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Table of Contents
Contributors
Preface
I On-Call Problems 1
1 Abdominal Pain 1
2 Acidosis: Metabolic 8
3 Acidosis Respiratory 11
4 Acute Liver Failure 13
5 Acute Loss of Pulse in an Extremity 15
6 Airway Pressure: Sudden Increase 18
7 Alkalosis: Metabolic 20
8 Alkalosis: Respiratory 23
9 Altered Mental Status/Hallucinations 24
10 Anaphylaxis 27
11 Anemia 29
12 Arterial Line: Expanding Hematoma, Malfunction 32
13 Aspiration 36
14 Bleeding at the Site of an Invasive Line/DIC 39
15 Bradycardia 42
16 Brain Death 46
17 Burns 47
18 Cardiopulmonary Arrest 53
19 Central Venous Pressure (CVP) Catheter: Cannot Withdraw Blood 57
20 Cervical Spine Precautions 67
21 Chest Pain 70
22 Chest Tube Air Leak 75
23 Death 76
24 Decreased Cardiac Output 78
25 Decreased Central Venous Pressure (CVP) 84
26 Decreased Intracranial Pressure (ICP) 86
27 Delirium Tremens 87
28 Dislodged ICP Monitor 89
29 Double Lumen Intubation 90
30 Dyspnea 95
31 Electrocardiogram (ECG) Changes: Acute Myocardial Infarction 96
32 Endotracheal Tube: Air Leak, Malposition, Malfunction 101
33 Fall from Bed 105
34 Fever 106
35 Foley Catheter: Cannot Place 109
36 Fungal Infection 111
37 Gastrointestinal Bleeding: Hematochezia 113
38 Gastrointestinal Bleeding: Melena 117
39 Gastrostomy Tube, Dislodged 119
40 Hematemesis 121
41 Hematuria 125
42 Hemoptysis 128
43 Hemothorax 132
44 Hyperglycemia 135
45 Hyperkalemia 136
46 Hypernatremia 139
47 Hypertension 141
48 Hypoglycemia 146
49 Hypokalemia 147
50 Hyponatremia 149
51 Hypotension 151
52 Hypothermia 156
53 Increased Intracranial Pressure 158
54 Intra-Aortic Balloon Pump: Hypotension 161
55 Intubation: Bronchospasm 165
56 Lumbar Drain Malfunction 169
57 Nasal Intubation 170
58 Nasogastric Tube Bleeding 172
59 Nasogastric Tube Removed Early 175
60 Nausea/Vomiting 176
61 Neck Swelling 180
62 Needlestick 182
63 Oliguria/Anuria 184
64 Operating Room Transport: Ventilator Issues 188
65 Otorrhea/Rhinorrhea 189
66 Oxygen Desaturation 191
67 Pacemaker Malfunction 196
68 Pain 198
69 Persistent Neuromuscular Blockade 201
70 Pleural Effusion 206
71 Pneumothorax 211
72 Polyuria 213
73 Posturing: Decorticate/Decerebrate 215
74 Pregnancy 217
75 Pruritus 220
76 Pulmonary Artery (PA) Catheter: Cannot Wedge, Malfunction 222
77 Pulse Oximeter Malfunction 225
78 Sedation: Indications and Techniques 229
79 Seizures 233
80 Stridor 235
81 Subcutaneous Emphysema 238
82 Swollen Extremity 240
83 Tachycardia 244
84 Tachypnea 248
85 Tracheal Deviation 251
86 Transfusion Reaction 254
87 Ventricular-Peritoneal (V-P) Shunt Malfunction 256
88 Ventilator: Bucking, High Peak Airway Pressure (PAP) 258
89 Wheezing 261
II Laboratory Tests and Their Interpretation 265
III Bedside Procedures 319
IV Fluid and Blood-Product Management 359
V Nutritional Management of the Critically Ill Patient 371
VI Ventilator Management 387
VII Transplantation: Special Considerations in Critical Care 407
VIII Commonly Used Medications 429
Appendices 529
1 Critical Care Formulas 530
2 Basic Approach to the Diagnosis of Acid-Based Disorders 532
3 Glasgow Coma Scale (GCS) Score 533
4 Body Surface Area Nomogram 534
Index 535

Forewords & Introductions
Preface
The field of critical care has undergone a revolution in the last twenty-five years. It is now defined by contributions from surgery, internal medicine, and anesthesiology. This new text is designed to help the people "in the trenches" of critical care and has been written with contributors from each of these three disciplines. Many of the contributors are residents and fellows in critical care who work daily in this field.

It is my hope that you will carry this book with you daily and refer to it often. It is intended as a practical reference to help deal with the problems that commonly occur in the Critical Care Unit while you are "on call." Although it is often said that the best way to avoid errors is to have experience, and the only way to get experience is to make errors, this book is intended to give you a framework for evaluating the problems that arise in the course of caring for critically ill patients. Once you have seen the patient and performed an evaluation, it may be necessary to seek more experienced advice. The information in this book will provide you with a way to think about a problem and its initial evaluation.

The continued support of the editorial staff at McGraw-Hill is gratefully acknowledged. This book and others in the On-Call series could not have been created without the unflagging efforts of Ms. Janet Foltin. I also wish to acknowledge the significant efforts of all three associate editors, Drs. David L. Bogdonoff, Douglas Geehan, and Lawrence Maldonado, without whose attention to detail this book would lack the balance so important among the three disciplines represented. Lastly, and most importantly, I want to thank the families and friends of all the authors, who support us, yet allow us to devote our time, perhaps our most precious resource, to academic pursuits.

Most of all, I hope that this information will improve the care that our patients receive in critical care units. -- Alan T. Lefor, MD, MPH, FACS, Los Angeles, California, April 2002