Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Introduction
- Pathophysiology of Atherosclerosis
- Clinical Features
- Investigations
- Management of ACS
- Acute Coronary Syndromes in Intensive Care
- Prognosis
- Introduction
- Pacemaker Nomenclature
- Management of Permanent Systems in the ICU
- Management of Temporary Systems in the ICU
- Introduction
- Causes
- Precipitants of Acute Heart Failure
- Pathophysiology
- Decompensated Presentation
- Management
- Introduction
- Aortic Stenosis
- Aortic Insufficiency/Regurgitation
- Mitral Regurgitation
- Mitral Stenosis
- Tricuspid Valve Disease and Pulmonary Valve Disease
- Introduction
- Common Cardiac Conditions Which May Present
- Why May a GUCH Patient Present to Hospital and What Causes Their Increased Mortality Rate?
- ICU Care
- History and Clinical Examination
- Investigations
- Management
- Summary
- Introduction
- Prevention
- The ‘Endocarditis Team’
- Diagnosis
- Prognostic Assessment
- Complications of Infective Endocarditis
- Infective Endocarditis in the Intensive Care Unit
- Right-Sided Infective Endocarditis
- Anti-thrombotic Therapy in Infective Endocarditis
- Definitions
- Epidemiology
- Presentation of Hypertensive Crises
- Management
- Disease-Specific Management
- Summary
- Introduction
- Causes
- Important Considerations
- Classification
- Investigations
- Treatment Goals
- Additional Arrhythmias
- Definition
- Causes
- Diagnosis
- Treatment
- Supportive Management, Veno-arterial Extracorporeal Membrane Oxygenation and Axial Flow Pumps
- Pericardial Syndromes
- Pericardium and Pericardial Fluid
- Signs of Cardiac Tamponade in the Spontaneously Ventilated Patient
- Introduction
- Oxygen Delivery
- Pressure versus Flow
- Specific Management of Shock
- Pathophysiology
- Incidence
- Classification
- Presentation
- Diagnosis
- Treatment
- Outcomes
- Of Historical Interest
- Introduction
- Diagnosis of AKI
- Common Causes of AKI in Intensive Care Units
- Risk Stratification in AKI
- Prevention
- Diagnostic Workup in AKI
- Management of Complications
- Principles of Management in AKI
- Drug Adjustment during AKI/RRT
- Palliative Care Nephrology
- Long-Term Effects of AKI and Post-AKI Care
- Conclusion
- Introduction
- Definition
- Diagnosis and Classification
- Aetiology
- Pathophysiology
- Prognosis
- Management
- Introduction
- Haem Metabolism
- Classification of Jaundice
- Pre-hepatic Jaundice
- Hepatic Jaundice
- Post-hepatic (Cholestatic) Jaundice
- Post-operative Jaundice
- Jaundice in the Transplant Recipient
- Investigations
- Management and Prognosis
- Pathophysiology
- Clinical
- Investigations
- Management
- Spontaneous Bacterial Peritonitis
- Introduction
- Aetiology
- Clinical Findings
- Diagnosis
- Management
- Transjugular Intrahepatic Portosystemic Shunt
- Portal Hypertensive Gastropathy
- Hepatorenal Syndrome
- Hepatopulmonary Syndrome
- Introduction
- Aetiology
- Pathogenesis
- Precipitants of Hepatic Encephalopathy
- Classification
- Clinical Manifestations
- Diagnosis and Investigation
- Management
- Prognosis
- Introduction
- Initial Resuscitation of the Unconscious Patient
- Assessment of Level of Consciousness
- Causes of Impaired Consciousness
- Further Investigations
- Prognosis
- Ongoing Critical Care Management
- Introduction
- Acute Symptomatic Seizure
- Unprovoked Seizure
- Epilepsy
- Early Post-seizure Management
- Differential Diagnosis
- Investigations
- Status Epilepticus
- Introduction
- Initial Assessment
- Thrombolysis
- Endovascular Interventions
- Neurosurgery
- Other General Measures
- Definition
- Causes
- Risk Factors
- Presentation
- Differential Diagnosis
- Diagnosis
- Management
- Long-Term Sequelae
- Prognosis
- Pathophysiology
- Signs and Symptoms
- Initial Management
- Investigations
- Severity
- Management
- Introduction
- Definition and Presentation
- Risk Factors
- Recognition
- Management
- Introduction
- Myasthenia Gravis
- Guillain–Barré Syndrome
- ICU-Acquired Weakness
- Introduction
- Epidemiology
- Classification
- Clinical Features
- Diagnosis
- Management
- Prognosis
- Upper Gastrointestinal Bleeding
- Clinical Presentation
- Investigations and Management
- Non-variceal Bleeding
- Variceal Bleeding
- Acute Severe Lower Gastrointestinal Bleeding
- Prevention of Upper Gastrointestinal Bleeding in Critical Care
- Introduction
- Aetiology and Pathogenesis
- Clinical Presentation, Investigation and Diagnosis
- Management
- Management of Complications
- Introduction
- Causes
- Clinical Features
- Investigations
- Management
- Introduction
- Symptoms and Signs
- Diagnosis
- Management
- Definitions
- Risk Factors
- Measurement of Intra-abdominal Pressure
- Clinical Impact
- Treatment
- Prognosis/Outcomes
- Definition
- Epidemiology
- Aetiology
- Classification
- Presentation and Diagnosis
- Treatment
- Long-Term Anticoagulation
- Pulmonary Hypertension
- Introduction
- Pathophysiology
- Signs and Symptoms
- Investigations
- Grading of Severity
- Admission to ICU and Management
- Introduction
- Grading of COPD
- Investigations
- General Management
- Long-Term Oxygen Therapy
- Acute Exacerbations of COPD
- COPD and Critical Care
- Non-invasive Ventilation
- Invasive Ventilation
- Introduction
- Classification
- Common Causative Organisms
- The Clinical Picture
- Diagnostic Approach to Pneumonia
- Treatment: General Approach to Anti-microbial Therapy
- Definition
- History
- Incidence
- Causes
- Risk Factors
- Clinical Presentation
- Diagnostic Criteria
- Investigations (Laboratory/Radiological)
- Management
- Prognosis
- Definition and Pathophysiology
- Common Causes
- Assessment and Investigations
- Management
- Introduction
- Classification
- Pathogenesis of Pulmonary Hypertension
- Clinical Features
- Diagnostic Investigations
- Treatment
- Prognosis
- Introduction
- Mediators and Their Actions
- Aetiology and Risk Factors for Severe or Fatal Episodes
- Clinical Features
- Management
- Investigation and Follow-Up
- Introduction
- The Innate Immune System
- The Adaptive Immune System
- Antibodies
- Immunodeficiency Disorders
- Aetiology
- Acquired Immune Deficiency Syndrome
- HIV and ICU
- Highly Active Anti-retroviral Therapy
- Immune Reconstitution Inflammatory Syndrome
- Specific Conditions Related to HIV
- Definition
- Pathophysiology
- Clinical Features and Diagnosis
- Investigations and Management
- Outcome
- Definition
- Pathophysiology
- Clinical Features
- Therapies
- Outcomes
- Definition
- Epidemiology
- Risk Factors
- Microbial Pathogens
- Specific Infections Seen in Critical Care
- Infection Prevention and Control
- Pressure Ulcers
- Skin and Soft Tissue Infections
- Cellulitis
- Toxic Shock Syndrome
- Necrotising Fasciitis
- Gas Gangrene/Myonecrosis
- Toxic Epidermal Necrolysis
- Compartment Syndrome
- Introduction
- General Principles of Antibiotic Use in Intensive Care
- How to Choose an Appropriate Antibiotic
- Body Site/Likely Pathogens
- Rationalising Treatment
- A Note on Blood Cultures
- Dose
- Timing and Duration
- Reasons for Failure of Antibiotic Therapy
- Monotherapy/Combination Antibiotic Therapy
- Acknowledgements
- Introduction
- Cell Wall Inhibitors
- Inhibitors of Protein Synthesis
- Inhibitors of Nucleic Acid Synthesis
- Folic Acid Synthesis Inhibitors
- Inhibitors of Membrane Function
- Antibiotic Prophylaxis
- Antibiotic Resistance
- Future Directions
- Introduction
- Introduction
- Regional Infection
- Treatments
- Introduction
- Diagnosis
- Pathophysiology
- Severe Malaria
- Management of Severe Malaria
- Other Tropical Infections
- Introduction
- The Virus
- Clinical Presentation and Pathophysiology
- COVID-19 and the Intensive Care Unit
- The Search for a Vaccine
- Large-Scale Crisis Management of a Highly Contagious Disease
- Conclusion
- Introduction
- Initial Management of an Overdose
- General Treatment Strategies
- Drugs: Over-the-Counter
- Drugs: Prescription
- Non-prescriptionAmphetamines and Cathinones
- Plants/Fungi
- Chemical
- Introduction
- Massive Obstetric Haemorrhage
- Introduction
- Definitions
- Pathophysiology
- Prevention
- Signs and Symptoms
- Grading of Severity
- Differential Diagnosis
- General Treatment of Pre-eclampsia
- Hypertensive Pulmonary Oedema
- Mode and Timing of Delivery and Removal of the Placenta
- Role of Critical Care
- Fluids, Inotropic Support and Cardiac Output Monitoring in ICU
- Prognosis
- Introduction
- Cardiac Disease
- Respiratory Disease
- Obesity
- Endocrine Disease
- Renal Disease
- Haematological Disease
- Cancer in Pregnancy
- Maternal Critical Care Guidelines
- Haemostasis Simplified
- Common Laboratory Screening Tests
- Acquired Disorders of Haemostasis
- Heparin-Induced Thrombocytopenia
- Thrombotic Microangiopathies
- Introduction
- Warfarin
- Direct Oral Anticoagulants
- Heparins
- Inferior Vena Cava Filters
- Anaemia
- Thrombocytopenia
- Sickle Cell Disease
- Overview of Haematological Malignancy and ICU Admission
- Complications of Haematological Malignancy and Treatment
- Introduction to Haematopoietic Stem Cell Transplantation
- Graft-versus-Host Disease
- Chimeric Antigen Receptor (CAR) T-Cell Therapy
- Management of Critical Illness in Malignant Haematology
- Complications of CAR T-cell Therapy
- Selection and Outcomes of Patients with Haematological Malignancy in the ICU
- Mechanisms of Coagulation and Haemostasis
- Coagulopathy
- Management of Haemorrhage
- Traumatic Coagulopathy
- Thrombocytopenia
- Disseminated Intravascular Coagulopathy
- Heparin-Induced Thrombocytopenic Thrombosis
- Thrombotic Microangiopathies
- Liver Disease
- Upper Gastrointestinal Bleeding
- Renal Disease
- Fibrinolytic Bleeding
- von Willebrand’s Disease
- Bleeding Associated with Anti-thrombotic Drugs
- Peripartum
- Introduction
- Introduction
- Hyponatraemia
- Hypernatraemia
- Introduction
- Hyperkalaemia
- Hypokalaemia
- Introduction
- Hypercalcaemia
- Hypocalcaemia
- Introduction
- Hypermagnesaemia
- Hypomagnesaemia
- Therapeutic Use of Magnesium in Specific Emergency Scenarios
- Phosphate
- Hyperphosphataemia
- Hypophosphataemia
- Introduction
- Diabetic Ketoacidosis
- Hyperosmolar Hyperglycaemic State
- Hypoglycaemic Coma
- Introduction
- Causes
- Diagnosis
- Management
- Cerebral Salt Wasting
- Introduction
- Assessment of Polyuria
- Diabetes Insipidus
- Primary Polydipsia
- Introduction
- Basic Physiology
- Myxoedema Coma
- Thyroid Storm
- The Role of Cortisol
- The Hypothalamic–Pituitary–Adrenal Axis
- Adrenocortical Insufficiency in Critical Illness
- Current Practice
- Introduction
- Pathophysiology
- Clinical Examination
- Imaging
- Neuromonitoring Techniques
- Intracranial Hypertension
- Decompressive Craniectomy
- Critical Care Management
- Maxillofacial Injuries
- Mandible Fractures
- Bifacial Fractures
- Orbital Injuries
- Other Associated Injuries
- Management
- Laryngotracheal Injuries
- Introduction
- Assessment and Management of Life-Threatening Thoracic Injuries
- Classification
- Epidemiology
- Pathophysiology
- Diagnosis
- Management of Suspected Traumatic Spinal Cord Injuries
- Management of Confirmed Traumatic Spinal Cord Injuries
- Long-Term Management
- Introduction
- The Initial Examination
- Investigations
- Initial Management
- Ongoing Management in Critical Care
- Introduction
- Anatomy
- Aetiology
- Epidemiology
- Microbiology
- Presentation
- Differential Diagnosis
- Investigations
- Management
- Specific Management
- Complications
- Prognosis
- Definition
- Epidemiology
- Pathophysiology
- Management
- Outcomes
- Introduction
- Pathophysiology
- Complications of Burns
- Ongoing and Critical Care Management
- Acknowledgements
- Introduction
- Hypothermia
- Hyperthermia
- Heatstroke
- Malignant Hyperthermia
- Neuroleptic Malignant Syndrome
- Serotonin Syndrome
- Anti-cholinergic Syndrome
- Sympathomimetic Syndrome
- Acknowledgements
- Introduction
- Anaphylaxis
- Aquatic Creatures
- Reptiles
- Insects
- Introduction
- Categories of Blast Injuries
- Gunshot Wounds
- Treatment Steps for Management of a Patient with Ballistic Injuries
- Intensive Care Management of the Patient with Ballistic Injuries
- Introduction
- ‘Lacks Capacity’
- The Assessment Process
- Who Should Assess Capacity?
- The Mental Capacity Act 2005 (England and Wales)
- Deprivation of Liberty Safeguards
- The Mental Health Act 1983
- Introduction
- Patients Who Understand Their Behaviours
- Possible Precipitants of Aggression (When There Is No Clear Precipitant)
- Specific Groups at Risk of Unpredictable Aggression
- Aggression Reduction
- Pharmacology
- After the Event
- Introduction
- Antidepressants
- Serotonin Syndrome
- Anti-psychotics
- Neuroleptic Malignant Syndrome
- Introduction
- Management of Patients Admitted to the ICU Following a Suicide Attempt
- Medical Management
- Psychiatric Management
- Risk Assessment and Management
- Staff Attitudes
- Support for ICU Staff
- Support for Family Members
- Anxiety
- Insomnia
- Post-Traumatic Stress Disorder and ICU
- Difficult Patients in ICU
- Introduction
- Alcohol Withdrawal Syndrome
- Opiates
- Other Substances
- Novel Agents in ICU to Treat Withdrawals
- Introduction
- Consequences for the Unit
- Risk Factors
- Interventions
- Duty of Self-Care
- Sources of Help
- Section 3.1 Cardiac and Circulatory Failure
- 3.1.1 Acute Coronary Syndromes
- 3.1.2 Cardiac Pacing, Implantable Cardioverter–Defibrillators and Cardiac Resynchronisation Therapy
- 3.1.3 Acute Heart Failure
- 3.1.4 Valvular Heart Disease
- 3.1.5 Congenital Heart Disease
- 3.1.6 Endocarditis
- 3.1.7 Management of Hypertensive Crises
- 3.1.8 Atrial Fibrillation in the Intensive Care Unit
- 3.1.9 Myocarditis
- 3.1.10 Pericardial Disease
- 3.1.11 Shock
- 3.1.12 Aortic Dissection
- Section 3.2 Acute Renal Failure
- Section 3.3 Acute Liver Failure
- Section 3.4 Neurological Impairment and Injury
- Section 3.5 Acute Gastrointestinal Failure
- Section 3.6 Acute Respiratory Failure
- Section 3.7 Infection and Immunity
- Section 3.8 Intoxication with Drugs or Environmental Toxins
- Section 3.9 Obstetrics and Maternal Peripartum Complications
- Section 3.10 Haematological and Oncological Disorders
- Section 3.11 Metabolic Disorders
- Section 3.12 Endocrine Disorders
- Section 3.13 Severe Trauma and Multiple Injuries
- Section 3.14 Environmental Injuries
- Section 3.15 Psychiatric Disorders Encountered in Intensive Care
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
3.1.12 - Aortic Dissection
from Section 3.1 - Cardiac and Circulatory Failure
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Introduction
- Pathophysiology of Atherosclerosis
- Clinical Features
- Investigations
- Management of ACS
- Acute Coronary Syndromes in Intensive Care
- Prognosis
- Introduction
- Pacemaker Nomenclature
- Management of Permanent Systems in the ICU
- Management of Temporary Systems in the ICU
- Introduction
- Causes
- Precipitants of Acute Heart Failure
- Pathophysiology
- Decompensated Presentation
- Management
- Introduction
- Aortic Stenosis
- Aortic Insufficiency/Regurgitation
- Mitral Regurgitation
- Mitral Stenosis
- Tricuspid Valve Disease and Pulmonary Valve Disease
- Introduction
- Common Cardiac Conditions Which May Present
- Why May a GUCH Patient Present to Hospital and What Causes Their Increased Mortality Rate?
- ICU Care
- History and Clinical Examination
- Investigations
- Management
- Summary
- Introduction
- Prevention
- The ‘Endocarditis Team’
- Diagnosis
- Prognostic Assessment
- Complications of Infective Endocarditis
- Infective Endocarditis in the Intensive Care Unit
- Right-Sided Infective Endocarditis
- Anti-thrombotic Therapy in Infective Endocarditis
- Definitions
- Epidemiology
- Presentation of Hypertensive Crises
- Management
- Disease-Specific Management
- Summary
- Introduction
- Causes
- Important Considerations
- Classification
- Investigations
- Treatment Goals
- Additional Arrhythmias
- Definition
- Causes
- Diagnosis
- Treatment
- Supportive Management, Veno-arterial Extracorporeal Membrane Oxygenation and Axial Flow Pumps
- Pericardial Syndromes
- Pericardium and Pericardial Fluid
- Signs of Cardiac Tamponade in the Spontaneously Ventilated Patient
- Introduction
- Oxygen Delivery
- Pressure versus Flow
- Specific Management of Shock
- Pathophysiology
- Incidence
- Classification
- Presentation
- Diagnosis
- Treatment
- Outcomes
- Of Historical Interest
- Introduction
- Diagnosis of AKI
- Common Causes of AKI in Intensive Care Units
- Risk Stratification in AKI
- Prevention
- Diagnostic Workup in AKI
- Management of Complications
- Principles of Management in AKI
- Drug Adjustment during AKI/RRT
- Palliative Care Nephrology
- Long-Term Effects of AKI and Post-AKI Care
- Conclusion
- Introduction
- Definition
- Diagnosis and Classification
- Aetiology
- Pathophysiology
- Prognosis
- Management
- Introduction
- Haem Metabolism
- Classification of Jaundice
- Pre-hepatic Jaundice
- Hepatic Jaundice
- Post-hepatic (Cholestatic) Jaundice
- Post-operative Jaundice
- Jaundice in the Transplant Recipient
- Investigations
- Management and Prognosis
- Pathophysiology
- Clinical
- Investigations
- Management
- Spontaneous Bacterial Peritonitis
- Introduction
- Aetiology
- Clinical Findings
- Diagnosis
- Management
- Transjugular Intrahepatic Portosystemic Shunt
- Portal Hypertensive Gastropathy
- Hepatorenal Syndrome
- Hepatopulmonary Syndrome
- Introduction
- Aetiology
- Pathogenesis
- Precipitants of Hepatic Encephalopathy
- Classification
- Clinical Manifestations
- Diagnosis and Investigation
- Management
- Prognosis
- Introduction
- Initial Resuscitation of the Unconscious Patient
- Assessment of Level of Consciousness
- Causes of Impaired Consciousness
- Further Investigations
- Prognosis
- Ongoing Critical Care Management
- Introduction
- Acute Symptomatic Seizure
- Unprovoked Seizure
- Epilepsy
- Early Post-seizure Management
- Differential Diagnosis
- Investigations
- Status Epilepticus
- Introduction
- Initial Assessment
- Thrombolysis
- Endovascular Interventions
- Neurosurgery
- Other General Measures
- Definition
- Causes
- Risk Factors
- Presentation
- Differential Diagnosis
- Diagnosis
- Management
- Long-Term Sequelae
- Prognosis
- Pathophysiology
- Signs and Symptoms
- Initial Management
- Investigations
- Severity
- Management
- Introduction
- Definition and Presentation
- Risk Factors
- Recognition
- Management
- Introduction
- Myasthenia Gravis
- Guillain–Barré Syndrome
- ICU-Acquired Weakness
- Introduction
- Epidemiology
- Classification
- Clinical Features
- Diagnosis
- Management
- Prognosis
- Upper Gastrointestinal Bleeding
- Clinical Presentation
- Investigations and Management
- Non-variceal Bleeding
- Variceal Bleeding
- Acute Severe Lower Gastrointestinal Bleeding
- Prevention of Upper Gastrointestinal Bleeding in Critical Care
- Introduction
- Aetiology and Pathogenesis
- Clinical Presentation, Investigation and Diagnosis
- Management
- Management of Complications
- Introduction
- Causes
- Clinical Features
- Investigations
- Management
- Introduction
- Symptoms and Signs
- Diagnosis
- Management
- Definitions
- Risk Factors
- Measurement of Intra-abdominal Pressure
- Clinical Impact
- Treatment
- Prognosis/Outcomes
- Definition
- Epidemiology
- Aetiology
- Classification
- Presentation and Diagnosis
- Treatment
- Long-Term Anticoagulation
- Pulmonary Hypertension
- Introduction
- Pathophysiology
- Signs and Symptoms
- Investigations
- Grading of Severity
- Admission to ICU and Management
- Introduction
- Grading of COPD
- Investigations
- General Management
- Long-Term Oxygen Therapy
- Acute Exacerbations of COPD
- COPD and Critical Care
- Non-invasive Ventilation
- Invasive Ventilation
- Introduction
- Classification
- Common Causative Organisms
- The Clinical Picture
- Diagnostic Approach to Pneumonia
- Treatment: General Approach to Anti-microbial Therapy
- Definition
- History
- Incidence
- Causes
- Risk Factors
- Clinical Presentation
- Diagnostic Criteria
- Investigations (Laboratory/Radiological)
- Management
- Prognosis
- Definition and Pathophysiology
- Common Causes
- Assessment and Investigations
- Management
- Introduction
- Classification
- Pathogenesis of Pulmonary Hypertension
- Clinical Features
- Diagnostic Investigations
- Treatment
- Prognosis
- Introduction
- Mediators and Their Actions
- Aetiology and Risk Factors for Severe or Fatal Episodes
- Clinical Features
- Management
- Investigation and Follow-Up
- Introduction
- The Innate Immune System
- The Adaptive Immune System
- Antibodies
- Immunodeficiency Disorders
- Aetiology
- Acquired Immune Deficiency Syndrome
- HIV and ICU
- Highly Active Anti-retroviral Therapy
- Immune Reconstitution Inflammatory Syndrome
- Specific Conditions Related to HIV
- Definition
- Pathophysiology
- Clinical Features and Diagnosis
- Investigations and Management
- Outcome
- Definition
- Pathophysiology
- Clinical Features
- Therapies
- Outcomes
- Definition
- Epidemiology
- Risk Factors
- Microbial Pathogens
- Specific Infections Seen in Critical Care
- Infection Prevention and Control
- Pressure Ulcers
- Skin and Soft Tissue Infections
- Cellulitis
- Toxic Shock Syndrome
- Necrotising Fasciitis
- Gas Gangrene/Myonecrosis
- Toxic Epidermal Necrolysis
- Compartment Syndrome
- Introduction
- General Principles of Antibiotic Use in Intensive Care
- How to Choose an Appropriate Antibiotic
- Body Site/Likely Pathogens
- Rationalising Treatment
- A Note on Blood Cultures
- Dose
- Timing and Duration
- Reasons for Failure of Antibiotic Therapy
- Monotherapy/Combination Antibiotic Therapy
- Acknowledgements
- Introduction
- Cell Wall Inhibitors
- Inhibitors of Protein Synthesis
- Inhibitors of Nucleic Acid Synthesis
- Folic Acid Synthesis Inhibitors
- Inhibitors of Membrane Function
- Antibiotic Prophylaxis
- Antibiotic Resistance
- Future Directions
- Introduction
- Introduction
- Regional Infection
- Treatments
- Introduction
- Diagnosis
- Pathophysiology
- Severe Malaria
- Management of Severe Malaria
- Other Tropical Infections
- Introduction
- The Virus
- Clinical Presentation and Pathophysiology
- COVID-19 and the Intensive Care Unit
- The Search for a Vaccine
- Large-Scale Crisis Management of a Highly Contagious Disease
- Conclusion
- Introduction
- Initial Management of an Overdose
- General Treatment Strategies
- Drugs: Over-the-Counter
- Drugs: Prescription
- Non-prescriptionAmphetamines and Cathinones
- Plants/Fungi
- Chemical
- Introduction
- Massive Obstetric Haemorrhage
- Introduction
- Definitions
- Pathophysiology
- Prevention
- Signs and Symptoms
- Grading of Severity
- Differential Diagnosis
- General Treatment of Pre-eclampsia
- Hypertensive Pulmonary Oedema
- Mode and Timing of Delivery and Removal of the Placenta
- Role of Critical Care
- Fluids, Inotropic Support and Cardiac Output Monitoring in ICU
- Prognosis
- Introduction
- Cardiac Disease
- Respiratory Disease
- Obesity
- Endocrine Disease
- Renal Disease
- Haematological Disease
- Cancer in Pregnancy
- Maternal Critical Care Guidelines
- Haemostasis Simplified
- Common Laboratory Screening Tests
- Acquired Disorders of Haemostasis
- Heparin-Induced Thrombocytopenia
- Thrombotic Microangiopathies
- Introduction
- Warfarin
- Direct Oral Anticoagulants
- Heparins
- Inferior Vena Cava Filters
- Anaemia
- Thrombocytopenia
- Sickle Cell Disease
- Overview of Haematological Malignancy and ICU Admission
- Complications of Haematological Malignancy and Treatment
- Introduction to Haematopoietic Stem Cell Transplantation
- Graft-versus-Host Disease
- Chimeric Antigen Receptor (CAR) T-Cell Therapy
- Management of Critical Illness in Malignant Haematology
- Complications of CAR T-cell Therapy
- Selection and Outcomes of Patients with Haematological Malignancy in the ICU
- Mechanisms of Coagulation and Haemostasis
- Coagulopathy
- Management of Haemorrhage
- Traumatic Coagulopathy
- Thrombocytopenia
- Disseminated Intravascular Coagulopathy
- Heparin-Induced Thrombocytopenic Thrombosis
- Thrombotic Microangiopathies
- Liver Disease
- Upper Gastrointestinal Bleeding
- Renal Disease
- Fibrinolytic Bleeding
- von Willebrand’s Disease
- Bleeding Associated with Anti-thrombotic Drugs
- Peripartum
- Introduction
- Introduction
- Hyponatraemia
- Hypernatraemia
- Introduction
- Hyperkalaemia
- Hypokalaemia
- Introduction
- Hypercalcaemia
- Hypocalcaemia
- Introduction
- Hypermagnesaemia
- Hypomagnesaemia
- Therapeutic Use of Magnesium in Specific Emergency Scenarios
- Phosphate
- Hyperphosphataemia
- Hypophosphataemia
- Introduction
- Diabetic Ketoacidosis
- Hyperosmolar Hyperglycaemic State
- Hypoglycaemic Coma
- Introduction
- Causes
- Diagnosis
- Management
- Cerebral Salt Wasting
- Introduction
- Assessment of Polyuria
- Diabetes Insipidus
- Primary Polydipsia
- Introduction
- Basic Physiology
- Myxoedema Coma
- Thyroid Storm
- The Role of Cortisol
- The Hypothalamic–Pituitary–Adrenal Axis
- Adrenocortical Insufficiency in Critical Illness
- Current Practice
- Introduction
- Pathophysiology
- Clinical Examination
- Imaging
- Neuromonitoring Techniques
- Intracranial Hypertension
- Decompressive Craniectomy
- Critical Care Management
- Maxillofacial Injuries
- Mandible Fractures
- Bifacial Fractures
- Orbital Injuries
- Other Associated Injuries
- Management
- Laryngotracheal Injuries
- Introduction
- Assessment and Management of Life-Threatening Thoracic Injuries
- Classification
- Epidemiology
- Pathophysiology
- Diagnosis
- Management of Suspected Traumatic Spinal Cord Injuries
- Management of Confirmed Traumatic Spinal Cord Injuries
- Long-Term Management
- Introduction
- The Initial Examination
- Investigations
- Initial Management
- Ongoing Management in Critical Care
- Introduction
- Anatomy
- Aetiology
- Epidemiology
- Microbiology
- Presentation
- Differential Diagnosis
- Investigations
- Management
- Specific Management
- Complications
- Prognosis
- Definition
- Epidemiology
- Pathophysiology
- Management
- Outcomes
- Introduction
- Pathophysiology
- Complications of Burns
- Ongoing and Critical Care Management
- Acknowledgements
- Introduction
- Hypothermia
- Hyperthermia
- Heatstroke
- Malignant Hyperthermia
- Neuroleptic Malignant Syndrome
- Serotonin Syndrome
- Anti-cholinergic Syndrome
- Sympathomimetic Syndrome
- Acknowledgements
- Introduction
- Anaphylaxis
- Aquatic Creatures
- Reptiles
- Insects
- Introduction
- Categories of Blast Injuries
- Gunshot Wounds
- Treatment Steps for Management of a Patient with Ballistic Injuries
- Intensive Care Management of the Patient with Ballistic Injuries
- Introduction
- ‘Lacks Capacity’
- The Assessment Process
- Who Should Assess Capacity?
- The Mental Capacity Act 2005 (England and Wales)
- Deprivation of Liberty Safeguards
- The Mental Health Act 1983
- Introduction
- Patients Who Understand Their Behaviours
- Possible Precipitants of Aggression (When There Is No Clear Precipitant)
- Specific Groups at Risk of Unpredictable Aggression
- Aggression Reduction
- Pharmacology
- After the Event
- Introduction
- Antidepressants
- Serotonin Syndrome
- Anti-psychotics
- Neuroleptic Malignant Syndrome
- Introduction
- Management of Patients Admitted to the ICU Following a Suicide Attempt
- Medical Management
- Psychiatric Management
- Risk Assessment and Management
- Staff Attitudes
- Support for ICU Staff
- Support for Family Members
- Anxiety
- Insomnia
- Post-Traumatic Stress Disorder and ICU
- Difficult Patients in ICU
- Introduction
- Alcohol Withdrawal Syndrome
- Opiates
- Other Substances
- Novel Agents in ICU to Treat Withdrawals
- Introduction
- Consequences for the Unit
- Risk Factors
- Interventions
- Duty of Self-Care
- Sources of Help
- Section 3.1 Cardiac and Circulatory Failure
- 3.1.1 Acute Coronary Syndromes
- 3.1.2 Cardiac Pacing, Implantable Cardioverter–Defibrillators and Cardiac Resynchronisation Therapy
- 3.1.3 Acute Heart Failure
- 3.1.4 Valvular Heart Disease
- 3.1.5 Congenital Heart Disease
- 3.1.6 Endocarditis
- 3.1.7 Management of Hypertensive Crises
- 3.1.8 Atrial Fibrillation in the Intensive Care Unit
- 3.1.9 Myocarditis
- 3.1.10 Pericardial Disease
- 3.1.11 Shock
- 3.1.12 Aortic Dissection
- Section 3.2 Acute Renal Failure
- Section 3.3 Acute Liver Failure
- Section 3.4 Neurological Impairment and Injury
- Section 3.5 Acute Gastrointestinal Failure
- Section 3.6 Acute Respiratory Failure
- Section 3.7 Infection and Immunity
- Section 3.8 Intoxication with Drugs or Environmental Toxins
- Section 3.9 Obstetrics and Maternal Peripartum Complications
- Section 3.10 Haematological and Oncological Disorders
- Section 3.11 Metabolic Disorders
- Section 3.12 Endocrine Disorders
- Section 3.13 Severe Trauma and Multiple Injuries
- Section 3.14 Environmental Injuries
- Section 3.15 Psychiatric Disorders Encountered in Intensive Care
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Acute aortic dissection is a rare, but life-threatening disorder.
2. Presentation may be similar to that of an acute coronary syndrome and should always be considered as a differential diagnosis.
3. Immediate treatment should focus on analgesia and blood pressure control, followed by rapid referral to a specialist unit.
4. ECG-gated computed tomography is usually the imaging modality of choice.
5. Urgent surgery is usually required for type A dissections.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 137 - 139Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Chiappini, B, Schepens, M, Tan, E, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J 2005;26:180–6.CrossRefGoogle ScholarPubMed
Erbel, R, Aboyans, V, Boileau, C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873–926.Google ScholarPubMed
Erbel, R, Engberding, R, Daniel, W, Roelandt, J, Visser, C, Rennollet, H. Echocardiography in diagnosis of aortic dissection. Lancet 1989;1:457–61.Google ScholarPubMed
Hiratzka, LF, Bakris, GL, Beckman, JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:e266–369.Google Scholar
Iliceto, S, Ettorre, G, Francioso, G, Antonelli, G, Biasco, G, Rizzon, P. Diagnosis of aneurysm of the thoracic aorta. Comparison between two non-invasive techniques: two-dimensional echocardiography and computed tomography. Eur Heart J 1984;5:545–55.CrossRefGoogle ScholarPubMed
Khandheria, BK, Tajik, AJ, Taylor, CL, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. J Am Soc Echocardiogr 1989;2:17–24.CrossRefGoogle Scholar
Mintz, GS, Kotler, MN, Segal, BL, Parry, WR. Two dimensional echocardiographic recognition of the descending thoracic aorta. Am J Cardiol 1979;44:232–8.CrossRefGoogle ScholarPubMed
Nienaber, CA, von Kodolitsch, Y, Nicolas, V, et al. The diagnosis of thoracic aortic dissection by non-invasive imaging procedures. N Engl J Med 1993;328:1–9.CrossRefGoogle Scholar
Novelline, RA, Rhea, JT, Rao, PM, Stuk, JL. Helical CT in emergency radiology. Radiology 1999;213:321–39.CrossRefGoogle ScholarPubMed
Sommer, T, Fehske, W, Holzknecht, N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 1996;199:347–52.CrossRefGoogle ScholarPubMed
Trimarchi, S, Nienaber, CA, Rampoldi, V, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005;129:112–22.CrossRefGoogle ScholarPubMed