Joseph Varon Handbook of Critical and Intensive Care Medicine Third Edition 123 Handbook of Critical and Intensive Care Medicine Handbook of Critical and Intensive Care Medicine Third Edition Joseph Varon, MD, FACP, FCCP, FCCM, FRSM Professor of Acute and Continuing Care, The University of Texas Health Science Center at Houston Clinical Professor of Medicine, The University of Texas Medical Branch at Galveston Professor of Medicine and Surgery UAT, UABC, USON, UPAEP, BUAP - Mexico President Dorrington Medical Associates, PA Houston, TX, USA With 25 Illustrations Joseph Varon MD, FACP, FCCP, FCCM, FRSM Professor of Acute and Continuing Care The University of Texas Health Science Center at Houston Clinical Professor of Medicine The University of Texas Medical Branch at Galveston Professor of Medicine and Surgery UAT, UABC, USON, UPAEP, BUAP - Mexico President Dorrington Medical Associates, PA Houston, TX, USA ISBN 978-3-319-31603-1 ISBN 978-3-319-31605-5 DOI 10.1007/978-3-319-31605-5 (eBook) Library of Congress Control Number: 2016941876 © Springer International Publishing Switzerland 2016 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland This book is again dedicated to my children Adylle, Jacques, Daryelle, and Michelle for their understanding as youngsters and adults, about those countless days, nights, and weekends, in which I was away from home caring for those patients who needed me the most at the time Joseph Varon, MD, FACP, FCCP, FCCM, FRSM Preface Why write another book on the management of critically ill patients? When I wrote the first edition of this book, over 20 years ago, I had realized the importance of a small pocket book that would be useful for those caring for critically ill patients Over the past six decades we have seen an enormous growth in the number of intensive care units (ICU) across the world Indeed, it is estimated that a large proportion of health-care expenses are devoted to patients in these specialized units Medical students, residents, fellows, attending physicians, critical care nurses, pharmacists, respiratory therapists, and other health-care providers (irrespective of their ultimate field of practice) will spend several months or years of their professional lives, taking care of critically ill or severely injured patients These clinicians must have special training, experience, and competence in managing complex problems in their patients Moreover, these clinicians must interpret data obtained by many kinds of monitoring devices, and they must integrate this information with their knowledge of the pathophysiology of disease Even more important is the fact that anyone working in an ICU or with a critically ill patient must approach patients with a multidisciplinary team The phrase there is no I in TEAM comes to mind This 3rd edition of this book was written for every practitioner engaged in Critical Care Medicine across the world I have attempted to present basic and generally accepted clinical information, my own personal experience in the field, facts and some important formulas, as well as laboratory values and tables which we feel will be useful to the practitioner of Critical Care Medicine The chapters of this book follow an outline format and are divided by organ-system (i.e., neurologic disorders, cardiovascular disorders), as well as special topics (i.e., environmental disorders, trauma, toxicology) Every chapter has been updated and many chapters are completely new It is important for the reader of this handbook to understand that Critical Care Medicine is not a static field and changes occur every day Therefore, this handbook is not meant to define the standard of care, but rather to be a general guide to current clinical practice used in Critical Care Medicine I wrote this book hoping that it will benefit thousands of critically ill patients, but more importantly that it will aid practicing clinicians to assume a multidisciplinary approach Joseph Varon, MD, FACP, FCCP, FCCM, FRSM Contents Approach to the Intensive Care Unit (ICU) Welcome to the ICU What Is an ICU? Historical Development of the ICU Economical Impact of the ICU Organization of the ICU Teamwork The Flow Sheet The Critically Ill Patient System-Oriented Rounds Identification Major Events Over the Last 24 h System Review Do Not Resuscitate (DNR) and Ethical Issues 1 1 2 3 6 The Basics of Critical Care Cardiac Arrest and Resuscitation The Alveolar Air Equation Oxygen Transport Mechanical Ventilation Hemodynamics The Cardiopulmonary Interaction Integrated Cardiopulmonary Management Principles 11 11 18 24 29 40 46 48 Cardiovascular Disorders Ischemic Heart Disease Unstable Angina Pectoris Myocardial Infarction Cardiac Pacemakers Congestive Heart Failure Cardiomyopathies Myocarditis Pericarditis 51 51 51 54 62 62 64 66 66 .. .Handbook of Critical and Intensive Care Medicine Handbook of Critical and Intensive Care Medicine Third Edition Joseph Varon, MD, FACP, FCCP, FCCM, FRSM Professor of Acute and Continuing Care, ... Publishing Switzerland 2016 J Varon, Handbook of Critical and Intensive Care Medicine, DOI 10.1007/978-3-319-31605-5_1 Approach to the Intensive Care Unit (ICU) Economical Impact of the ICU Since... Rescuer’s hand located in the lower margin of sternum 14 2. The Basics of Critical Care (b) Heel of one hand is placed on the lower half of the sternum, and the other hand is placed on top of the hand