Download Civetta, Taylor, and Kirby’s Manual of Critical Care by Gabrielli, Yu, Layon PDF

By Gabrielli, Yu, Layon

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Extra resources for Civetta, Taylor, and Kirby’s Manual of Critical Care

Example text

TA B L E 2 . , myocardial insufficiency) Volume imbalances (sepsis, diuretics, hypovolemia, hemorrhage) Preload dependent physiology Valvular heart disease, congestive heart failure, pulmonary embolus, right ventricular failure, restrictive pericarditis, cardiac tamponade Hypoxia-related hemodynamic deterioration Hyperkalemia-induced deterioration (succinylcholine) sCuff leak volume (CLV) may be measured as the difference of tidal volume delivered with and without cuff deflation and stated as a percentage of leak or as an absolute volume.

5 mV. ASSESSMENT OF THE PATIENT sA complete patient assessment must be made prior to pacemaker placement. sBradycardia alone is not sufficient. sHemodynamic instability, symptoms, or evidence of significant conduction system disease on the electrocardiogram (ECG) (bundle branch block, high-degree heart block) favors therapy. sReversible causes, especially medications, should be sought. sGlucagon may be effective for β-blocker overdose, calcium for calcium channel overdose, and digoxin immune Fab (Digibind) for digitalis glycoside overdose sSome bradycardias can be treated medically with agents such as isoproterenol, a β 1 -receptor agonist that increases heart rate.

TA B L E 2 . 1 1 THE DIFFICULT EXTUBATION: TWO CATEGORIES FOR EVALUATION 1. Evaluate the patient’s inability to tolerate extubation a. Airway obstruction (partial or complete) b. Hypoventilation syndromes c. Hypoxemic respiratory failure d. Failure of pulmonary toilet e. Inability to protect airway 2. Evaluate for potential difficulty re-establishing the airway a. Difficult airway b. Limited access to the airway c. Inexperienced personnel pertaining to airway skills d. Airway injury, edema formation TA B L E 2 .

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