Critical Care and Hospitalist Medicine Made Ridiculously Simple
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Critical Care and Hospitalist Medicine Made Ridiculously Simple

by Mark T. Gladwin, Michael Donahoe,

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A fundamental and thorough guide to the treatment of hospitalized patients in critical care situations, Critical Care and Hospitalist Medicine Made Ridiculously Simple provides both introductory information as well as a complete base of knowledge that will be useful from medical student, to resident, to fellow, to practicing intensivist, hospitalist, internist, and specialists all charged with caring for patients in the ICU and Emergency Department, as well as the wards, as critical care situations arise throughout the hospital, wherever the hospitalist practices. The current and practical content is organized in a logical conceptual manner, using plain English for rapid assimilation of information, and focusing on critical care facts and approaches required to keep the critically ill patient alive and thriving.

Topics include: The Art of Patient Presentation, Approach to Acute Care Chest Radiology with the Top Ten X-ray Bad Guys, goals and findings of Point of Care Ultrasound, Sepsis and Resuscitation, Management of Tachyarrythmias, Running a Code, Hemodynamic Monitoring, Acute Coronary Syndromes, Acute Decompensated Heart Failure, High Systemic Arterial Blood Pressure, Pulmonary Thromboembolic Disease, Basic Airway Management, Acute Respiratory Failure, Mechanics of Respiratory Failure, Mechanical Ventilation, Acute Respiratory Distress Syndrome, Obstructive Lung Disease and Respiratory Failure, Weaning From Mechanical Ventilation, Bleeding Clotting and Hematological Emergencies, Transfusion Medicine, Acute Kidney Injury, GI Bleeding, Acid-Base Disorders, Drug Overdose, and Neurologic Emergencies.

Despite its in-depth treatment of Critical Care, the book is written in the reader-friendly and often humorous style of other Made Ridiculously Simple publications.
  • Pages: 388
  • Publication: Edition 1 (October 23, 2019)
  • Language: English
  • ISBN: 9781935660347

About the Authors

Mark T. Gladwin

Mark T. Gladwin, M.D. is Jack D. Myers Professor and Chair of the Department of Medicine and Director, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute UPMC and the University of Pittsburgh School of Medicine.

Michael Donahoe

Michael Donahoe, M.D. is Professor of Medicine, division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh School of Medicine and UPMC.

A fundamental and thorough guide to the treatment of hospitalized patients in critical care situations, Critical Care and Hospitalist Medicine Made Ridiculously Simple provides both introductory information as well as a complete base of knowledge that will be useful from medical student, to resident, to fellow, to practicing intensivist, hospitalist, internist, and specialists all charged with caring for patients in the ICU and Emergency Department, as well as the wards, as critical care situations arise throughout the hospital, wherever the hospitalist practices. The current and practical content is organized in a logical conceptual manner, using plain English for rapid assimilation of information, and focusing on critical care facts and approaches required to keep the critically ill patient alive and thriving.

Topics include: The Art of Patient Presentation, Approach to Acute Care Chest Radiology with the Top Ten X-ray Bad Guys, goals and findings of Point of Care Ultrasound, Sepsis and Resuscitation, Management of Tachyarrythmias, Running a Code, Hemodynamic Monitoring, Acute Coronary Syndromes, Acute Decompensated Heart Failure, High Systemic Arterial Blood Pressure, Pulmonary Thromboembolic Disease, Basic Airway Management, Acute Respiratory Failure, Mechanics of Respiratory Failure, Mechanical Ventilation, Acute Respiratory Distress Syndrome, Obstructive Lung Disease and Respiratory Failure, Weaning From Mechanical Ventilation, Bleeding Clotting and Hematological Emergencies, Transfusion Medicine, Acute Kidney Injury, GI Bleeding, Acid-Base Disorders, Drug Overdose, and Neurologic Emergencies.

Despite its in-depth treatment of Critical Care, the book is written in the reader-friendly and often humorous style of other Made Ridiculously Simple publications.
  • Pages: 388
  • Publication: Edition 1 (October 23, 2019)
  • Language: English

About the Authors

Mark T. Gladwin

Mark T. Gladwin, M.D. is Jack D. Myers Professor and Chair of the Department of Medicine and Director, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute UPMC and the University of Pittsburgh School of Medicine.

Michael Donahoe

Michael Donahoe, M.D. is Professor of Medicine, division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh School of Medicine and UPMC.

Table of Contents

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  • Introduction Contributors 

    The Illustrator

    The Consultant for Point of Care Ultrasound (POCUS)

    Chapter 1 The Art of the Patient Presentation 

    1.1 Welcome to Acute Hospital Medicine

    1.2 How to Summarize Your Patient

    1.3 Structure Those Random Thoughts

    1.4 Think Data—Diagnosis—Direction

    1.5 A Sample Presentation

    Chapter 2 Acute Care Chest Radiology 

    2.1 Basics of Reading Portable Chest Radiographs

     Is the Radiograph Worth Reading?

     Ignore the Most Interesting Findings

     Get to the Heart of the Matter

     The Pleural Space and Costophrenic Angles

     Finally, the Lungs!

    2.2 Our Top Ten X-Ray Bad Guys

     #10 Mediastinal and Hilar Masses

     #9 Pericardial Effusion and Tamponade

     #8 Pulmonary Hypertension and Pulmonary Emboli

     #7 Tube Mishaps

     #6 Pneumothorax and Barotrauma

     #5 Effusions, Empyema, and Hemothorax

     #4 Atelectasis and Lobar Collapse

     #3 Congestive Heart Failure

     #2 Pneumonia

     #1 Adult Respiratory Distress Syndrome

    Suggested Reading

      Chapter 3 Point of Care Ultrasound (Pocus) 

    3.1 The Three Goals of POCUS

     Procedural Guidance

     Diagnosis

     Shock Management

    3.2 POCUS Lingo

    3.3 Our Top Ten POCUS Findings in the ICU

     Vessel Location for Catheter Placement

     Pneumothorax

     Pleural Fluid

     Lung Patterns

     Left Ventricle and Right Ventricle Dysfunction

     Valvular Vegetation

     Inferior Vena Cava (IVC) Size

     Distended Bladder

     Peritoneal Fluid

     Deep Venous Thrombosis (DVT)

    3.4 POCUS Focus

    Chapter 4 Sepsis and Resuscitation 

    4.1 Sepsis Defined

    4.2 Sepsis and Shock

    4.3 Initial Sepsis Management

     Reverse Hypoxemia and Limited Ventilation

     Reverse Hypotension and Support Organ Perfusion

    4.4 Fluid Administration in Sepsis

     Crystalloids vs. Colloids

    4.5 Vasopressors and Inotropes

    4.6 Assessment of Tissue Oxygenation

     Mixed Venous Oxygen Saturation

     Blood Lactate

    4.7 Hydrocortisone and Septic Shock

    4.8 Antibiotics and Source Control

    Suggested Reading

      Chapter 5 Management of Tachyarrythmias 

    5.1 Do I Have Time to Think?

    5.2 What is the Diagnosis?

     Narrow Complex Tachycardia

     Wide Complex Tachycardia

    5.3 How Do I Stop the Arrhythmia?

     Sinus Tachycardia

     Atrial Fibrillation and Flutter

     Multi-focal Atrial Tachycardia

     Paroxysmal Supraventricular Tachycardia (PSVT)

     Ventricular Tachycardia

    5.4 What is the Rhythm Trying to Tell Me?

    5.5 Do I Need to Anticoagulate?

    Suggested Reading

      Chapter 6 Running a Code 

    6.1 Chest Compressions

    6.2 Circulation: Take Charge and Shock

     Defibrillators

     Pulseless and a Shockable Rhythm

     Pulseless Electrical Activity (PEA)

     Pulseless and Asystole (Flat Line)

    6.3 Breathing and Airway

    6.4 Post-Arrest Care

    Suggested Reading

      Chapter 7 Hemodynamic Monitoring 

    7.1 Arterial Blood Pressure

     The Arterial Catheter

    7.2 Pressure Transducers

    7.3 Vascular Pressures and the Pulmonary Artery Catheter

     Atrial Pressures and Waveforms

     Ventricular Pressures and Waveforms

     Pulmonary Artery Pressure and Waveforms

    7.4 Cardiac Chamber Pressures and Pericardial Disease

    7.5 Cardiac Output

    7.6 Vascular Resistance

    7.7 Shock and Hemodynamic Assessment

     Hypovolemic Shock

     Cardiogenic Shock

     Distributive Shock

    7.8 Limitations of the Pulmonary Artery (PA) Catheter

    7.9 Hemodynamic Assessment without the PA Catheter

     Techniques to Change Preload

     Techniques to Assess Stroke Volume

     Inferior Vena Cava Diameter

     Miscellaneous Methods for Preload Assessment

    7.10 Hemodynamic Approach to Your ICU Patient

    Suggested Reading

      Chapter 8 Acute coronary syndromes 

    8.1 Step 1: Cool down the Heart

    8.2 Step 2: Classify the ACS Syndrome (STEMI, Unstable Angina, NSTEMI)

     The ECG

     Cardiac Biomarkers

     ST Elevation Myocardial Infarction (STEMI)

     Non-ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA)

    8.3 Step 3: Crush the Platelets

    8.4 Step 4: Bash the Coagulation System for UA and NSTEMI

    8.5 Step 5: Blast Open the Obstruction for STEMI and High-Risk NSTEMI

     Treatment at a PCI-Capable Hospital

     Pharmacologic Therapy for Non-PCI-Capable Hospital

     Coronary Artery Bypass Grafting (CABG)

    8.6 Wrapping it up

    Suggested Reading

      Chapter 9 Acute Decompensated Heart Failure 

    9.1 Diagnosis of Decompensated Left Heart Failure

     Imaging

     Brain Natriuretic Peptide

     Echocardiography

    9.2 Treatment of Acute Decompensated Left Heart Failure

     Reduce Left Ventricular Filling Pressure (Preload)

     Reduce Systemic Vascular Resistance (Afterload)

     Fix the Broken Heart (Dam)—Increase Cardiac Output

     Find the Cause

     Arrythmia Management

     Hypertension Management

    9.3 Diagnosis of Pulmonary Hypertension and Right Heart Failure

     Pulmonary Hypertension Classification

     Pulmonary Hypertension Diagnosis

     Why Pulmonary Hypertension Matters

    9.4 Treatment of Pulmonary Hypertension in the Hospital

     Nitric Oxide

     Endothelin A and B Receptor Blockers

     Prostanoids

     Inotropes

     Heroics

    9.5 Pulmonary Hypertension with Shock

    Suggested Reading

      Chapter 10 High Systemic Arterial Blood Pressure 

    10.1 Pathophysiology of Hypertensive Urgency

    10.2 Patient Assessment

    10.3 Drug Therapy

     Calcium Channel Blockers

     Nitric Oxide Vasodilators

     Beta-Blockers

     Miscellaneous Medications

    10.4 Hypertensive Emergency Clinical Syndromes

     Cardiovascular Disease

     Cerebrovascular Disease

     Subarachnoid Hemorrhage (SAH)

     Renovascular Disease

     Excess Catecholamine States

     Miscellaneous Conditions

      Chapter 11 Pulmonary Thromboembolic Disease 

    11.1 Pathophysiology

     Right Heart Failure in PE

     Gas Exchange in PE

    11.2 Diagnosis and Risk Stratification

     Diagnostic Risk – PE Clinical Decision Rules

     Mortality Risk

    11.3 Treatment of Massive PE

     Oxygenate and Ventilate

     Optimize RV Cardiac Output

     Reduce RV Afterload with Anticoagulation

     To Lyse or Not to Lyse

    11.4 Treatment of Submassive PE

    Suggested Reading

      Chapter 12 Basic Airway Management 

    12.1 Establish a Patent Airway with Ventilation

    12.2 Clinical Clues for a Difficult Intubation

    12.3 Key Steps to a Successful Airway

    12.4 Endotracheal Intubation

     The Tools

     Pre-oxygenation

     Intubation Pharmacology

     Post-intubation Hemodynamics

    12.5 The Difficult Airway

    12.6 Changing the Endotracheal Tube

    Suggested Reading

      Chapter 13 Acute Respiratory Failure 

    13.1 Assessment of Arterial Blood Oxygenation

     Partial Pressure of Oxygen (PaO2)

     Pathophysiology of Hypoxemia

     Non-invasive Oxygen Saturation (SpO2)

     Assessment of Tissue Oxygen Delivery (DO2)

    13.2 Supplemental Oxygen and Hypoxemic Respiratory Failure

     Low-Flow Oxygen Systems

     High-Flow Oxygen Systems

     High-Flow Nasal Cannula

     Fixing Hypoxemia

    13.3 Assessment of Ventilation (PaCO2 )

     Non-Invasive Assessment of Carbon Dioxide

    13.4 Hypercapnic Respiratory Failure

     Primary and Secondary Compensation

     Etiology of Ventilation Disorders in the ICU

    Suggested Reading

      Chapter 14 Mechanics of Respiratory Failure 

    14.1 Simple Mechanics of Lung Inflation – the EOM

    14.2 Compliance/Elastance and Pleural Pressure

                Measurement of Compliance

    14.3 Resistance and Time Constants

     Measurement of Airways Resistance

    14.4 Let’s Put it Together

    Suggested Reading

      Chapter 15 Mechanical Ventilation 

    15.1 Ventilator Components

    15.2 Setting the Breath Rate (Triggering)

     Pressure-Based Triggering

     Flow-Based Triggering

    15.3 Setting the Breath Type

     Control Breaths

     Support Breaths

    15.4 Modes of Mechanical Ventilation—The Full Monty

     Control (Assist Control) Ventilation

     Intermittent Mandatory Ventilation (IMV)

     Spontaneous Mode of Ventilation

     APRV and BiLevel Ventilation

    15.5 Mode summary

    15.6 Positive End-Expiratory Pressure—PEEP, CPAP, and EPAP

     Adverse Effects of End-Expiratory Pressure

    15.7 How to Set Your Best PEEP on the Ventilator

    15.8 Extrinsic vs. Intrinsic PEEP

    15.9 Mean Airway Pressure and Oxygenation

    Suggested Reading

      Chapter 16 Acute Respiratory Distress Syndrome (Ards) 

    16.1 ARDS Ridiculously Simple Overview

    16.2 Berlin Definition

    16.3 Causes of ARDS

    16.4 Pathophysiology of ARDS

     ARDS as a Heterogeneous Lung Disease

    16.5 Airway Management in ARDS

    16.6 ARDS and the Ventilator – First Do No Harm

     Oxygen Toxicity: Hyperoxic Lung Injury

     Barotrauma—No Pressure!

     Volutrauma—Turn Down the Volume!

     Atelectrauma—The Elusive Best Peep!

    16.7 Mechanical Ventilation in ARDS

     Control Breaths

     PEEP Management

     Alveolar Recruitment Maneuvers

    16.8 Fluid Management in ARDS—Wet or dry?

    16.9 Approach to Intractable Hypoxemia in ARDS

    Pharmacologic Paralysis

    Prone Ventilation

    Inhaled Vasodilators

    High-frequency Oscillation

    APRV and Bilevel Ventilation

    Extracorporeal Support

    Hypoxemia Overview

    16.10 The Little Things

    16.11 Prognosis

    Suggested Reading

      Chapter 17 Obstructive Lung Disease (Old) and Respiratory Failure 

    17.1 Pathophysiology of Airflow Obstruction

    17.2 Intrinsic PEEP (PEEPi) in OLD

     Intrinsic PEEP Assessment

    Complications of Intrinsic PEEP

     Limiting Intrinsic PEEP in OLD

    17.3 Mechanical Ventilation in OLD

     Non-Invasive Mechanical Ventilation in OLD

     Invasive Mechanical Ventilation in OLD

     Ventilator Management in OLD

    17.4 Drug Therapy in OLD

     Antibiotics

     Bronchodilators

     Corticosteroids

               Miscellaneous Interventions

    17.5 Patient Outcome

    Suggested Reading

      Chapter 18 Weaning From Mechanical Ventilation 

    18.1 Control That SOB

    18.2 Spontaneous Breathing Trial (SBT)

     Spontaneous Breathing Trial Intolerance

     Removing the Tube

    18.3 Non-invasive Ventilation (NIV) and Weaning

    18.4 Alternatives to the SBT Trial

    18.5 Beyond the SBT Trial – Pain, Sedation, and Delirium

     Sedation Management: Less Is More

     Pain Management

     Delirium

     Early Mobility in the ICU

    18.6 Coordination of Ventilator Care – Know Your Alphabet?

    18.7 When Is a Tracheostomy Indicated?

     Timing and Technique of Tracheostomy

     Type and Size of the Tracheotomy Tube

     Care of the Tracheotomy Tube

     Swallowing

     Decannulation

    Suggested Reading

      Chapter 19 Bleeding, Clotting and Hematological Emergencies 

    19.1 Clotting Cascade: Help Me Memorize!!!

     Extrinsic or Tissue Factor Pathway

     Intrinsic or Contact (collagen) Activation Pathway

     Anti-Clotting Pathways

    19.2 Overview of Bleeding and Clotting disorders

     Things that Elevate the PT-INR

     Things that Elevate the PTT

     Things that Elevate both PT-INR and PTT

    19.3 Top four Bad Boys of ICU Hematology

     Public Enemy #1: Heparin-Induced Thrombocytopenia (HIT)

     Public Enemy #2: Disseminated Intravascular Coagulation (DIC)

     Public Enemy #3: Thrombotic Thrombocytopenic Purpura (and HELLP! and HUS!)

     Public Enemy #4: Catastrophic Antiphospholipid Antibody Syndrome (CAPS)

    Suggested Reading

      Chapter 20 Transfusion Medicine 

    20.1 Quick-Thinking Rapid Transfusion

    20.2 Red Blood Cell Transfusions

     When to Transfuse?

     Complications of Red Blood Cell Transfusion

    20.3 Platelets

    20.4 Fresh Frozen Plasma (FFP)

    20.5 Cryoprecipitate

    20.6 Recombinant Factor VIIa (Novo-Seven)

    20.7 Four-Factor Prothrombin Complex Concentrate

    Suggested Reading

      Chapter 21 Acute Kidney Injury 

    21.1 Classification of Acute Kidney Injury

    21.2 Drug-induced Acute Kidney Injury

    21.3 Prevention of Acute Kidney Injury

     Hypoperfusion

     Contrast-Induced AKI

     Aminoglycoside Nephropathy

    21.4 Management of Acute Kidney Injury

     Diuretic Use in AKI

     Dialysis Therapy

     Dialysis Methods

     Dialysis Dose

    Suggested Reading

      Chapter 22 Gastrointestinal Bleeding 

    22.1 ABC’s (and D) of GI Bleeding

     Access

     Blood and Blood Products

     Call for Help

     Diagnose the Bleeding Source

    Suggested Reading

      Chapter 23 Acid-Base Disorders 

    23.1 Simple Acid-Base

    23.2 Primary Disturbance and Secondary Compensation

    23.3 The Four Steps of Acid-Base Analysis

     STEP 1: Define the Primary Disorder

     STEP 2: Assess the Compensation

     STEP 3: Calculate the Anion Gap

     STEP 4: Calculate the Delta Gap

    23.4 Respiratory Acid-Base Disorders

     Respiratory Acidosis

     Respiratory Alkalosis

    23.5 Metabolic Acid-Base Disorders

     Metabolic Acidosis and the Anion Gap

     Metabolic Acidosis and the Osmolar Gap

     Anion Gap Metabolic Acidosis and Management

     Non-Anion Gap Acidosis

    23.6 Metabolic Alkalosis

     Contraction Alkalosis

     Post-Hypercapnic Metabolic Alkalosis

     Mineralocorticoid Excess

    Suggested Reading

      Chapter 24 Drug Overdose 

    24.1 The Basics

     Resuscitate and Stabilize

     Confirm Diagnosis and Toxin

     Antidotes and Toxin Elimination

     The Overdose Booby Traps

    24.2 Specific Overdoses

     Acetaminophen

     Alcohols

     Benzodiazepines

     Slow it Down: Beta Blockers and Calcium Channel Blockers

     Speed it Up: Cocaine and Cathinones

     Hypoglycemia Secondary to Insulin and Oral Hypoglycemic Agents

     Antidepressants and the Abnormal ECG

     Salicylates and the Pseudosepsis Syndrome

     Serotonin Syndrome

     Opioids

    Suggested Reading

    Chapter 25 Neurologic Emergencies 

    25.1 Acute Ischemic Stroke

    25.2 Acute Intracerebral Hemorrhage

     Blood Pressure Control

     Reversal of Coagulopathy

     Elevated Intracranial Pressure

    25.3 Status Epilepticus

    25.4 Acute Myasthenic Crisis

    Suggested Reading

    References Index   

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