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
- 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
- 3.15.1 Capacity and Consent Issues in Intensive Care
- 3.15.2 Managing Aggression in Intensive Care
- 3.15.3 Overdose, Serotonin Syndrome and Neuroleptic Malignant Syndrome
- 3.15.4 Suicidal Patients in Intensive Care
- 3.15.5 Anxiety, Psychological Trauma and the Difficult Patient in Intensive Care
- 3.15.6 Substance Misuse and Withdrawal in Intensive Care
- 3.15.7 Staff Burnout 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
3.15.3 - Overdose, Serotonin Syndrome and Neuroleptic Malignant Syndrome
from Section 3.15 - Psychiatric Disorders Encountered in Intensive Care
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
- 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
- 3.15.1 Capacity and Consent Issues in Intensive Care
- 3.15.2 Managing Aggression in Intensive Care
- 3.15.3 Overdose, Serotonin Syndrome and Neuroleptic Malignant Syndrome
- 3.15.4 Suicidal Patients in Intensive Care
- 3.15.5 Anxiety, Psychological Trauma and the Difficult Patient in Intensive Care
- 3.15.6 Substance Misuse and Withdrawal in Intensive Care
- 3.15.7 Staff Burnout 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. Features of overdose depend on the type of antidepressant or anti-psychotic agent taken.
2. All patients suspected of overdose must be monitored for QRS/QT prolongation.
3. In some overdoses (monoamine oxidase inhibitors, hypoglycaemic agents, long-acting insulin, anticoagulants), onset of symptoms may be delayed; an asymptomatic patient may still require admission and treatment in the intensive care unit.
4. Serotonin syndrome is a medical emergency defined as an adverse reaction to serotonergic agents.
5. Neuroleptic malignant syndrome is a medical emergency caused by an idiosyncratic reaction to neuroleptic medication.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 441 - 444Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Ambulkar, RP, Patil, VP, Moiyadi, AV. Neuroleptic malignant syndrome: a diagnostic challenge. J Anaesthesiol Clin Pharmacol 2012;28:517–19.CrossRefGoogle ScholarPubMed
Boyer, EW, Shannon, M. The serotonin syndrome. N Engl J Med 2005;352:1112–20.CrossRefGoogle ScholarPubMed
Kateon, H. Differentiating serotonin syndrome and neuroleptic malignant syndrome. Mental Health Clinician 2013;3:129–33.CrossRefGoogle Scholar
National Organization for Rare Disorders. 2004. Neuroleptic malignant syndrome. rarediseases.org/rare-diseases/neuroleptic-malignant-syndrome/Google Scholar