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2017 pocket ICU




POCKET

NOTEBOOK

Pocket
ICU
SecondEdition

Editors
GYORGYFRENDL,MD,PHD,FCCM
AssociateProfessorofAnesthesia
HarvardMedicalSchool
DirectorofResearch,SurgicalCriticalCare
TranslationalResearchCenter
BrighamandWomen’sHospital
Boston,Massachusetts

RICHARDD.URMAN,MD,MBA,CPE

AssociateProfessorofAnesthesia
HarvardMedicalSchool
Director(Anesthesia),CenterforPerioperativeResearch
MedicalDirector,SedationforInterventionalMedicineServices
Director,AnesthesiaService,BWHHealthCareCenteratChestnutHill
BrighamandWomen’sHospital
Boston,Massachusetts


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Secondedition
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Title:PocketICU/editors,GyorgyFrendl,RichardD.Urman.
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Description:Secondedition.|Philadelphia:WoltersKluwer,[2017]|Series:
Pocketnotebook|Includesbibliographicalreferencesandindex.
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CONTRIBUTORS
AshleyE.Aaron,MD
SurgeryResident
BrighamandWomen’sHospital
Boston,Massachusetts
EdwinPascalAlyea,III,MD
AssociateProfessorofMedicine
DanaFarberCancerInstitute
HarvardMedicalSchool
Boston,Massachusetts
RebeccaM.Baron,MD
AssistantProfessor
HarvardMedicalSchool
AssociatePhysician
BrighamandWomen’sHospital
Boston,Massachusetts
SheriBerg,MD
InstructorinAnesthesia
MassachusettsGeneralHospital
HarvardMedicalSchool
Boston,Massachusetts
SamuelClarkBerngard,MD
PrimaryCarePhysician
InternalMedicine
Aurora,Colorado
TarunBhalla,MD
ViceChairman,ComprehensivePainServices
DepartmentofAnesthesiology
NationwideChildren’sHospital
ClinicalAssociateProfessor
TheOhioStateUniversityMedicalCenter
Columbus,Ohio


JamesM.Blum,MD
AssistantProfessorofAnesthesiology
Chief,CriticalCareandSurgicalSpecialtiesAnesthesia
EmoryUniversitySchoolofMedicine
Atlanta,Georgia
NathanE.Brummel,MD,MSCI
InstructorinMedicine
DepartmentofMedicine
DivisionofAllergy,PulmonaryandCriticalCareMedicine
VanderbiltUniversitySchoolofMedicine
Nashville,Tennessee
GauravBudhrani,MD
AssistantProfessorofAnesthesiology
DivisionofCriticalCareMedicine
EmoryUniversitySchoolofMedicine
EmoryUniversityHospitalandTheEmoryClinic
Atlanta,Georgia
KathrynL.Butler,MD
ConsultantinSurgery
MassachusettsGeneralHospital
Lecturer
HarvardMedicalSchool
Boston,Massachusetts
PhillipCamp,MD
InstructorinSurgery
SpecialtyinThoracicSurgeryandLungTransplant
HarvardMedicalSchool
Boston,Massachusetts
JonathanH.Chow,MD
CriticalCareFellow
DepartmentofAnesthesiology
DivisionofCriticalCareMedicine
GeorgeWashingtonUniversity
Washington,DC


KennethB.Christopher,MD
AssistantProfessorofMedicine
RenalDivision
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
AlexandraB.Columbus,MD
CenterforSurgeryandPublicHealth
BrighamandWomen’sHospital
Boston,Massachusetts
AntonioCoppolinoIII,MD
ChiefResidentinThoracicSurgery
DivisionofThoracicSurgery
BrighamandWomen’sHospital
Boston,Massachusetts
AllisonK.Dalton,MD
AssistantProfessor
DepartmentofAnesthesiaandCriticalCare
UniversityofChicago
Chicago,Illinois
MarcusD.Darrabie,MD
DepartmentofSurgery
UniversityofFlorida
Gainesville,Florida
HormuzdiyarH.Dasenbrock,MD,MPH
ResidentinNeurosurgery
BrighamandWomen’sHospital
Boston,Massachusetts
MatthewT.Dudley,MD
CriticalCareScholarandFellowinCriticalCareMedicine
UniversityofCalifornia,SanFrancisco
SanFrancisco,California
IanF.Dunn,MD


AssociateProfessorofNeurosurgery
HarvardMedicalSchool
Boston,Massachusetts
BrianL.Edlow,MD
InstructorofNeurology
MassachusettsGeneralHospital
HarvardMedicalSchool
Boston,Massachusetts
AliA.El-Solh,MD,MPH
ProfessorofMedicine,Anesthesiology,andSocialandPreventiveMedicine
UniversityatBuffalo
VAWesternNewYorkHealthcareSystem
Buffalo,NewYork
EugeneWesleyEly,MD,MPH
ProfessorofMedicine
VanderbiltUniversityMedicalCenter
Nashville,Tennessee
HollyR.Ende,MD
AssistantProfessorofAnesthesiology
VanderbiltUniversityMedicalCenter
Nashville,Tennessee
PeterJ.Fagenholz,MD
AssistantProfessorofSurgery
HarvardMedicalSchool
DepartmentofSurgery
DivisionofTrauma,EmergencySurgery,andCriticalCare
MassachusettsGeneralHospital
Boston,Massachusetts
MichaelG.Fitzsimons,MD
AssistantProfessorofAnaesthesia
DepartmentofAnesthesia,CriticalCareandPainMedicine
MassachusettsGeneralHospital
Boston,Massachusetts


SamuelM.Galvagno,Jr.,DO,PhD,FCCM
AssociateProfessor
Chief,DivisionofCriticalCareMedicine
DepartmentofAnesthesiology
UniversityofMarylandSchoolofMedicine
Baltimore,Maryland
BrettE.Glotzbecker,MD
AssistantProfessorofMedicine
DepartmentofMedicalOncology
DanaFarberCancerInstitute
HarvardMedicalSchool
Boston,Massachusetts
WilliamB.Gormley,MD,MBA,MPH
Director,NeurosurgicalCriticalCare,DepartmentofNeurosurgery
BrighamandWomen’sHospital
AssociateProfessor
HarvardMedicalSchool
Boston,Massachusetts
DavidGreer,MD,MA,FCCM,FAHA,FNCS,FAAN
ProfessorofNeurologyandNeurosurgery
ViceChairman,DepartmentofNeurology
YaleUniversitySchoolofMedicine
NewHeaven,Connecticut
MichaelA.Gropper,MD,PhD
ProfessorandChair
DepartmentofAnesthesiaandPerioperativeCare
Investigator
CardiovascularResearchInstitute
UniversityofCalifornia,SanFrancisco
SanFrancisco,California
AnkitGupta,MD,MS
AttendingPhysician
PulmonaryCriticalCare
TheWilliamW.BackusHospital,HartfordHealthcare


Norwich,Connecticut
HirotoHatabu,MD,PhD
ProfessorofRadiology
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
JoaquimM.Havens,MD
AssistantProfessorofSurgery
HarvardMedicalSchool
DirectorofEmergencyGeneralSurgery
DivisionofTrauma,Burns,andSurgicalCriticalCare
BrighamandWomen’sHospital
Boston,Massachusetts
GalenV.Henderson,MD
DirectorofNeurocriticalCare
DepartmentofNeurology
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
JenniferHofer,MD
AssistantProfessor
TheDepartmentofAnesthesiaandCriticalCare
TheUniversityofChicagoHospitals
Chicago,Illinois
PeterC.Hou,MD
InstructorinEmergencyMedicine
BrighamandWomen’sHospital
Boston,Massachusetts
DannyO.Jacobs,MD,MPH
ExecutiveVicePresidentandProvost,
DeanoftheSchoolofMedicine
UniversityofTexasMedicalBranch
Galveston,Texas


GeorgeKasotakis,MD,MPH
AssistantProfessor
BostonUniversitySchoolofMedicine
Boston,Massachusetts
EdwardKelly,MD
AssistantProfessor
HarvardMedicalSchool
Trauma,BurnandSurgicalCriticalCare
BrighamandWomen’sHospital
Boston,Massachusetts
EmilyZ.Keung,MD
MDAndersonCancerCenter
Houston,Texas
JesseJ.Kiefer,MD
ChiefResident
DepartmentofAnesthesiology
UniversityofMarylandSchoolofMedicine
CollegePark,Maryland
YasserElKouatli,MD
CriticalCareMedicine
UniversityofMichiganHealthSystem
AnnArbor,Michigan
JohnP.Kress,MD
ProfessorofMedicine
DirectorofMedicalICU
DepartmentofMedicine
SectionofPulmonaryandCriticalCare
UniversityofChicago
Chicago,Illinois
KellyB.Kromer,MD
PediatricAnesthesiologist
GilletteChildren’sSubspecialtyHealthcare
MinneapolisChildren’sHospital


Minneapolis,Minnesota
PatrickR.Lawler,MD,MPH
ClinicalFellowinMedicineandInstructor
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
AgnieszkaLesicka,MD
InstructorinAnesthesia
MassachusettsGeneralHospital
HarvardMedicalSchool
Boston,Massachusetts
WenyaLindaBi,MD,PhD
ClinicalFellowinSurgery
Neurosurgery
BostonChildren’sHospital
Boston,Massachusetts
GeoffreyS.F.Ling,MD,PhD,Col(Ret.)
MedicalCorps,USArmy
Arlington,Virginia
TensingMaa,MD
DivisionofCriticalCare
NationwideChildren’sHospital
OhioStateUniversityCollegeofMedicine
Columbus,Ohio
SayeedK.Malek,MD,FACS
ClinicalDirector
DivisionofTransplantSurgery
BrighamandWomen’sHospital
AssistantProfessor
HarvardMedicalSchool
Boston,Massachusetts
AtulMalhotra,MD
KennethM.MoserProfessorofMedicine


UniversityofCalifornia,SanDiego
LaJolla,California
HariR.Mallidi,MD
ExecutiveDirector,forECMO,Heart&VascularCenter
Co-Director,LungTransplant,ECMOandLungAssistDevices,TheLung
Center
BrighamandWomen’sHospital
Boston,Massachusetts
ErnestI.Mandel,MD
AssociatePhysician
BrighamandWomen’sHospital
InstructorinMedicine
HarvardMedicalSchool
Boston,Massachusetts
OveysMansuri,MD,MBA,FACS
ShannonS.McKenna,MD
MedicalDirector,ThoracicSurgicalICU
AssistantProfessorofAnesthesia
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
AlessandroM.Morandi,MD,MPH
RehabilitationHospitalAncellediCremona(Italy)
GeriatricResearchGroup(Italy)
CenterforQualityofAgeing(Nashville,TN,USA)
ICUdeliriumgroup(Nashville,TN,USA)
DavidA.Morrow,MD,MPH
Director,SamuelA.LevineCardiacIntensiveCareUnit
ProfessorofMedicine
HarvardMedicalSchool
SeniorInvestigator
TIMIStudyGroup
CardiovascularDivision


BrighamandWomen’sHospital
Boston,Massachusetts
LenaM.Napolitano,MD,FACS,FCCP,MCCM
ProfessorofSurgery
DivisionChief,AcuteCareSurgery
AssociateChairofSurgery(Trauma,Burn,CriticalCare,EmergencySurgery)
DepartmentofSurgery,TraumaandSurgicalCriticalCare
UniversityofMichiganHealthSystem
UniversityHospital
AnnArbor,Michigan
EmilyNelson,MD
AssistantProfessor
AnesthesiaandPerioperativeMedicine
MedicalUniversityofSouthCarolina
RalphH.JohnsonVAMedicalCenter
Charleston,SouthCarolina
PatriceK.Nicholas,DNSc,DHL(Hon.),MPH,RN,ANP-C,FAAN
ProfessorinNursing
MassachusettsGeneralHospital
Boston,Massachusetts
HeikkiNikkanen,MD
InstructorinEmergencyMedicine
MountAuburnHospital
HarvardMedicalSchool
Boston,Massachusetts
MichaelF.O’Connor,MD
Professor
DepartmentofAnesthesiaandCriticalCare
TheUniversityofChicago
Chicago,Illinois
YukaOkajimaA,MD,MPH
AssistantProfessorofRadiology
ResearchCenter


St.Luke’sInternationalUniversity
Tokyo,Japan
DavidOxman,MD
AssistantProfessorofMedicine
SidneyKimmelMedicalCollegeatThomasJeffersonUniversity
Philadelphia,Pennsylvania
LouisaJ.Palmer,MBBS
InstructorinAnesthesia
HarvardMedicalSchool
BrighamandWomen’sHospital
Boston,Massachusetts
AmeekaPannu,MD
ClinicalFellow
DepartmentofAnesthesiology,PerioperativeandPainMedicine
BethIsraelDeaconessMedicalCenter
HarvardMedicalSchool
Boston,Massachusetts
BhaktiK.Patel,MD
ClinicalInstructor
SectionofPulmonary/CriticalCare
UniversityofChicagoMedicalCenter
Chicago,Illinois
MaryPennington,RN,MSN,CCRN
DirectorofNeurosurgicalNursing
BrighamandWomen’sHospital
Boston,Massachusetts
SujathaPentakota,MD
InstructorinAnesthesia
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
MaryB.Rice,MD,MPH
AssistantProfessorofMedicine


BethIsraelDeaconessMedicalCenter
HarvardMedicalSchool
Boston,Massachusetts
StevenA.Ringer,MD,PhD
ProfessorofNeonatology
DepartmentofNeonatology
Children’sHospitalatDartmouth
Dartmouth-HitchcockMedicalCenter
Lebanon,NewHampshire
SelwynO.Rogers,Jr.,MD,MPH
ChiefMedicalOfficerandVicePresident
UTMBHealth
AssistantDean,ClinicalAffairs
TheUniversityofTexasMedicalBranch
Galveston,Texas
AmodSawardekar,MD
AssistantProfessorofAnesthesiology
NorthwesternUniversityFeinbergSchoolofMedicine
Chicago,Illinois
RaghuSeethala,MD
InstructorinEmergencyMedicine
BrighamandWomen’sHospital
Boston,Massachusetts
AnupamaaJ.Seshadri,MD
ResidentinGeneralSurgery
DepartmentofSurgery
BrighamandWomen’sHospital
Boston,Massachusetts
SajidShahul,MD,MPH
AssociateProfessorofAnesthesiaandCriticalCare
UniversityofChicagoMedicine
Chicago,Illinois
DanielS.Talmor,MD,MPH


ChairandEdwardLowensteinProfessorofAnaesthesia
BethIsraelDeaconessMedicalCenter
Boston,Massachusetts
StefanG.Tullius,MD,PhD,FACS
Chief,DivisionofTransplantSurgery
BrighamandWomen’sHospital
DirectorofTransplantSurgeryResearchLaboratory
ProfessorofSurgery
HarvardMedicalSchool
Boston,Massachusetts
AveryTung,MD,FCCM
Professor
DepartmentofAnesthesiaandCriticalCare
UniversityofChicago
Chicago,Illinois
VincentM.Vacca,RN,MSN,CCRN,SCRN
ClinicalNurseEducator
NeuroscienceIntensiveCareUnit
BrighamandWomen’sHospital
Boston,Massachusetts
HenrikasVaitkevicius,MD
InstructorinNeurology
BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
DirkJ.Varelmann,MD,DESA,EDIC
InstructorinAnesthesia
HarvardMedicalSchool
DepartmentofAnesthesiology,PerioperativeandPainMedicine
BrighamandWomen’sHospital
Boston,Massachusetts
VirenS.Vasudeva,MD
DepartmentofNeurosurgery


BrighamandWomen’sHospital
HarvardMedicalSchool
Boston,Massachusetts
GeorgeVelmahos,MD,PhD
ProfessorofSurgery,DivisionChiefofTrauma
EmergencySurgeryandSurgicalCriticalCare
MassachusettsGeneralHospital
HarvardMedicalSchool
Boston,Massachusetts
M.BrandonWestover,MD,PhD
AssistantProfessorofNeurology
MassachusettsGeneralHospital
HarvardMedicalSchool
Boston,Massachusetts
TraciA.Wolbrink,MD,MPH
AssociateDirector
OPENPediatrics
AssociateinCriticalCareMedicine
BostonChildren’sHospital
AssistantProfessorinAnesthesia
HarvardMedicalSchool
Boston,Massachusetts
DanielDanteYeh,MD,FACS
AssistantProfessor
DepartmentofSurgery
DivisionofTrauma,EmergencySurgery,andSurgicalCriticalCare
HarvardMedicalSchool
MassachusettsGeneralHospital
Boston,Massachusetts


PREFACE
Critical(intensive)carewasbornandremainsamultidisciplinaryspecialty.This
isobviousintwofacetsofcriticalcare:(a)itintegratesknowledgeandpractices
from many medical specialties (trauma, transplant medicine, cardiology,
pulmonarymedicine,anesthesiologyandpainmedicine,andmanyothers);and
(b) it requires the close collaboration of medical professionals from many
specialties (physicians, nurses, physiotherapists, respiratory therapists,
nutritionists,pharmacists,etc.).Toachievethis,criticalcareprofessionalsmust
bemastersofcommunication,teambuilding,management,andpossessthemost
up-to-dateclinicalknowledge.
Since its inception in the polio era in the 1950s, critical care has grown
beyondadolescenceandnowisconsideredtobeanevidence-basedspecialty.In
the past 15 years, dozens of high-quality clinical trials built a solid scientific
foundationforcriticalcareandallowedustosignificantlyimprovebothpatient
survivalandthequalityoftheirlivesfollowingcriticalillness.Thisisobviousas
evidencedbythemuchimprovedsurvivalfromARDSandsepsis.Inthisbook,
ourgoalwastohighlightthisextensivebodyofknowledgeforourreadersinan
easytoviewformat.
As we reach for personalized (individualized) medicine to custom tailor our
managementofthepatient,providecarefortheelderlyintheir80sand90s,treat
diseases that were untreatable just years before, the knowledge has to be solid
and the commitment firm. Critical care professionals will always put their
patients first.Thechallengesremainingaresubstantialandwillrequireawelltrained, collaborative, patient-centered, and cost-effective effort from all of us.
The era of precision medicine is becoming a reality in cancer care and is
expanding to other medical specialties. Critical care is not far behind in this
effort.
This significantly updated and reorganized second edition is intended to
provide concise, evidence-based information for all critical (intensive) care
professionals,aswellasforthosewhoarehavingtheirfirstencounterwithICUs
and critically ill patients. To accomplish our goals, we solicited contributions
frommanyleadingcriticalcareexperts,incorporatedthemostrecentevidence,
improvedthetableofcontentsandtheindexingofthebook.Wearegratefulfor
ourauthors’clinicalinsightsandforsharingtheirmanyyearsofexperience.
Therewardsofprovidingcareforthemostneedyaregreat.Withourbook,we
inviteallofyouforagreatandsatisfyingprofessionaljourney.


GYORGYFRENDL,MD,PhD,FCCM
RICHARDD.URMAN,MD,MBA,CPE
HarvardMedicalSchool
Boston,Massachusetts


CONTENTS
Contributors
Preface
COMMONICUPROBLEMS
RaghuSeethala
Hyperkalemia
Shock
Sepsis
Arrhythmias
Hypotension
Hypoxemia
PericardialTamponade
TensionPneumothorax
AcuteMentalStatusChange
LowUrineOutput—AcuteRenalFailure
FeverintheICU
MONITORING
SamuelM.Galvagno,Jr.,JonathanH.Chow
NoninvasiveMonitoring
InvasiveMonitoring
MinimallyInvasiveHemodynamicMonitoring
AIRWAYMANAGEMENT
TarunBhalla,TensingMaa,AmodSawardekar
Introduction
AirwayAssessment
AirwayDevices
DifficultMaskVentilation:ManeuverstoMaintainAirwayPatency
IndicationsforTrachealIntubation
Drugs
AirwayManagement:OrotrachealIntubation
AirwayManagement:NasotrachealIntubation
AirwayManagement:AwakeFlexibleFiberopticIntubation
ASADifficultAirwayAlgorithm
TranstrachealProcedures


Tracheotomy
ComplicationsofLaryngoscopyandIntubation
Extubation
ACID–BASEDISTURBANCES
SamuelClarkBerngard,MaryB.Rice,AtulMalhotra
Definitions
Workup
ManagementofSevereAcid–BaseDisturbancesinCriticalIllness
MetabolicAcidosis
MetabolicAlkalosis
RespiratoryAcidosis
RespiratoryAlkalosis
AssessingOxygenationbyArterialBloodGas
PAIN,AGITATION,ANDDELIRIUMINTHEICU
NathanE.Brummel,AlessandroM.Morandi,EugeneWesleyEly
GeneralPrinciples
Pain/Analgesia
Agitation/Sedation
DeliriumintheICU
NUTRITION
MarcusD.Darrabie,DannyO.Jacobs
Significance
NutritionalAssessment
NutritionRequirements
NutritionalSupportRoutes
MalnutritionLeadingtoPulmonaryFailure
RenalFailureLeadingtoMalnutrition
HepaticFailureLeadingtoMalnutrition
ObesityandMalnutrition
SCORINGSYSTEMFORTHESEVERITYOFILLNESSINCRITICAL
CARE
EdwardKelly
APACHE(AcutePhysiologyandChronicHealthEvaluation)
SAPS(SimplifiedAcutePhysiologyScore)
SAPSII


SAPSIII
SOFA(SequentialOrganFailureAssessment)
MELD(ModelforEnd-StageLiverDisease)
STSRiskCalculator
RevisedTraumaScore
qSOFA
PREVENTIVESTRATEGIESANDEVIDENCE-BASEDPRACTICE
ShannonS.McKenna
Introduction
CentralVenousCatheter(CVC)AssociatedBloodStreamInfections(CABSI)
Ventilator-AssociatedEvents(VAE)
VenousThromboembolism(VTE)
StressUlcers
PressureUlcers
Catheter-AssociatedUrinaryTractInfections(CAUTI)
NosocomialTransmissionofMethicillin-ResistantStaphylococcusAureus
(MRSA)
DailyAssessment:FASTHUGGS
ADVANCEDCARDIACLIFESUPPORT(ACLS)
SamuelM.Galvagno,Jr.,JesseJ.Kiefer
AdvancedCardiacLifeSupport(ACLS)
CardiacArrestAlgorithm
CardiacArrestCircularAlgorithm
Bradycardia
BradycardiawithPulseAlgorithm
Tachycardia
TachycardiawithPulseAlgorithm
OpioidAssociatedLifeThreateningEmergency
OpioidInducedArrest
CardiopulmonaryResuscitation(CPR)
EMERGENCYDEPARTMENTTOICUCOMMUNICATION
STRATEGIES
PeterC.Hou
KeyElementsofIntegratedPre-andIntrahospitalCare
CareandCommunicationStrategiesforSpecificDiseaseConditions
Summary


INFORMEDCONSENT,PROCEDURALSTANDARDIZATION,AND
SAFETY
JenniferHofer,MichaelF.O’Connor
InformedConsent
FiveElementsofInformedConsent
ProceduralStandardization
OCCUPATIONALANDPHYSICALTHERAPY
BhaktiK.Patel,JohnP.Kress
ICU-AcquiredWeakness(ICU-AW)
EarlyMobilization
PATIENT-ANDFAMILY-CENTEREDCARE
MaryPennington,PatriceK.Nicholas
Introduction
Definitions
Objective
Rationale
KeyConcepts
Patient-andFamily-CenteredCareInterventions
FlexibleVisitationPolicy
Family’sLevelofInvolvement
FamilyPresenceduringCodes
CulturalIssues
TRANSITIONINGFROMACUTECARETOREHABILITATION
ShannonS.McKenna
TheNeed
TypesofPostAcuteCareFacilities
Outcomes
EvaluatingPatientsforSuitabilityofTransfertoanLTAC
StepstoEnsuringaSuccessfulTransfer
ETHICS,PALLIATIVEANDEND-OF-LIFECARE
MichaelF.O’Connor,AllisonK.Dalton
DecisionalCapacity
GoalsofCare
PalliativeCare
Autonomy


AdvancedDirectives
Surrogate/Proxy
WithdrawalofCare
DoctrineofDoubleEffect
ComfortMeasures
SubstitutedJudgment
LivingWill
DurablePowerofAttorney
Beneficence
Nonmaleficence
NURSINGSTANDARDSINCRITICALCARE
MaryPennington,VincentM.Vacca
Introduction
CriticalCareNursingWorkFlow
GuideforHead-to-ToeNursingAssessment
INTER-ANDINTRAHOSPITALTRANSPORTOFCRITICALLYILL
PATIENTS
MichaelG.Fitzsimons,AgnieszkaLesicka
Definitions
Risks
AssessmentandManagement
MECHANICALVENTILATIONANDPULMONARYISSUES
RebeccaM.Baron
Ventilation,PulmonaryPhysiology,VentilatorManagement
GasExchange
Ventilation
ModesofMechanicalVentilation
AcuteFailuretoLiberatefromVentilatorSupport
RespiratoryFailureandVentilatorManagement
VentilatorManagement
CommunityAcquiredPneumoniaandAtypicalPneumonias
TypesofPneumoniasandPathogens
ACUTERESPIRATORYDISTRESSSYNDROME
AmeekaPannu,DanielS.Talmor
Introduction


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