By Peter Papadakos

A pleasant extensive established gigantic photo evaluation of all suitable subject matters in severe care. presentation is fresh and fresh. a very good adjunct to The ICU e-book. you could crank out a bankruptcy in 20 min and feature it down strong.

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Extra resources for Critical Care: A Volume in the Requisites in Anesthesiology Series

Example text

The presence of an indwelling arterial catheter is independently correlated with the frequency of blood work drawn from any one particular patient. Therefore, arterial catheters correlate with the cost of ICU care. Biochemical laboratory analyses are frequently most easily drawn from arterial catheters. Routine monitoring of blood chemistries may phlebotomize an adult ICU patient at the rate of one unit of packed red blood cells per week. Whenever possible adult ICU patients should have all their blood work drawn in pediatric tubes.

Tachycardia may not be desirable because it increases myocardial oxygen demand and consumption and also may compromise cardiac output due to a rate-related impairment of diastolic ventricular filling. Patients with either fixed coronary obstruction or those with dynamic left ventricular outflow tract obstruction do not tolerate tachycardia well. Additionally, patients who are receiving beta-blocker therapy may not manifest a compensatory tachycardia in hypovolemic states; these patients will instead retain a controlled slower heart rate and the only sign of hypovolemia may be progressive hypotension.

If a paresthesia is obtained in an awake patient, the needle is injuring the cervical segment of the brachial plexus and needle location is too far posterior. The carotid artery runs close and medial to the IJ. Moreover, “cutting-tip” needles should never be repositioned subcutaneously because of the risk of lacerating vital structures; successive attempts requiring redirection of the needle tip must always be initiated at the level of the skin. Recently, the use of bedside ultrasound technology such as the Site-RiteR can help better locate the IJ vein, decrease the incidence of pneumothorax and arterial puncture, and also improve patient comfort.

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