Critical care medicine encompasses the clinical, diagnostic and therapeutic skills required to manage critically ill patients in a variety of settings including intensive care, high dependency, surgical recovery and coronary care units. These disciplines have developed rapidly over the past 30 years and are an integral part of most medical, anaesthetic and surgical specialties. Medical students, junior doctors, nursing and paramedical staff are increasingly expected to develop the skills necessary to recognize and manage critically ill patients, and most will be familiar with the apprehension that precedes such training. Unfortunately, most current texts relating to critical care medicine are unavoidably extensive. It is the aim of Critical Care Medicine at a Glance to provide a brief, rapidly informative text, easily assimilated before starting a new job, that will prepare the newcomer for those aspects of these specialties with which they may not be familiar. These include assessment of the acutely unwell patient, monitoring, emergency resuscitation, oxygenation, circulatory support, methods of ventilation and management of a wide variety of medical and surgical emergencies.
As with other voiumes in the 'At a Glance' series, this book is based around a two-page spread for each main topic, with figures and text complementing each other to give an overview of a topic at a glance. Although primarily designed as an introduction to critical care medicine, it should also be a useful undergraduate revision aid. However, such a brief text cannot hope to provide a complete guide to clinical practice and postgraduate students are advised that additional reference to more detailed textbooks will aid deeper and wider understanding of the subject. On the advice of our readers, the third edition includes new chapters on fluid management, arrhythmias, infection, stroke, jaundice, intestinal obstruction, ascites and imaging; and previous chapters have been extensively updated to include recent guidelines and innovations. As with many new specialties, certain aspects of critical care medicine remain controversial. When controversy exists, I have attempted to highlight the differences of opinion and, with the help of many colleagues and reviewers, to provide a balanced perspective, although on occasions this has proven difficult. Nevertheless, errors and omissions may have occurred and these are entirely our responsibility.
Many colleagues, junior doctors and medical students have advised and commented on the content of Critical Care Medicine at a Glance. I would particularly like to thank my medical colleagues on the acute medical, high dependency and intensive care units at Guy's, St Thomas' and Johns Hopkins Hospitals, and the Anaesthetic Department at St Thomas' Hospital. Special thanks are due to the senior nurses at Guy's and St Thomas' Hospitals and to Mrs Clare Leach for their advice on the many aspects of nursing care so essential in critical care medicine. Finally, I would like to thank all the staff at Wiley-Blackwell, especially Karen Moore and Katrina Rimmer, for all their help and support in producing this text. Richard Leach

Preface viii

Acknowledgements ix

Units, symbols and abbreviations x

How to use your textbook xvi

Part 1 General 1

1 Recognizing the unwell patient 2

2 Managing the critically ill patient 4

3 Monitoring in critical care medicine 6

4 The electrocardiogram 8

5 Cardiopulmonary resuscitation 10

6 Oxygen transport 12

7 Shock 14

8 Circulatory assessment 16

9 Fluid management: pathophysiological factors 18

10 Fluid management: assessment and prescription 20

11 Fluid management: fluid choice 22

12 Inotropes and vasopressors 23

13 Failure of oxygenation and respiratory failure 24

14 Oxygenation and oxygen therapy 26

15 Airways obstruction and management 28

16 Non-invasive ventilation 30

17 Endotracheal intubation 32

18 Mechanical ventilation 34

19 Respiratory management, weaning and tracheostomy 36

20 Arterial blood gases and acid-base balance 38

21 Analgesia, sedation and paralysis 40

22 Enteral and parenteral nutrition 42

23 Hypothermia and hyperthermia 44

24 Assessment of the patient with suspected infection 46

25 Bacteraemia, SIRS and sepsis 48

26 Hospital-acquired (nosocomial) infections 50

27 Fever in the returning traveller 52

28 Fever (pyrexia) of unknown origin 54

29 End of life issues 56

Part 2 Medical 59

Cardiac

30 Acute coronary syndromes I: clinical pathophysiology 60

31 Acute coronary syndromes II: investigations and management 62

32 Arrhythmias: tachyarrhythmias 64

33 Arrhythmias: bradyarrhythmias 67

34 Heart failure and pulmonary oedema 68

35 Cardiac emergencies 70

36 Deep venous thrombosis and pulmonary embolism 72

Respiratory

37 Chest imaging and bronchoscopy 74

38 Community-acquired pneumonia 76

39 Hospital-acquired (nosocomial) pneumonia 78

40 Asthma 80

41 Chronic obstructive pulmonary disease 82

42 Acute respiratory distress syndrome 84

43 Pneumothorax and air leaks 86

44 Respiratory emergencies 88

Renal and metabolic

45 Acute kidney injury: pathophysiology and clinical aspects 90

46 Acute kidney injury: management and renal replacement therapy 92

47 Electrolyte disturbances: sodium and potassium 94

48 Electrolyte disturbances: calcium 96

49 Electrolyte disturbances: magnesium and phosphate 98

50 Diabetic emergencies 100

51 Endocrine emergencies 102

Gastrointestinal

52 Gastrointestinal haemorrhage 104

53 Jaundice 106

54 Acute liver failure 108

55 Acute pancreatitis 110

56 Vomiting and intestinal obstruction 112

57 Diarrhoea 114

58 Ascites 116

59 Abdominal imaging 117

Neurological

60 Acute confusional state, coma and status epilepticus 118

61 Stroke 120

62 Other cerebral vascular disorders 122

63 Infective neurological emergencies 123

64 Neuromuscular conditions 124

Infective

65 Specific bacterial infections 126

66 Common adult viral infections 128

67 Common fungal and protozoal infections 130

68 The immune compromised patient 132

Other systems

69 Coagulation disorders and transfusion 134

70 Drug overdose and poisoning 136

Part 3 Surgical 138

71 Trauma 140

72 Head injury 142

73 Chest trauma 144

74 Acute abdominal emergencies 146

75 Obstetric emergencies 148

76 Burns, toxic inhalation and electrical injuries 150

Part 4 Self-assessment

Case studies and questions 152

Case studies answers 155

Appendices

Appendix I Classification of antiarrhythmic drugs 162

Appendix II Pacemaker types and classifications 163

Appendix III Acute injury network staging system 2008 for acute kidney injury (AKI) 164

Appendix IV Rockall risk-scoring system for Gl bleeds 165

Appendix V Child-Pugh grading 166

Appendix VI Typical criteria for liver transplantation 167

Appendix VII Royal College of Physicians' top nutrition tips 168

Index 169

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