Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0118
C. Keller
Shigeto Ikeda in Japan developed fiberoptic bronchoscopy (FOB), beginning a revolution in the diagnosis and treatment of diverse pulmonary conditions. FOB evolved with additional diagnostic and interventional tools. FOB has become an essential bedside tool for diagnosis and management in critically ill patients. FOB is safe, even in patients with respiratory failure and, if done cautiously, in patients with increased intracranial pressure.
{"title":"Diagnostic and Interventional Bronchoscopy in the Intensive Care Unit","authors":"C. Keller","doi":"10.1093/MED/9780190862923.003.0118","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0118","url":null,"abstract":"Shigeto Ikeda in Japan developed fiberoptic bronchoscopy (FOB), beginning a revolution in the diagnosis and treatment of diverse pulmonary conditions. FOB evolved with additional diagnostic and interventional tools. FOB has become an essential bedside tool for diagnosis and management in critically ill patients. FOB is safe, even in patients with respiratory failure and, if done cautiously, in patients with increased intracranial pressure.","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":"127892181","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/9780190862923.003.0141
David T Jones
Advances in critical care medicine have allowed for more patients to survive catastrophic brain injuries. However, the degree of recovery from serious neurologic injury is highly variable. An acute, severe neurologic insult can cause a state of pathologic unconsciousness referred to as a coma. Common causes of brain injuries leading to a comatose state include cardiac arrest, a severe vascular event, a profound metabolic disturbance (eg, hypoglycemia), carbon monoxide or other poisoning, intoxications, or overdoses. The duration of a comatose state is rarely longer than days to weeks.
{"title":"Minimally Conscious State and Persistent Vegetative State","authors":"David T Jones","doi":"10.1093/MED/9780190862923.003.0141","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0141","url":null,"abstract":"Advances in critical care medicine have allowed for more patients to survive catastrophic brain injuries. However, the degree of recovery from serious neurologic injury is highly variable. An acute, severe neurologic insult can cause a state of pathologic unconsciousness referred to as a coma. Common causes of brain injuries leading to a comatose state include cardiac arrest, a severe vascular event, a profound metabolic disturbance (eg, hypoglycemia), carbon monoxide or other poisoning, intoxications, or overdoses. The duration of a comatose state is rarely longer than days to weeks.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"104 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":"132710951","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/9780190862923.003.0097
P. Dhawan, J. Tracy
Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.
{"title":"Myopathy and Neuropathy Acquired in the Intensive Care Unit","authors":"P. Dhawan, J. Tracy","doi":"10.1093/MED/9780190862923.003.0097","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0097","url":null,"abstract":"Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"89 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":"131366138","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/9780190862923.003.0003
Amelia Lowell, Bhavesh M Patel
The primary purpose of mechanical ventilation is to support the physiologic processes of oxygenation and ventilation and to reduce the work of breathing. The present chapter focuses on advanced modes and modalities of therapy for patients receiving mechanical ventilation. The term advanced must be interpreted with caution because the use of many of the newer modes of ventilation is not supported with substantial evidence of superiority to the basic modes of ventilation for patient outcomes. Rather, advanced refers to the engineering controls and the proposed patient benefits.
{"title":"Mechanical Ventilation: Advanced Modes","authors":"Amelia Lowell, Bhavesh M Patel","doi":"10.1093/MED/9780190862923.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0003","url":null,"abstract":"The primary purpose of mechanical ventilation is to support the physiologic processes of oxygenation and ventilation and to reduce the work of breathing. The present chapter focuses on advanced modes and modalities of therapy for patients receiving mechanical ventilation. The term advanced must be interpreted with caution because the use of many of the newer modes of ventilation is not supported with substantial evidence of superiority to the basic modes of ventilation for patient outcomes. Rather, advanced refers to the engineering controls and the proposed patient benefits.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"122 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":"116499871","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/9780190862923.003.0020
B. Nokes, R. Cartin-Ceba
Venous thromboembolism (VTE) is a major public health concern with an annual incidence of 1 per 1,000 patients in the United States. VTE encompasses a spectrum of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is a precursor to PE, and approximately 80% of patients have DVT when PE is diagnosed. The risk factors for PE are the same as those for DVT; consequently, diagnosis and management of VTE are contingent on the underlying risk factors and the extent of disease. A suspected VTE diagnosis should be pursued with risk stratification tools such as the Wells DVT and PE criteria and the Revised Geneva Score for PE. This chapter reviews PE diagnosis, risk stratification, and management.
{"title":"Pulmonary Embolism: An Overview","authors":"B. Nokes, R. Cartin-Ceba","doi":"10.1093/MED/9780190862923.003.0020","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0020","url":null,"abstract":"Venous thromboembolism (VTE) is a major public health concern with an annual incidence of 1 per 1,000 patients in the United States. VTE encompasses a spectrum of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is a precursor to PE, and approximately 80% of patients have DVT when PE is diagnosed. The risk factors for PE are the same as those for DVT; consequently, diagnosis and management of VTE are contingent on the underlying risk factors and the extent of disease. A suspected VTE diagnosis should be pursued with risk stratification tools such as the Wells DVT and PE criteria and the Revised Geneva Score for PE. This chapter reviews PE diagnosis, risk stratification, and management.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"7 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":"122784023","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/9780190862923.003.0051
Carl Ruthman, J. Yataco
Patients with cancer can present to the ICU with the complications and conditions of the general population, but a few are particular to their type of cancer or treatment. Some of the most common of cancer-related ICU complications are reviewed in this chapter, particularly those that need complex and urgent management.
{"title":"Hematologic and Oncologic Complications in the Intensive Care Unit","authors":"Carl Ruthman, J. Yataco","doi":"10.1093/MED/9780190862923.003.0051","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0051","url":null,"abstract":"Patients with cancer can present to the ICU with the complications and conditions of the general population, but a few are particular to their type of cancer or treatment. Some of the most common of cancer-related ICU complications are reviewed in this chapter, particularly those that need complex and urgent management.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"243 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":"122868562","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/9780190862923.003.0063
J. Hughes, D. S. Morris
Injuries to the chest or abdomen frequently affect management of traumatic brain injury (TBI). Neurocritical care clinicians must be familiar with management principles for these injuries. This chapter reviews common injuries to the torso, with particular attention to problems affecting neurologic management, but it cannot provide an exhaustive list of injuries and management principles for this broad topic. Close interaction with clinicians familiar with the management of nonneurologic traumatic injury is recommended.
{"title":"Chest and Abdominal Trauma","authors":"J. Hughes, D. S. Morris","doi":"10.1093/MED/9780190862923.003.0063","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0063","url":null,"abstract":"Injuries to the chest or abdomen frequently affect management of traumatic brain injury (TBI). Neurocritical care clinicians must be familiar with management principles for these injuries. This chapter reviews common injuries to the torso, with particular attention to problems affecting neurologic management, but it cannot provide an exhaustive list of injuries and management principles for this broad topic. Close interaction with clinicians familiar with the management of nonneurologic traumatic injury is recommended.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"47 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":"126582807","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/9780190862923.003.0059
D. S. Aviles, W. Hellinger
Antimicrobial therapy is a critical component in the management of many infections. Antimicrobial therapy should not be initiated before infection with a susceptible pathogen is suspected or confirmed or before appropriate diagnostic specimens, including those for cultures, are collected. Recognizing indications for antibiotic administration and appropriately selecting antimicrobial agents based on clinical and microbiologic findings are required. Distinguishing between empiric prescribing, when infection syndromes and pathogens are suspected, and therapeutic prescribing, when infection syndromes are confirmed and pathogens identified, is critically important.
{"title":"Antibiotics in the Intensive Care Unit","authors":"D. S. Aviles, W. Hellinger","doi":"10.1093/MED/9780190862923.003.0059","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0059","url":null,"abstract":"Antimicrobial therapy is a critical component in the management of many infections. Antimicrobial therapy should not be initiated before infection with a susceptible pathogen is suspected or confirmed or before appropriate diagnostic specimens, including those for cultures, are collected. Recognizing indications for antibiotic administration and appropriately selecting antimicrobial agents based on clinical and microbiologic findings are required. Distinguishing between empiric prescribing, when infection syndromes and pathogens are suspected, and therapeutic prescribing, when infection syndromes are confirmed and pathogens identified, is critically important.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"14 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":"126296093","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/9780190862923.003.0078
S. Grewal, Benjamin Brown
Hemispheric infarction is a major cause of morbidity and death among patients with acute stroke. These patients must receive a timely diagnosis and treatment for the best outcomes. Treatment is often multimodal and requires close and meaningful communication with the patient and family about management options and the risks and benefits of each.
{"title":"Diagnosis and Management of Hemispheric Infarction","authors":"S. Grewal, Benjamin Brown","doi":"10.1093/MED/9780190862923.003.0078","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0078","url":null,"abstract":"Hemispheric infarction is a major cause of morbidity and death among patients with acute stroke. These patients must receive a timely diagnosis and treatment for the best outcomes. Treatment is often multimodal and requires close and meaningful communication with the patient and family about management options and the risks and benefits of each.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"74 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":"131855368","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/9780190862923.003.0111
D. Sella, G. Sturchio, B. Schueler
Fluoroscopy is a valuable tool that can be used in critically ill patients. Detrimental effects on a patient physiologically and on hospital resources from unnecessary transport can be minimized with bedside procedures performed by an appropriately trained team. Operators must understand the basics of fluoroscopic imaging systems, radiation dose, and the ways in which exposure can be limited to both patients and personnel to avoid undesirable effects.
{"title":"Fluoroscopy: Principles and Safety","authors":"D. Sella, G. Sturchio, B. Schueler","doi":"10.1093/MED/9780190862923.003.0111","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0111","url":null,"abstract":"Fluoroscopy is a valuable tool that can be used in critically ill patients. Detrimental effects on a patient physiologically and on hospital resources from unnecessary transport can be minimized with bedside procedures performed by an appropriately trained team. Operators must understand the basics of fluoroscopic imaging systems, radiation dose, and the ways in which exposure can be limited to both patients and personnel to avoid undesirable effects.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"20 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":"131994446","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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