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Chapter 28: Critical Care

INTRODUCTION

  • Routine Care of the Critically Ill Patient

    • ICU Progress Note

    • Routine Monitoring in the Intensive Care Unit

    • Considerations When Transporting Critically Ill Patients

    • End-of-Life Considerations

  • Management Considerations in the Intensive Care Unit: Central Nervous System (CNS)

    • Analgesia and Sedation

    • Delirium

  • Management Considerations in the Intensive Care Unit: Cardiovascular System

    • Inspection

    • Auscultation and Heart Murmurs

    • Blood Pressure

  • Cardiovascular Physiology

    • General Principles

    • Central Venous Pressure (CVP)

    • Pulmonary Artery Catheters (Swan–Ganz Catheter)

  • Pulmonary Physiology

    • Ventilation

    • Oxygenation

  • Guidelines for Airway Management in the ICU Setting

    • Indications for Endotracheal Intubation

    • Noninvasive Ventilation (NIV)

    • Securing the Airway

    • Surgical Options for Airway Management

  • Principles of Mechanical Ventilation

    • Ventilator Management

  • Nutrition and the ICU Patient

  • Complications and Special Conditions in Critical Care

    • Abdominal Compartment Syndrome

    • Acalculous Cholecystitis

    • Acute Adrenal Insufficiency

    • Acute Renal Failure (ARF)

    • Acute Respiratory Distress Syndrome (ARDS)

    • COVID-19 ICU Management

    • Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE)

    • Gastrointestinal Bleeding

    • Infectious Complications

    • Shock

  • ICU Outcomes and Severity of Illness Measures

  • Quick Reference to Common ICU Equations

  • Guidelines for Adult Critical Care Drug Infusions

Chapter update by J. Patton Robinette, MD, Luis C. Suarez-Rodriguez, MD, and John A. Morris, MD. Technical Contributor: Vanessa Gleason, PharmD. Original chapter and artwork by John A. Morris, MD.

ROUTINE CARE OF THE CRITICALLY ILL PATIENT

Patients admitted to the intensive care unit (ICU) often have multisystem disease, traumatic injuries, or are under intensive treatment regimens to manage end-organ dysfunction. The interactions between dysfunctional organ systems are complicated and can be overwhelming to students and new house officers. This chapter describes an organ-system approach to evaluate and treat critically ill patients and resultant complications.

The first part of this critical care chapter will address routine documentation and management of patients in the ICU. The second part of the chapter focuses on the physiologic approach to organ function and dysfunction in the ICU. The last section addresses complications and guidelines for treatment.

The field of critical care medicine is rapidly advancing and practice guidelines and protocols are being introduced to standardize care, reduce variation, and improve outcomes. Where available, national practice guidelines will be presented to frame the student’s understanding of treatment options for the following domains:

  • Sedation and analgesia

  • Delirium and substance withdrawal

  • Nutrition

  • Intensive insulin therapy

  • Deep venous thrombosis (DVT) and stress ulcer prophylaxis

  • Weaning from mechanical ventilation

  • Management of sepsis including:

    • Goal-directed therapy oxygen delivery; fluid resuscitation; transfusion; vasopressors; antibiotics

    • Adrenal insufficiency and use of steroids

    • Adult respiratory distress syndrome (ARDS)

We have divided the routine care of patients in the ICU into four parts:

  • ICU Progress Note

  • Routine ICU Monitoring

  • The Risk of Transport

  • End-of-Life Issues

ICU Progress Note

Understanding the complex care delivered in an ICU starts with a structured approach of the ICU progress note. The ICU progress note is a concise ...

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