Introduction Over the last decades, cardiovascular monitoring techniques used in the intensive care unit (ICU) and operating room (OR) have progressively evolved from invasive toward less invasive approaches. In the 1990s, the pulmonary artery catheter (PAC) was at its apogee,…
Recent advances in ultrasound technology have allowed ultrasound instruments to become smaller, more portable, and less expensive, so that this powerful imaging tool can be readily and repeatedly used in everyday intensive care unit (ICU) care. The concept of point-of-care…
The identification of myocardial injury is an important problem in the critical care setting. Biomarkers have been used to detect myocardial injury since 1954. Since then, the sensitivity of serologic techniques has increased dramatically. Although increased sensitivity has allowed clinicians…
Initial approach Several life-threatening conditions can cause chest pain in the critically ill, and the initial approach should focus on prompt evaluation and resuscitation of the airway, breathing, and circulation. Assess the patient’s level of consciousness, palpate the pulse, and…
Diarrhea is one of the most common manifestations of gastrointestinal (GI) dysfunction in the intensive care unit (ICU); the reported incidence is between 2% and 63%. Diarrhea is best defined as bowel movements that, because of increased frequency, abnormal consistency,…
Introduction Evidence of ileus, gastroparesis, or small bowel dysmotility is common in the setting of critical illness. Data on the incidence of ileus estimate an occurrence ranging from 50% to 80% in critically ill patients, with an average incidence of…
Introduction Diagnosing acute abdominal pain in critically ill patients can be difficult if the clinician tries to work through a comprehensive list of differential diagnoses ( Fig. 25.1 ). The most common etiologies seen outside of the intensive care unit…
Definition and diagnosis Whereas a normal peritoneal cavity contains only 25 mL of fluid, the peritoneum has the capacity to absorb 900 mL Ascites is the pathologic accumulation of peritoneal fluid, occurring most commonly in decompensated liver cirrhosis (85%), with…
Bilirubin is a by-product of heme metabolism. Heme is largely derived from the hemoglobin in senescent red blood cells and is oxidized in the spleen, liver, and other organs by two isoforms of the enzyme heme oxygenase, in the presence…
Divergent patient populations: Trauma versus sepsis Noncardiac intensive care units (ICUs) predominantly manage coagulopathy in patients with trauma or sepsis. Although trauma is known as the third most frequent cause of death in the United States, sepsis, which is not…