TOPICS

• cardiology
• endocrinology
• gastroenterology
• hematology/oncology
• infectious diseases
• nephrology
• neurology
• obstetrics
• pulmonology
• rheumatology
• toxicology & temperature

introduction 

• About this book
• The karma of training in the ICU
• Things to avoid in the ICU

cardiology

Aortic dissection

Arrhythmia

• Bradycardia
• Narrow-complex tachycardia
  • Approach to supraventricular tachycardia
  • Multifocal atrial tachycardia (MAT)
  • Atrial fibrillation & flutter
• Wide-complex tachycardia
  • Approach to wide-complex tachycardia & VT
  • Monomorphic VT/VF storm
  • Torsade de pointes
• AVRT & accessory pathways

Endocarditis

LV failure

• SCAPE (a.k.a. flash pulmonary edema)
• Cardiogenic shock & severe heart failure
• LV outflow tract obstruction (LVOTO)
• Takotsubo syndrome

Hypertensive emergency

MI

• Troponin elevation in non-cardiac critical illness
• Type-1 MI (plaque rupture)
• Post-MI complications
• Right ventricular MI (RVMI)

Shock, undifferentiated

RV failure

• Massive PE: Resuscitation
• Decompensated chronic pulmonary hypertension
• Right ventricular MI (RVMI)

Pericardial tamponade

Post-arrest

• Post-cardiac arrest management
• Neurologic prognostication

Vasopressors

endocrinology

Adrenal crisis

Glucose / Insulin

• Diabetic ketoacidosis (DKA)
• Hyperglycemic hyperosmolar state (HHS)
• Glycemic control in the ICU
• Hypoglycemia

Thyroid

• Thyroid tests & sick euthyroid
• Myxedema coma
• Thyroid Storm

gastroenterology

Abdominal compartment syndrome

Biliary

• Acalculous cholecystitis
• Community-acquired biliary sepsis (ascending cholangitis & calculus cholecystitis)

Bleeding

• GI hemorrhage
• Prophylaxis against GI bleeding

Intestine

• Clostridium difficile
• Colonic pseudoobstruction (Oglivie's syndrome)
• Illeus

Ischemia

• Acute mesenteric ischemia
• Ischemic colitis

Liver failure

• Acute hepatic failure
• Coagulopathy in liver failure
• Decompensated cirrhosis
• Hepatic encephalopathy
• Hepatorenal syndrome
• Spontaneous bacterial peritonitis

Nutrition

• Overview: feeding the intubated patient
• Tube feed cheat sheet
• Refeeding syndrome

Pancreas

• Pancreatitis
• Hypertriglyceridemic pancreatitis

hematology/oncology

Anemia & PRBC transfusion

• Anemia & hemoglobin transfusion targets
• Massive Transfusion Protocol (MTP)

Anticoagulation, therapeutic

• Anticoagulant reversal
• DVT prophylaxis
• Heparin, LMWH, fondaparinux

Coagulopathy & coags

• Coagulopathy in liver failure
• Disseminated intravascular coagulation (DIC)
• Coag labs & thromboelastography (TEG)

Malignant

• Acute promyelocytic leukemia (APL)
• Tumor lysis syndrome

Thrombocytopenia

• Thrombocytopenia
• Thrombotic thrombocytopenic purpura (TTP)
• Catastrophic Antiphospholipid Syndrome

infectious diseases

General approach

• Antibiotic selection overview
• Approach to fever in ICU
• Procalcitonin
• Septic shock
• Penicillin allergy

Specific infections

• Biliary sepsis (ascending cholangitis & calculus cholecystitis)
• Candidiasis
• Clostridium difficile
• Endocarditis
• Epiglottitis
• Lemierre's disease
• Line infection
• Meningitis & encephalitis
• Necrotizing fasciitis
• Pneumonia
  • Community-onset pneumonia
  • Ventilator-associated pneumonia
• Spontaneous bacterial peritonitis
• Tickborne illnesses
• Toxic Shock Syndrome
• Urologic
  • Community-acquired urosepsis
  • Catheter-associated UTI (CAUTI)

nephrology

Acid-base disorders

• Diagnosis
• HAGMA (high anion-gap metabolic acidosis)
• NAGMA (non-anion-gap metabolic acidosis)
• Metabolic alkalosis
• Respiratory acidosis
• Respiratory alkalosis

AKI & oliguria

Electrolytes

• Sodium
  • Hypernatremia
  • Hyponatremia
• Potassium
  • Hypokalemia
  • Hyperkalemia
  • BRASH syndrome
• Calcium
  • Hypocalcemia
  • Hypercalcemia
• Magnesium
  • Hypomagnesemia
  • Hypermagnesemia
• Phosphorous
  • Hypophosphatemia
  • Hyperphosphatemia

Hepatorenal syndrome

IV Fluids

• Volume status, maintenance fluids & fluid boluses
• Selection of which fluid to give
• Removing fluid: dominating diuresis

Rhabdomyolysis

Tumor lysis syndrome

neurology

Therapeutic interventions

• Analgesia for the critically ill patient
• Procedural sedation
• Sedating the intubated patient
• Therapeutic paralysis

Approaches to common problems

• Delirium
• Stupor & Coma
• Brain death

Specific disorders

• Alcohol withdrawal
• Anoxic brain injury neuroprognostication
• ICP elevation
• Intraparenchymal hemorrhage
• Ischemic stroke
• Meningitis & encephalitis
• Paroxysmal sympathetic hyperactivity
• PRES (posterior reversible encephalopathy syndrome)
• Status epilepticus

obstetrics

Preeclampsia

pulmonology

Diagnostics

• ABG/VBG
  • When to get ABG, VBG, or etCO2
  • End-tidal CO2
  • Diagnosis of acid-base disorders
• Diagnostic approach to respiratory failure
• Lung ultrasonography

Specific disorders

• ARDS
• Asthma
• COPD exacerbation
• Diffuse alveolar hemorrhage & pulmonary vasculitis
• Flash pulmonary edema
• Hemoptysis
• Pneumonia
  • Community-onset pneumonia
  • Ventilator-associated pneumonia
• Pulmonary embolism
  • DVT prophylaxis
  • Diagnosis & tx of DVT and small PE
  • Massive PE: Resuscitation
  • Submassive PE: Lytic strategies
• Pulmonary hypertension, chronic decompensated
• Vocal cord dysfunction

Therapeutics

• Noninvasive respiratory support
  • Selection of BiPAP vs. HFNC
  • High-flow nasal cannula
• Invasive mechanical ventilation
  • Decision to intubate
  • Extubation

rheumatology

• Anaphylaxis
• Angioedema
• Penicillin allergy
• Pulmonary vasculitis
• Hemophagocytic lymphohistiocytosis (HLH)

toxicology & temperature

Basic toxicology

• Approach to the poisoned patient
• Lipid rescue

Common intoxications

• Acetaminophen
• Alcohol intoxication (EtOH)
• Alcohols, toxic (ethylene glycol & methanol)
• Alcohol withdrawal
• Antihistamines
• Calcium channel blocker & beta-blocker
• Carbon monoxide
• Cyanide
• Digoxin
• Hypoglycemics (insulin, sulfonylurea)
• Lithium
• Local Anesthetic Systemic Toxicity (LAST)
• Metformin-associated lactic acidosis (MALA)
• Methemoglobinemia
• Opioid intoxication
• Salicylate
• Sympathomimetics
• Tricyclics & Na-channel blockers

Temperature abnormality

• Hyperthermia
  • Malignant hyperthermia
  • Neuroleptic Malignant Syndrome
  • Serotonin Syndrome
• Hypothermia