Critical Care Medicine

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Approach to the Critically Ill Patient

• Introduction to the Approach to the Critically Ill Patient

• Monitoring and Testing the Critical Care Patient
  • Blood Tests
  • Cardiac Monitoring
  • Pulmonary Artery Catheter (PAC) Monitoring
    • Procedure
    • Pulmonary artery occlusion pressure (pulmonary artery wedge pressure)
    • Mixed venous oxygenation
    • Cardiac output (CO)
    • Complications
  • Noninvasive Cardiac Output Assessment
    • Point-of-care ultrasonography
    • Esophageal Doppler monitor (EDM)
    • Thoracic bioimpedance
    • Noninvasive cardiac output assessment reference
  • Intracranial Pressure (ICP) Monitoring
  • Near Infrared Spectroscopy (NIRS)

• Critical Care Scoring Systems

• Vascular Access
  • Peripheral Vein Catheterization
  • Central Venous Catheterization
    • Complications of central venous catheterization
  • Midline Peripheral Catheterization
  • Arterial Catheterization
    • Complications of arterial catheterization
    • Catheterization reference
  • Intraosseous Infusion

• Oxygen Desaturation
  • Etiology
  • Evaluation
    • History
    • Physical examination
    • Testing
  • Treatment
    • Oxygen therapy
  • Key Points

• Oliguria
  • Etiology
  • Evaluation
    • History
    • Physical examination
    • Testing
  • Treatment
  • Key Points

• Agitation, Confusion, and Neuromuscular Blockade in Critically Ill Patients
  • Etiology
  • Evaluation
    • History
    • Physical examination
    • Testing
  • Treatment
    • Analgesia
    • Sedation
    • Neuromuscular blockade
    • Treatment reference
  • Key Points

Cardiac Arrest and Cardiopulmonary Resuscitation (CPR)

• Cardiac Arrest
  • General references
  • Etiology
    • Etiology references
  • Pathophysiology
  • Symptoms and Signs
  • Diagnosis
    • Diagnosis references
  • Treatment
    • Treatment references
  • Prognosis
    • Prognosis references

• Cardiopulmonary Resuscitation (CPR) in Adults
  • Overview of CPR
  • General references
  • CPR: Airway and Breathing
    • Airway and breathing references
  • CPR: Circulation
    • Chest compressions
    • Complications of chest compression
    • Circulation reference
  • CPR: Defibrillation
  • CPR: Monitoring and IV Access
  • CPR: Special Circumstances
  • CPR: Medications for ACLS
    • First-line medications
    • Other medications
    • Medications for ACLS references
  • Arrhythmia Treatment in CPR
  • CPR: Termination of Resuscitation
    • Termination of resuscitation references
  • CPR: Postresuscitative Care
    • Coronary angiography
    • Neurologic support
    • Blood pressure support
    • Post-return of spontaneous circulation arrhythmia treatment
    • Postresuscitative care references
  • More Information

• Cardiopulmonary Resuscitation (CPR) in Infants and Children
  • General reference
  • Major Differences Between Pediatric and Adult CPR
    • Prearrest
    • Chest compressions
    • Medications
    • Blood pressure
    • Equipment and environment
    • Temperature management
    • Airway and ventilation
    • Defibrillation
    • Treatment references
  • More Information

How To Do Basic Airway Procedures

• How To Do Bag-Valve-Mask (BVM) Ventilation
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks
  • References
  • More Information

• How To Do Head Tilt–Chin Lift and Jaw-Thrust Maneuvers
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • More Information

• How To Do the Heimlich Maneuver in the Conscious Adult or Child
  • Indications
  • Contraindications
  • Complications
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks
  • More Information

• How To Insert a Nasopharyngeal Airway
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors
  • More Information

• How To Insert an Oropharyngeal Airway
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors

• How To Treat the Choking Conscious Infant
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks
  • More Information

How To Do Other Airway Procedures

• How To Do a Percutaneous Cricothyrotomy
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Tips and Tricks

• How To Do Noninvasive Positive Pressure Ventilation
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Tips and Tricks

• How To Do Orotracheal Intubation Using Video Laryngoscopy
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks

• How To Insert an Esophageal-Tracheal Double Lumen Tube (Combitube) or a King Laryngeal Tube
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Aftercare
  • Warnings and Common Errors

• How To Insert a Laryngeal Mask Airway
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
  • Warnings and Common Errors
  • Tips and Tricks

How To Do Central Vascular Procedures

• How To Do Femoral Artery Cannulation, Ultrasound-Guided
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Ultrasound guidance
    • Seldinger (catheter-over-guidewire) technique
    • Arterial pressure monitoring
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment
    • Prepare the sterile field
    • Place a sterile cover over the ultrasound probe
    • Anesthetize the cannulation site
    • Insert the femoral artery introducer needle using ultrasound guidance
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Extend the skin insertion site
    • Place the catheter
    • Dress the site
  • Warnings and Common Errors

• How To Do Femoral Vein Cannulation (Without Ultrasound Guidance)
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Seldinger (catheter-over-guidewire) technique
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment
    • Prepare the sterile field
    • Establish the needle insertion path
    • Anesthetize the cannulation site
    • Insert the introducer needle (or finder needle, optional)
    • Assess the blood return
    • Optional: Use the finder needle to guide insertion of the introducer needle
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Widen the insertion tract
    • Place the catheter
    • Dress the site
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Femoral Vein Cannulation, Ultrasound-Guided
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Ultrasound guidance
    • Seldinger (catheter-over-guidewire) technique
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Preliminary preparation (nonsterile)
    • Prepare the equipment
    • Prepare the sterile field
    • Place a sterile cover over the ultrasound probe
    • Anesthetize the cannulation site
    • Insert the introducer needle
    • Assess the blood return
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Widen the insertion tract
    • Place the catheter
    • Dress the site
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Infraclavicular Subclavian Vein Cannulation
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Seldinger (catheter-over-guidewire) technique
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment
    • Prepare the sterile field
    • Establish the needle insertion path (subclavian vein, infraclavicular approach)
    • Anesthetize the cannulation site
    • Insert the introducer needle (or finder needle, optional)
    • Assess the blood return
    • Optional: Use the finder needle to guide insertion of the introducer needle
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Widen the insertion tract
    • Place the catheter
    • Dress the site
  • Aftercare
  • Warnings and Common Errors

• How To Do Infraclavicular Subclavian Vein Cannulation, Ultrasound-Guided
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Ultrasound guidance
    • Seldinger (catheter-over-guidewire) technique
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment
    • Prepare the sterile field
    • Place a sterile cover over the ultrasound probe
    • Anesthetize the cannulation site
    • Insert the introducer needle using ultrasound guidance
    • Assess the blood return
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Widen the insertion tract
    • Place the catheter
    • Dress the site
  • Aftercare
  • Warnings and Common Errors

• How To Do Internal Jugular Vein Cannulation
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Seldinger (catheter-over-guidewire) technique
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment
    • Prepare the sterile field
    • Establish the needle insertion path (internal jugular vein, central approach)
    • Anesthetize the cannulation site
    • Insert the finder needle
    • Assess the blood return
    • Insert the introducer needle, using the finder needle as a guide
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Widen the insertion tract
    • Place the catheter
    • Dress the site
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Internal Jugular Vein Cannulation, Ultrasound-Guided
  • Indications
  • Contraindications
  • Complications
  • Equipment
    • Sterile procedure, barrier protection
    • Ultrasound guidance
    • Seldinger (catheter-over-guidewire) technique
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Preliminary preparation (nonsterile)
    • Prepare the equipment
    • Prepare the sterile field
    • Place a sterile cover over the ultrasound probe
    • Anesthetize the cannulation site
    • Insert the introducer needle
    • Assess the blood return
    • Insert the guidewire
    • Remove the introducer needle (after successful guidewire insertion)
    • Widen the insertion tract
    • Place the catheter
    • Dress the site
  • Aftercare
  • Warnings and Common Errors

How To Do Peripheral Vascular Procedures

• How To Do Intraosseous Cannulation, Manually and With a Power Drill
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment and the insertion site
    • Anesthetize the needle insertion site
    • Insert the intraosseous needle
    • Confirm intramedullary needle placement
    • Begin intramedullary infusion
    • Dress the site
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks
  • Reference

• How To Do Peripheral Vein Cannulation
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Identify and prepare the site
    • Insert the peripheral venous catheter
    • Advance the catheter into the vein
    • Begin the IV infusion/establish the saline lock
    • Dress the site
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Peripheral Vein Cannulation, Ultrasound-Guided
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the ultrasonography device and identify a candidate vein
    • Insert the peripheral venous catheter using ultrasound guidance
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Radial Artery Cannulation
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the equipment and the sterile field
    • Anesthetize the cannulation site
    • Insert the needle into the artery
    • Assess the blood return
    • Thread the arterial catheter
    • Connect the arterial line
    • Dress the site
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Radial Artery Cannulation, Ultrasound-Guided
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Prepare the ultrasonography device and identify the radial artery
    • Prepare the equipment and the sterile field
    • Place a sterile cover over the ultrasound probe
    • Anesthetize the cannulation site
    • Insert the needle into the radial artery using ultrasound guidance
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Venous Blood Sampling
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Relevant Anatomy
  • Positioning
  • Step-by-Step Description of Procedure
    • Identify and prepare the site
    • Obtain the blood sample
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks

How To Do Other Emergency Medicine Procedures

• How To Do Diagnostic Peritoneal Lavage (DPL)
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Positioning
  • Relevant Anatomy
  • Step-by-Step Description of Procedure
    • Prepare the patient
    • Access the peritoneal cavity
    • Do the peritoneal lavage
  • Aftercare
  • Warnings and Common Errors
  • Tips and Tricks
  • References

• How To Do E-FAST Examination
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Additional Considerations
  • Positioning
  • Relevant Anatomy
  • Step-by-Step Description of Procedure
    • Pericardial view (cardiac)
    • Perihepatic view (right upper quadrant)
    • Perisplenic view (left upper quadrant)
    • Pelvic view (suprapubic)
    • Thoracic view
  • Warnings and Common Errors
  • Tips and Tricks

• How To Do Ultrasonography
  • Indications
  • Contraindications
  • Complications
  • Equipment
  • Step-by-Step Description of Procedure
    • Choose a probe
    • Operate the ultrasound console
    • Maneuver the probe do ultrasound imaging
  • Warnings and Common Errors
  • Tips and Tricks

Respiratory Arrest

• Overview of Respiratory Arrest
  • Etiology
    • Airway obstruction
    • Decreased respiratory effort
    • Respiratory muscle weakness
    • Etiology references
  • Symptoms and Signs
    • Impending respiratory arrest
    • Symptoms and signs references
  • Diagnosis
    • Diagnosis references
  • Treatment
    • Treatment reference

• Airway Establishment and Control
  • General references
  • Clearing and Opening the Upper Airway
    • Heimlich maneuver (subdiaphragmatic abdominal thrusts)

• Airway and Respiratory Devices
  • Bag-Valve-Mask Devices
  • Laryngeal Mask Airways (LMA)
  • Endotracheal Tubes
  • Other Devices

• Tracheal Intubation
  • Before Intubation
    • Evaluation of the airway
    • Preparing for intubation
    • Before intubation references
  • Tube Selection and Preparation for Intubation
    • Tube selection reference
  • Insertion Technique for Intubation
    • Insertion technique references
  • Alternative Intubation Devices
    • Alternative intubation devices references
  • Confirming Tube Placement
  • Nasotracheal Intubation
  • Complications of Tracheal Intubation
    • Complications of intubation reference

• Surgical Airway
  • Cricothyrotomy
  • Tracheostomy

• Medications to Aid Intubation
  • Sedation and analgesia for intubation
  • Medications to cause paralysis for intubation
  • Topical anesthesia for intubation
  • Post-intubation sedation and analgesia
  • References

Respiratory Failure and Mechanical Ventilation

• Overview of Respiratory Failure

• Overview of Mechanical Ventilation
  • Indications
  • Respiratory Mechanics
  • Means and Modes of Mechanical Ventilation
    • Volume-cycled ventilation
    • Pressure-cycled ventilation
    • Ventilator settings
    • Patient positioning
    • Means and modes references
  • Sedation and Comfort for Mechanical Ventilation
    • Sedation and comfort references
  • Complications of Mechanical Ventilation and Safeguards
    • Complications of endotracheal intubation
    • Complications of mechanical ventilation itself
    • Complications of immobility
    • Safeguards to reduce complications of mechanical ventilation

• Noninvasive Positive Pressure Ventilation (NIPPV)

• Acute Hypoxemic Respiratory Failure (AHRF, ARDS)
  • Etiology
  • Pathophysiology
    • ARDS
    • Refractory hypoxemia
    • Pathophysiology references
  • Symptoms and Signs
  • Diagnosis
  • Treatment
    • Mechanical ventilation in cardiogenic pulmonary edema
    • Mechanical ventilation in ARDS
    • Treatment references
  • Prognosis
    • Prognosis reference

• Ventilatory Failure
  • Pathophysiology
  • Symptoms and Signs
  • Diagnosis
    • Determination of cause
  • Treatment
    • Status asthmaticus
    • Acute-on-chronic respiratory failure

• Other Types of Respiratory Failure

• Liberation from Mechanical Ventilation
  • References

Sepsis and Septic Shock

• Sepsis and Septic Shock
  • General references
  • Etiology
    • Etiology reference
  • Pathophysiology
  • Symptoms and Signs
  • Diagnosis
    • Diagnosis references
  • Treatment
    • Perfusion restoration
    • Oxygen support
    • Antibiotics
    • Source control
    • Other supportive measures
    • Treatment references
  • Prognosis
    • Prognosis reference
  • Key Points

Shock and Fluid Resuscitation

• Shock
  • Pathophysiology
    • Compensation for shock
    • Reperfusion following shock
    • Multiple organ dysfunction syndrome (MODS)
  • Etiology and Classification
    • Hypovolemic shock
    • Distributive shock
    • Cardiogenic and obstructive shock
    • Etiology and classification references
  • Symptoms and Signs
  • Diagnosis
    • Identifying etiology
    • Additional testing
    • Diagnosis references
  • Treatment
    • General management of shock
    • Treatment of hemorrhagic shock
    • Treatment of distributive shock
    • Treatment of cardiogenic shock
    • Treatment references
  • Prognosis

• Intravenous Fluid Resuscitation
  • Fluids
    • Hemorrhage
    • Nonhemorrhagic hypovolemia
    • Fluids references
  • Route and Rate of Fluid Administration
  • End Point and Monitoring of Fluid Resuscitation
    • Central venous pressure
    • Traumatic hemorrhagic shock
  • Complications