Table Of ContentCOMMON PROBLEMS
The following is a list of problems which commonly cause
diffi culty on the ICU. Help can be readily found on the pages
indicated :
Consent 29 Hyperthermia 224
Sedation 34 Raised intracranial
pressure 281
Enteral feed 57
Unexplained sepsis 334
Diarrhoea 70
Antibiotic therapy 336
Hypotension 87
Arterial pressure
Hypertension 88
monitoring 342
Dysrhythmias 90
Central venous access 376
Cardiac arrest 109
Pulmonary artery
Ventilation 127
catheters 389
Oliguria 188
Tracheostomy 404
Hypernatraemia 202
Chest drains 416
Hyperkalaemia 204
IMPORTANT PRESCRIBING INFORMATION
All doses recommended in this book are, unless stated
otherwise, based on an average (70 kg) adult. Doses
suggested are those typically suitable for critically ill
patients. Individual patients may, however, require more
or less than the doses stated to achieve the optimal
therapeutic, effect depending on particular circumstances.
Many drugs for example may need dose adjustment in
presence of reduced creatinine clearance.
Every effort has been made to ensure the accuracy of the
information contained in this book, particularly that relating
to drugs and drug doses. It is, however, the responsibility
of the prescribing practitioner to ensure that all drug
prescriptions are correct and neither the authors nor the
publishers can be held liable for any errors.
If in doubt seek advice from your pharmacist or consult
the British National Formulary (BNF).
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CHURCHILL’S POCKETBOOKS
Intensive Care
Commissioning Editor: Timothy Horne
Senior Development Editor: Ailsa Laing
Project Manager: Frances Affleck
Designer: Kirsteen Wright
Illustration Manager: Bruce Hogarth
Illustrations: Cactus
CHURCHILL’S POCKETBOOKS
Intensive
Care
Simon M Whiteley
MB BS FRCA MA
Consultant, Intensive Care, St James’s University
Hospital, Leeds, UK
Andrew Bodenham
MB BS FRCA
Consultant, Intensive Care, The General Infirmary
at Leeds, Leeds, UK
Mark C Bellamy
MA MB BS FRCA
Professor, Intensive Care, St James’s University
Hospital, Leeds, UK
THIRD EDITION
EDINBURGH LONDON NEW YORK OXFORD
PHILADELPHIA ST LOUIS SYDNEY TORONTO 2010
CHURCHIL LIVINGSTONE
An imprint of Elsevier Limited
First Edition © Pearson Professional Limited 1996
Second Edition © Elsevier Limited 2004
Third edition © 2010, Elsevier Limited. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher.
Details on how to seek permission, further information about the Publisher’s
permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our
website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).
ISBN 978-0-443-06977-2
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notice
Knowledge and best practice in this fi eld are constantly changing. As new research
and experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge
in evaluating and using any information, methods, compounds, or experiments
described herein. In using such information or methods they should be mindful of
their own safety and the safety of others, including parties for whom they have a
professional responsibility.
With respect to any drug or pharmaceutical products identifi ed, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and / or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the material herein.
Printed in China
PREFACE
This small book follows other successful titles in the Churchill’s
Pocketbooks format. It is not intended to compete with the many
already well-established texts in the fi eld of intensive care, but is
intended to present a distillation of sensible practice and ideas.
Every new doctor who is resident in the intensive care unit will
be faced with a large variety of clinical problems to be solved. This
book is therefore based on the common problems the authors are
asked about on a regular basis, most of which can be easily solved
by following simple rules. The aim has been to use the minimum
of space by avoiding excessive detail, and no apology is made
for repetition, or for what may on occasion appear a didactic
approach. Information related to the specialist areas such as
paediatric and cardiothoracic intensive care has been specifi cally
excluded, although the general principles described are equally
applicable in those areas. In many countries there are increasing
moves to rotate trainees from different specialties, without
previous intensive care experience, through intensive care. The
hope is that this guide will prove timely and useful in this respect.
In the 13 years since the fi rst edition and nine years since the
second was published, there have been a number of changes in
intensive care. We have incorporated these changes into this
new edition. As a result, we have extensively revised the text
and included a number of new or revised fi gures. The overall
format however, remains the same. We hope that this edition
will continue to provide new trainees in intensive care with safe,
sensible and practical advice.
We are also aware that the book has proved popular with
critical care nurses, physiotherapists and other healthcare
professionals working in critical care, and hope that we have
pitched the detail at the right level to also satisfy this readership
S .M.W.
A .B.
M .C.B.
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