packing, 128

valproate sodium, status epilepticus, 201

vancomycin, 205

varices, oesophageal, 40, 95–104

vascular resistance see systemic vascular

resistance

vasoconstrictors

asthma and sedation, 180

in hypovolaemia, 6, 44

for oliguria, 45

vasodilation

contrast media reaction, 67

spinal trauma, 209

vasodilators

postoperative, 8

pre-eclampsia, 128–129

vasogenic oedema, brain, 142

vasopressin, oesophageal varices, 101–102

INDEX

249






vasopressors

burns, 157

septic shock, 80, 82

vecuronium, tracheal intubation in asthma,

181

venous access

burns, 159


haemodialysis, 54–55, 58

venous return, 2

PEEP on, 17

ventilation

asthma, 180–184

burns, 155–156

cascade humidifier, 112 (Table)


31–36


head injury, 144

for hypoxaemia, 11–12, 16–19

lung injury from, 14


pancreatitis, 137

tension pneumothorax from, 15


trauma, 144

spinal, 214, 217

see also non-invasive ventilation; positive

pressure ventilation

ventilation: perfusion mismatch, trauma, 12

ventilator associated pneumonia, 204

ventilators, 16–17

settings for asthma, 182, 184

volatile anaesthetic administration, 184

ventilatory failure

see also respiratory failure

muscle weakness, 163–173

viral infections


disease, 26, 27

pancreatitis from, 135

vital capacity (VC), Guillain–Barré

syndrome, 168

vitamin deficiency, haemodialysis, 59

volatile anaesthetics see inhalational

anaesthetics

volume-limited ventilation, asthma, 182

volume of distribution, extra-corporeal drug

removal and, 57–58

volume replacement see fluid resuscitation

von Willebrand disease, 122–123

wakefulness, 188

warm shock, 76

water

aspiration, 108

ionic dissociation, 92

waterfall analogy, dynamic hyperinflation,

26 (Fig.)

weaning, mechanical ventilation

asthma, 184


disease, 35

white blood cells, massive transfusion and,

100

whole bowel irrigation, 230

work of breathing, intrinsic PEEP on,

33–34

INDEX

250






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