Algorithms in Critical Care Medicine

Emergency clinical medicine and intensive care are areas where complex conditions present with overlapping clinical manifestations. Symptoms of several life-threatening conditions are often similar, while the therapeutic options are diametrically opposite. Understanding the variability is crucial for quick initiation of appropriate therapy at the right time. In medical emergencies, an algorithmic approach to investigations, differential diagnosis and treatment is often adopted. It is regularly the case that the endpoint of one algorithm results in clinical conditions which themselves need another algorithmic approach. Subsequently, there is a need for all algorithms to end seamlessly and lead to destination algorithms. This book seeks to fill the gap that exists in providing seamless algorithms. Its algorithms begin with a syndromic approach, and lead to disease specific algorithms. These algorithms have been curated and edited by senior practitioners in intensive care who, with their years of teaching and work experience, have translated clinical science into a practical framework. This collection of algorithms will be of help in emergency rooms, high-dependency units, and intensive care units, as well as any location or facility where patients with acute presentations are cared for.

Table of Contents:
SECTION 1: SYNDROMIC APPROACH 1. Hypoxia 2. Shock 3. Chest Pain 4. Shortness of Breath 5. Oliguria 6. Rhabdomyolysis 7. DIC 8. Altered Sensorium 9. Anaphylaxis   SECTION 2: SYSTEMWISE APPROACH PART 1: RESPIRATORY 10. Type 2 Respiratory Failure 11. Pneumothorax 12. Acute Exacerbation of Asthma 13. Acute Exacerbation of Chronic Obstructive Pulmonary Disease. 14. Acute Respiratory Distress Syndrome 15. Severe Community-acquired Pneumonia 16. Bronchopleural Fistula 17. Weaning 18. Ventilator-associated Pneumonia/Hospital-acquired Pneumonia/ Healthcare-associated Pneumonia 19. Massive Hemoptysis 20. Pneumonia in an Immunocompromised Host 21. Pleural Effusions in Intensive Care Unit 22. Algorithm for Dyspnea in ER: USG-based Approach PART 2: CARDIOVASCULAR/HEMODYNAMICS 23. ST-segment Elevation Myocardial Infarction 24. Non-ST-segment Elevation Myocardial Infarction 25. Algorithm for Acute Coronary Syndrome Evaluation and Unstable Angina 26. New-onset Atrial Fibrillation 27. New-onset Ventricular Arrhythmia 28. Symptomatic Bradyarrhythmias 29. Cardiac Tamponade 30. Pulmonary Thromboembolism 31. Cardiogenic Shock 32. Sudden Cardiac Death 33. Pulmonary Hypertension 34. Cardiac Failure 35. Right Heart Failure 36. Native Valve Infective Endocarditis 37. Prosthetic Valve Endocarditis 38. Hypertensive Crisis 39. Aortic Dissection 40. Acute Cardiogenic Pulmonary Edema PART 3: CNS 41. Ischemic Stroke 42. Hemorrhagic Stroke 43. Subarachnoid Hemorrhage 44. Management of Severe and Non-severe Traumatic Brain Injury 45. Traumatic Spinal Cord Injury 46. Acute Flaccid Paresis 47. Acute Inflammatory Demyelinating Polyneuropathy 48. Myasthenia Gravis 49. Status Epilepticus and Super-refractory Status Epilepticus 50. Delirium in Intensive Care Unit 51. Community-acquired Meningitis 52. Nosocomial Meningitis 53. Neurogenic Shock 54. New-onset Weakness in the Intensive Care Unit 55. Cerebral Venous Thrombosis PART 4: GASTROENTEROLOGY/HEPATOLOGY 56. Massive Upper Gastrointestinal Bleed 57. Acute Severe Pancreatitis 58. Dysmotile Gut in Critical Care Settings 59. Enteral and Parenteral Nutritional Support in Intensive Care Unit 60. Total Parenteral Nutrition 61. Fulminant Hepatic Failure 62. Enteral Nutrition 63. Decompensated Cirrhosis Management 64. Drug-induced Liver Injury 65. Spontaneous Bacterial Peritonitis 66. Diarrhea in Intensive Care Unit 67. Lower Gastrointestinal Bleeding PART 5: RENAL 68. Acute Kidney Injury 69. Acute-on-chronic kidney disease 70.Pyelonephritis 71. Urinary Tract Infection 72.Hematuria 73.Polyuria PART 6: TRAUMA 74. Polytrauma 75. Chest Trauma 76. Penetrating Abdominal Trauma 77. Nonpenetrating Abdominal Trauma 78. Cervical Trauma 79. Pelvic Trauma 80. Vascular Injuries Management 81. Burns 82. Inhalational Injury 83. Drowning 84. Suicidal Hanging PART 7: METABOLIC ISSUES 85. Hyponatremia 86. Hypernatremia 87. Hypokalemia 88. Hyperkalemia 89. Hypocalcemia 90. Hypercalcemia 91. Hypophosphatemia 92. Hypomagnesemia 93. Hypermagnesemia 94. Hyperammonemia 95. Hyperchloremia 96. Hypothermia 97. Hyperthermia PART 8: ENDOCRINE 98. Diabetic Ketoacidosis Management Protocol 99. Hyperglycemic Hyperosmolar Nonketotic Syndrome 100. Myxedema Coma 101. Thyrotoxicosis. 102. Adrenal Insufficiency PART 9: BLOOD GAS ANALYSIS 103. Arterial Blood Gas 104. Metabolic Alkalosis 105. Respiratory Acidosis 106. Respiratory Alkalosis PART 10: TOXICOLOGY 107. Approach to Unknown Poisoning 108. Organophosphorus (OP) Poisoning 109. Hair Dye Poisoning: Super Vasmol Overdose 110. Zinc or Aluminum Phosphide Poisoning 111. Corrosive Poisoning 112. Calcium Channel Blocker/Beta-blocker Toxicity 113. Snake Envenomation 114. Paracetamol Poisoning 115. Paraquat Poisoning 116. Recreational Drug Overdose PART 11: SKIN AND SOFT TISSUE 117. Lupus Flare 118. Catastrophic Antiphospholipid Syndrome 119. TTP/HUS/MAHA 120. Stevens-Johnson Syndrome: Toxic Epidermal Necrolysis 121. Necrotizing Fasciitis 122. Generalized Rash and Purpura in Intensive Care Unit PART 12: HEMATOLOGY 123. Pancytopenia 124. Hemophagocytic Lymphohistiocytosis 125. Thrombocytopenia 126. Anemia 127. Deranged Prothrombin Time/Activated Partial Thromboplastin Time 128. Hemolytic Crisis 129. Tumor Lysis Syndrome 130. Mismatched Blood Transfusion PART 13: INFECTIONS 131. Approach to a Patient with Fever and Thrombocytopenia 132. Fever with Jaundice 133. Fever in an Immunocompromised Host 134. Patient with Fever and Rash in the ICU 135. Fever with Altered Sensorium 136. Fever of Unknown Origin in Neutropenia 137. Pyrexia of Unknown Origin 138. MDR/XDR Infections 139. Septic Shock 140. New-onset Fever in Intensive Care Unit PART 14: AIRWAY 141. Post-extubation Stridor 142. Difficult Airway Management 143. Emergency Airway Access PART 15: OBSTETRICS 144. Jaundice in Pregnancy 145. Thrombocytopenia in Pregnancy 146. Hypertension in Pregnancy 147. Trauma Management of Pregnant Patient 148. Shock during Pregnancy 149. Cardiac Arrest in Pregnancy 150. Ovarian Hyperstimulation Syndrome 151. Pregnancy-related Acute Kidney Injury 152. Peripartum Cardiomyopathy 153. Postpartum Hemorrhage PART 16: CHECKLISTS 154. Intra-hospital Transport of Critically Ill 155. Intubation 156. Extubation 157. Bedside Percutaneous Tracheostomy 158. Intercostal Drainage 159. Proning 160. Central Venous Line Cannulation 161. Arterial Cannulation 162. Brain Death Declaration 163. Ends-of-Life 164. Venovenous Extracorporeal Membrane Oxygenation 165. High Peak Pressure on Ventilator 166. Low Minute Ventilation 167. High Membrane Pressure on RRT

About the Author :
Srinivas Samavedam MD DNB FRCP FNB EDIC FICCM DMLE MBA Chief Intensivist, Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India; Associate Editor, IJCCM Ganshyam M Jagathkar MBBS MD FNB FICCM MBA Director, Department of Critical Care, Medicover Hospitals, Hyderabad, Telangana, India