Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0052
G. Johns
Platelet disorders are quantitative or qualitative, or both. Either markedly increased or decreased numbers of platelets can cause harmful sequelae. Platelet disorders can be divided into acquired or hereditary; acquired disorders are much more common than congenital disorders. Platelet disorders can be due to increased platelet destruction or decreased platelet production. Pseudothrombocytopenia, dilutional effects, or possible splenic sequestration should be considered when the platelet count is low for the first time. The recent addition of a drug, commonly used in intensive care units, is also an important consideration for patients with newly acquired thrombocytopenia.
{"title":"Thrombocytopenia and Thrombocytopathy","authors":"G. Johns","doi":"10.1093/MED/9780190862923.003.0052","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0052","url":null,"abstract":"Platelet disorders are quantitative or qualitative, or both. Either markedly increased or decreased numbers of platelets can cause harmful sequelae. Platelet disorders can be divided into acquired or hereditary; acquired disorders are much more common than congenital disorders. Platelet disorders can be due to increased platelet destruction or decreased platelet production. Pseudothrombocytopenia, dilutional effects, or possible splenic sequestration should be considered when the platelet count is low for the first time. The recent addition of a drug, commonly used in intensive care units, is also an important consideration for patients with newly acquired thrombocytopenia.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127484111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0076
J. Renew, M. Mordecai
Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal reaction to antipsychotic medications. Most cases occur in men between the ages of 20 and 50 because they have the highest proportion of antipsychotic consumption. The prevalence of NMS has been reported as 0.07% to 2.2%, but the published diagnostic criteria for NMS varied widely until the Diagnostic and Statistical Manual of Mental Disorders addressed the issue in 2013. NMS is characterized by a constellation of clinical symptoms and laboratory abnormalities, including hyperthermia, muscle rigidity, and increased serum creatine kinase levels. Patients may also present with tremor, altered mental status, autonomic dysfunction, and leukocytosis.
{"title":"Neuroleptic Malignant Syndrome and Hyperthermia","authors":"J. Renew, M. Mordecai","doi":"10.1093/MED/9780190862923.003.0076","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0076","url":null,"abstract":"Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal reaction to antipsychotic medications. Most cases occur in men between the ages of 20 and 50 because they have the highest proportion of antipsychotic consumption. The prevalence of NMS has been reported as 0.07% to 2.2%, but the published diagnostic criteria for NMS varied widely until the Diagnostic and Statistical Manual of Mental Disorders addressed the issue in 2013. NMS is characterized by a constellation of clinical symptoms and laboratory abnormalities, including hyperthermia, muscle rigidity, and increased serum creatine kinase levels. Patients may also present with tremor, altered mental status, autonomic dysfunction, and leukocytosis.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126869589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0058
D. S. Aviles, W. Hellinger
Infection is a common complication in the intensive care unit (ICU). Furthermore, infection more than doubles the mortality rate in the ICU. Antibiotic resistance in Staphylococcus aureus, Enterococcus, Enterobacteriaceae, and fungal infection is among the most challenging issues in the ICU. In addition, critical illness affects antibiotic pharmacokinetics. Thus, implementation of strategies to prevent infection is of utmost importance to improve patient outcome.
{"title":"Infectious Diseases Complicating Critical Care","authors":"D. S. Aviles, W. Hellinger","doi":"10.1093/MED/9780190862923.003.0058","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0058","url":null,"abstract":"Infection is a common complication in the intensive care unit (ICU). Furthermore, infection more than doubles the mortality rate in the ICU. Antibiotic resistance in Staphylococcus aureus, Enterococcus, Enterobacteriaceae, and fungal infection is among the most challenging issues in the ICU. In addition, critical illness affects antibiotic pharmacokinetics. Thus, implementation of strategies to prevent infection is of utmost importance to improve patient outcome.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129604872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0053
P. Vishnu, S. Ailawadhi
Disseminated intravascular coagulation (DIC) is a phenomenon with the potential for causing thrombosis and bleeding. DIC, typically occurring in patients with critical illness, can manifest as an acute, life-threatening emergency or as a chronic, subclinical process depending on the influence of morbidity from the underlying cause. The presence of DIC increases the risk of mortality by twofold in patients with trauma and severe sepsis and is an independent predictor of mortality. The pathogenesis of DIC is not only related to abnormal coagulation activation and platelet consumption but also involves multiple mechanisms of the inflammatory system and innate immunity.
{"title":"Disseminated Intravascular Coagulation: Clinical Diagnosis and Management","authors":"P. Vishnu, S. Ailawadhi","doi":"10.1093/MED/9780190862923.003.0053","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0053","url":null,"abstract":"Disseminated intravascular coagulation (DIC) is a phenomenon with the potential for causing thrombosis and bleeding. DIC, typically occurring in patients with critical illness, can manifest as an acute, life-threatening emergency or as a chronic, subclinical process depending on the influence of morbidity from the underlying cause. The presence of DIC increases the risk of mortality by twofold in patients with trauma and severe sepsis and is an independent predictor of mortality. The pathogenesis of DIC is not only related to abnormal coagulation activation and platelet consumption but also involves multiple mechanisms of the inflammatory system and innate immunity.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114421460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0049
Y. Zaw, M. Keddis
This chapter describes the physiology of water balance; disorders of hyponatremia and hypernatremia and the approach to their evaluation, diagnosis, and treatment; and disorders of electrolyte imbalance, including those of potassium, calcium, phosphorus, and magnesium.
{"title":"Disorders of Water and Electrolyte Balance","authors":"Y. Zaw, M. Keddis","doi":"10.1093/MED/9780190862923.003.0049","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0049","url":null,"abstract":"This chapter describes the physiology of water balance; disorders of hyponatremia and hypernatremia and the approach to their evaluation, diagnosis, and treatment; and disorders of electrolyte imbalance, including those of potassium, calcium, phosphorus, and magnesium.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"382 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113989582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0010
Arnoley S Abcejo, J. Pasternak
Cardiac arrest occurs suddenly, often without premonitory symptoms. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow in the midst of complete hemodynamic collapse. Anoxic-ischemic brain injury is most commonly caused by cardiac arrest, which is frequently lethal; of the US patients with out-of-hospital cardiac arrest treated by emergency medical services, almost 90% die. Among the patients who survive to hospital admission, inpatient mortality may be decreasing, but a substantial number of those survivors have poor neurologic outcomes from anoxic-ischemic brain injury.
{"title":"Cerebral Circulation and Cerebral Blood Flow","authors":"Arnoley S Abcejo, J. Pasternak","doi":"10.1093/MED/9780190862923.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0010","url":null,"abstract":"Cardiac arrest occurs suddenly, often without premonitory symptoms. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow in the midst of complete hemodynamic collapse. Anoxic-ischemic brain injury is most commonly caused by cardiac arrest, which is frequently lethal; of the US patients with out-of-hospital cardiac arrest treated by emergency medical services, almost 90% die. Among the patients who survive to hospital admission, inpatient mortality may be decreasing, but a substantial number of those survivors have poor neurologic outcomes from anoxic-ischemic brain injury.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"365 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132550510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0134
L. Tucker
Hypothermia therapy, better known as targeted temperature management (TTM), has increased in popularity in the past several years and has only proven benefits in the setting of cardiac arrest. It has been unsuccessful or not sufficiently proven in traumatic brain injury,bacterial meningitis, cerebral hemorrhage and ischemic stroke. TTM has been shown to decrease intracranial pressure and is used in the management of refractory intracranial pressure despite recent evidence suggesting harm.
{"title":"Effects of Targeted Temperature Management on Drugs","authors":"L. Tucker","doi":"10.1093/MED/9780190862923.003.0134","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0134","url":null,"abstract":"Hypothermia therapy, better known as targeted temperature management (TTM), has increased in popularity in the past several years and has only proven benefits in the setting of cardiac arrest. It has been unsuccessful or not sufficiently proven in traumatic brain injury,bacterial meningitis, cerebral hemorrhage and ischemic stroke. TTM has been shown to decrease intracranial pressure and is used in the management of refractory intracranial pressure despite recent evidence suggesting harm.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133265972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0070
A. Sadiqi, J. Jahanyar
The challenges of managing heart transplant recipients postoperatively relate to right ventricular failure, immunosuppression, and the unique physiology of the donor heart. Clinical management of heart transplant recipients requires a multidisciplinary team approach with a coordinated effort between intensivists, cardiac surgeons, heart transplant cardiologists, and infectious disease specialists.
{"title":"Clinical Management of Heart Transplant Recipients","authors":"A. Sadiqi, J. Jahanyar","doi":"10.1093/MED/9780190862923.003.0070","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0070","url":null,"abstract":"The challenges of managing heart transplant recipients postoperatively relate to right ventricular failure, immunosuppression, and the unique physiology of the donor heart. Clinical management of heart transplant recipients requires a multidisciplinary team approach with a coordinated effort between intensivists, cardiac surgeons, heart transplant cardiologists, and infectious disease specialists.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132756678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0122
S. Beamer
The pleural cavity is a negative-pressure airtight space that serves as the interface between the lung and the chest wall. Fluid is produced normally by the parietal pleura and absorbed by the visceral pleura as a result of difference in capillary pressure. The fluid is subsequently absorbed by the pleural lymphatics and ultimately into the thoracic duct. Disruption of the pleural space can result in a pneumothorax (air) or a pleural effusion (fluid). Pleural effusions can be caused by blood (hemothorax), infection (parapneumoic effusion or empyema), chyle (chylothorax), malignancy, inflammatory conditions, or imbalances in hydrostatic and oncotic pressures. Both types of pleural processes alter the negative pressure of the thorax. The resulting positive pressure causes partial or complete lung collapse and respiratory symptoms. Thoracentesis and chest tube placement are essential procedures for both diagnosis and treatment of pleural conditions.
{"title":"Thoracentesis and Chest Tubes","authors":"S. Beamer","doi":"10.1093/MED/9780190862923.003.0122","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0122","url":null,"abstract":"The pleural cavity is a negative-pressure airtight space that serves as the interface between the lung and the chest wall. Fluid is produced normally by the parietal pleura and absorbed by the visceral pleura as a result of difference in capillary pressure. The fluid is subsequently absorbed by the pleural lymphatics and ultimately into the thoracic duct. Disruption of the pleural space can result in a pneumothorax (air) or a pleural effusion (fluid). Pleural effusions can be caused by blood (hemothorax), infection (parapneumoic effusion or empyema), chyle (chylothorax), malignancy, inflammatory conditions, or imbalances in hydrostatic and oncotic pressures. Both types of pleural processes alter the negative pressure of the thorax. The resulting positive pressure causes partial or complete lung collapse and respiratory symptoms. Thoracentesis and chest tube placement are essential procedures for both diagnosis and treatment of pleural conditions.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123501155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0001
Minkyung Kwon, J. Diaz-Gomez
The practice of critical care medicine requires detailed knowledge of the practical aspects of respiratory physiology, including lung mechanics, the physiology of hypoxia, and the control of breathing. Before the lungs can enable gas exchange, air must move from the upper airway down a series of branching small airways and reach the alveoli. In the walls of the alveoli, capillaries form a dense network and receive blood flowing from the pulmonary artery before it flows to the pulmonary vein. Between the capillary network and the alveoli lies a thin blood-gas barrier through which oxygen and carbon dioxide move, chiefly by simple diffusion.
{"title":"Respiratory Physiology in Critical Illness","authors":"Minkyung Kwon, J. Diaz-Gomez","doi":"10.1093/MED/9780190862923.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0001","url":null,"abstract":"The practice of critical care medicine requires detailed knowledge of the practical aspects of respiratory physiology, including lung mechanics, the physiology of hypoxia, and the control of breathing. Before the lungs can enable gas exchange, air must move from the upper airway down a series of branching small airways and reach the alveoli. In the walls of the alveoli, capillaries form a dense network and receive blood flowing from the pulmonary artery before it flows to the pulmonary vein. Between the capillary network and the alveoli lies a thin blood-gas barrier through which oxygen and carbon dioxide move, chiefly by simple diffusion.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124650903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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