Here is the first book to combine the essentials of respiratory care with practical discussions of critical care! 74 authorities - from educators and RRTs to pulmonary and critical care physicians - offer state-of-the-art insights into all aspects of respiratory care. This all-in-one resource provides in-depth coverage of specific diseases and conditions, and background information on cardiopulmonary science - enabling readers to diagnose and react to clinical signs and symptoms quickly and easily. Plus, it features up-to-the-minute discussions of clinical applications and the newest respiratory therapy technologies - helping readers to minimize patient discomfort using today's most effective respiratory care techniques.
SECTION I FUNDAMENTALS OF ANATOMY AND PHYSIOLOGY Lung Anatomy and Development 1(17) David R. Dantzker Evolutionary Development 3(3) Embryology 4(2) Anatomy of the Lung and the Airways 6(12) The Lungs 8(2) The Airways 10(3) The Blood Vessels 13(1) The Alveolar-Capillary Interface 14(1) Neural Innervation 15(2) Summary 17(1) Lung Mechanics 18(14) Jonathon Truwit Pressure Gradients 18(1) Respiratory Muscles 18(2) Impedances 20(1) Compliance 20(2) Resistance 22(4) Work of Breathing 26(4) Pressure-Time Index 30(2) Summary 31(1) Respiratory Muscles 32(23) David R. Dantzker Anatomy 32(4) The Diaphragm 33(1) Intercostal Muscles 34(1) Abdominal Muscles 35(1) Diaphragmatic Blood Flow 36(1) Tests of Respiratory Muscle Function 37(9) Static Voluntary Tests 38(2) Dynamic Voluntary Tests of Respiratory Muscle Endurance 40(1) STATIC Motivation-Independent Tests of Nerve and Muscle Stimulation 41(2) Dynamic Motivation-Independent Tests 43(3) Management of Respiratory Muscle Dysfunction 46(9) Nutritional Repletion 47(1) Conditioning and Training 47(1) Weaning From Mechanical Ventilation 48(1) Rest of the Ventilatory Muscles 49(1) Positive Pressure Ventilation 50(1) Pharmacologic Manipulation 50(1) Summary 51(4) Dyspnea: Pathophysiology and Clinical Evaluation 55(15) Evelyn Shearer-Poor Peter S. Kussin Definition of Dyspnea 55(1) Central Nervous System Control of Respiration 55(3) Cortical Influences 56(1) Chemical Control of Respiration as Related to Dyspnea 56(1) Brain Stem 57(1) Sensory Receptors 57(1) Chest Wall Muscle Apparatus and Dyspnea 58(1) Measurement of Dyspnea 58(2) Psychophysical Parameters 59(1) Physiologic Correlates of Dyspnea 60(3) Contribution of the Upper Airway 61(1) Chest Wall Mechanics 61(1) Dyspnea and Exercise Testing 62(1) Clinical Causes of Dyspnea 63(4) Psychiatric 63(1) Upper Airway 63(1) Lower Airway Obstruction 64(1) Parenchymal Disease 64(1) Pulmonary Vascular Disease 65(1) Pleural Disease 66(1) Cardiac Disease 66(1) Neuromuscular Disease 66(1) Chest Wall-Associated Disorders 67(1) Other Disorders 67(1) Clinical Evaluation of the Patient With Dyspnea 67(3) Summary 68(2) Acid-Base Disorders and Electrolyte Imbalance 70(28) Catherine S. Thompson Acid-Base Physiology 70(2) Acid-Base Disorders 72(6) Metabolic Acidosis 73(4) Metabolic Alkalosis 77(1) Respiratory Acid-Base Disorders 78(3) Respiratory Acidosis 79(1) Respiratory Alkalosis 80(1) Disturbances of Osmolarity: Hyponatremia and Hypernatremia 81(4) Hyponatremia 81(3) Hypernatremia 84(1) Disorders of Serum Potassium 85(4) Hypokalemia 86(2) Hyperkalemia 88(1) Disorders of Serum Calcium 89(3) Hypocalcemia 90(1) Hypercalcemia 91(1) Disorders of Serum Magnesium 92(1) Hypomagnesemia 92(1) Hypermagnesemia 93(1) Disorders of Serum Phosphorus 93(5) Hypophosphatemia 93(2) Hyperphosphatemia 95(1) Summary 96(2) Pulmonary Gas Exchange 98(21) David R. Dantzker The Gas-Exchanging Unit of the Lung 98(2) Oxygen and Carbon Dioxide Transport in Blood 100(3) Abnormal Pulmonary Gas Exchange 103(16) Reduction of the Inspired PO2 103(2) Hypoventilation 105(1) Abnormal Diffusion 106(2) Ventilation-Perfusion Inequality 108(5) Shunt 113(2) Nonpulmonary Factors 115(1) Summary 116(3) Ventilatory Control 119(12) David R. Dantzker The Respiratory Controllers 120(1) The Sensors 121(3) Central Chemoreceptors 121(1) Peripheral Chemoreceptors 122(1) Other Receptors 122(2) Effectors 124(1) Tests of Ventilatory Function 124(4) Abnormal Ventilatory Patterns 128(3) Summary 130(1) Cardiovascular Anatomy and Physiology 131(25) David J. Frid Stuart Sheifer Functional Anatomy of the Heart 131(6) Inflow Vessels 131(2) Atria 133(1) Ventricles 133(1) Outflow Vessels 133(1) Atrioventricular Values 133(2) Semilunar Values 135(1) Anatomic Position of the Heart 135(1) Protection Around the Heart 135(1) Blood Supply to the Heart 135(2) Hearts Electrical System 137(1) Pressure, Flow, and Volume During the Cardiac Cycle 137(2) Factors With An Impact on the Hearts Pumping Function 139(1) Pump Failure 140(1) Relationship of Pump Functioning to Peripheral Oxygen Demand 140(1) Clinical Manifestation of Pump Failure 141(15) Types of Heart Failure 141(2) Clinical Findings in Heart Failure 143(7) Precipitants of Heart Failure 150(1) Clinical Manifestations in Heart Failure Secondary to Various Cardiac Diseases 150(1) Summary 150(6) Tissue Oxygen Delivery 156(19) David R. Dantzker The Metabolic Requirement for Oxygen 156(3) Oxygen Transport 159(1) Tissue Oxygen Diffusion 160(2) Regulation of Oxygen Utilization 162(4) Monitoring the Adequacy of Tissue Oxygenation 166(9) Summary 171(4) SECTION II DIAGNOSTIC TECHNIQUES Physical Examination 175(13) Arthur S. Banner Inspection 175(5) Respiratory Pattern 175(4) Other Signs of Respiratory Disease Evident on Inspection 179(1) Palpation 180(1) Percussion 180(1) Auscultation 180(4) Sounds at the Mouth 181(1) Lung Sounds 181(3) Cardiac Examination 184(1) Diagnosis of Conditions Associated with Dyspnea 184(4) Obstructive Lung Disease 184(1) Asthma 185(1) Acute Pulmonary Edema 185(1) Pulmonary Vascular Disease 185(1) Neuromuscular Disease 186(1) Summary 186(2) Conventional Chest Radiography 188(17) Paul W. Burrowes Carl E. Ravin Airspace Diseases 188(8) Atelectasis 190(1) Pneumonia 191(1) Pulmonary Edema 192(2) Pulmonary Embolism 194(2) Extra-Alveolar Air 196(4) Pneumothorax 196(2) Interstitial Emphysema 198(2) Pneumomediastinum 200(1) Evaluation of Support and Monitoring Equipment 200(5) Endotracheal and Tracheostomy tubes 200(1) Chest Tubes 201(1) Central Venous Catheters 202(1) Swan-Ganz Catheter 202(1) Intra-aortic Balloon Pump 202(1) Nasogastric Tube 203(1) Transvenous Pacemakers 203(1) Summary 203(2) Newer Imaging Techniques in the Thorax 205(9) Edward F. Patz, Jr. Computed Tomography 205(2) Magnetic Resonance Imaging 207(4) Positron Emission Tomography 211(3) Summary 213(1) Hemodynamic Monitoring 214(29) Charles G. Durbin, Jr. Clinical Assessment of the Circulatory System 214(1) Arterial Blood Pressure Measurement 214(2) Oxygen Delivery: Role of the Heart 216(5) Preload in Cardiac Performance 217(2) Afterload 219(1) Contractility 220(1) Estimating Preload 220(1) Cannulation of a Central Vein for Pressure Monitoring 221(9) Venous Cannulation Complications 222(3) Pressure Measurement 225(1) Radiologic Assessment of Catheters 225(1) Catheter Management 226(2) Pressure Waveforms 228(1) Respiratory-Induced Pulmonary Artery Wedge Pressure Changes 229(1) Determination of Cardiac Output 230(3) Hemodynamic Variables 233(1) Other Monitors of Ventricular Performance 233(5) Ultrasound and Doppler Techniques for Evaluating Cardiac Function 235(1) Pressure-Volume Loops 236(1) Monitoring of Mixed Venous Oxygen (Sv02) 237(1) Hemodynamic Patterns in Common Pathologic Conditions 238(1) Myocardial Ischemia 238(1) Acute Pulmonary Embolism 239(1) Putting It Together 239(4) Summary 241(2) Respiratory Monitoring 243(23) Morris I. Bierman Basic Measurements 243(8) Respiratory Motion 243(1) Pressure 244(4) Airflow 248(1) Lung Volume 249(2) Derived Variables 251(4) Airway Resistance 251(2) Respiratory System Compliance 253(1) Work of Breathing 254(1) Noninvasive Monitoring of Arterial Blood Gas Parameters 255(4) Measures of Arterial Oxygenation 255(2) Measures of Arterial Carbon Dioxide 257(2) Measures of the Efficiency of Gas Exchange 259(7) Efficiency of Oxygenation 259(2) Efficiency of Ventilation 261(1) Summary 262(4) Neurologic Monitoring 266(12) John M. Luce Serial Measurement of Vital Signs and Repeated Physical Examinations 266(1) Assessment of Central Nervous System Anatomy 267(1) Cerebrospinal Fluid Analysis 268(1) Electroencephalography 268(1) Evoked Potential Recording 269(1) Measurement of Cerebral Perfusion Pressure 269(3) Evaluation of Arterial Blood Gas Values 272(1) Assessment of Cerebral Oxygenation 273(1) Measurement of Cerebral Arterial Flow 274(1) Estimation of Cerebral Blood Flow and Metabolism 274(4) Summary 276(2) Electrocardiography 278(37) Steven J. L. Evans Stephen Blumberg Electrical Properties of the Cardiac Muscle Cell 278(2) Electrical Conduction System of the Heart 280(1) P Wave, QRS Complex, and T Wave 281(6) Electrodes and Leads 281(2) Rhythm and Rate 283(2) Electrical Axis 285(2) Complexes, Intervals, and Segments 287(4) P Wave 287(1) PR Interval 288(1) QRS Complex 288(1) ST Segment 289(1) T Wave 290(1) QT Interval 290(1) U Wave 291(1) TP Segment 291(1) RR Interval 291(1) Chamber Enlargement 291(3) Left Ventricular Hypertrophy 291(1) Right Ventricular Enlargement 292(1) Right Atrial Enlargement 293(1) Left Atrial Enlargement 293(1) Bundle Branch Block 294(1) Atrioventricular Block 294(3) First-Degree Atrioventricular Block 295(1) Second-Degree Atrioventricular Block 295(1) Complete Heart Block or Third-Degree Atrioventricular Block 296(1) Hemiblocks, Bifascicular Blocks, and Trifascicular Blocks 297(3) Hemiblock 297(1) Bifascicular and Trifascicular Block 297(3) Extrasystoles 300(2) Premature Atrial Complexes 300(1) Premature Ventricular Complexes 301(1) Premature Junctional Complexes 302(1) Supraventricular Tachycardia 302(2) Atrial Flutter 303(1) Atrial Fibrillation 303(1) Atrial Tachycardia 304(1) Ventricular Tachycardia 304(3) Ventricular Fibrillation 307(1) Accelerated Idioventricular Rhythm 307(1) Pre-Excitation 308(1) Ectopic Supraventricular Rhythms 308(1) Junctional Rhythm 309(1) Accelerated Junctional Rhythm 309(1) Wandering Pacemaker 309(1) Ectopic Atrial Rhythms 309(1) Sinus-Related Arrhythmia 309(2) Sinus Tachycardia 309(1) Sinus Bradycardia 309(1) Sinus Arrhythmia 310(1) Sinoatrial Block 310(1) Sick Sinus Syndrome 310(1) Myocardial Ischemia and Infarction 311(4) Myocardial Ischemia 311(1) Myocardial Infarction 312(1) Summary 313(2) Pulmonary Function Testing 315(20) Jane Luchsinger Harry Steinberg Normal Values 315(1) Lung Volumes 316(4) Definitions 316(1) Methods of Measurement 317(2) Interpretation 319(1) Expiratory Flow Rates 320(4) Definitions 320(1) Methods of Measurement 320(2) Spirometry and Flow-Volume Loop Interpretation 322(1) Assessment of Airway Reactivity 323(1) Sources of Spirometry and Flow-Volume Loop Error or Artifact 324(1) Diffusing Capacity 324(1) Definitions 324(1) Methods of Measurement 324(1) Interpretation 325(1) Distribution of Ventilation 325(2) Methods of Measurement 325(2) Interpretation 327(1) Control of Ventilation 327(1) Definitions 327(1) Methods of Measurement 327(1) Compliance 327(1) Definitions 327(1) Methods of Measurement 327(1) Interpretation 328(1) Airway Resistance 328(1) Definitions 328(1) Methods of Measurement 328(1) Interpretation 328(1) Maximal Inspiratory and Expiratory Pressures 328(1) Definitions 328(1) Methods of Measurement 329(1) Interpretation 329(1) Exercise Testing 329(2) Methods of Measurement 329(2) Preoperative Evaluation 331(1) Neonatal and Pediatric Pulmonary Function Testing 332(3) Summary 333(2) Clinical Application of Laboratory Examinations 335(20) Suzanne M. Burns Complete Blood Count 335(3) Red Blood Cell Count (Erythrocyte Count) 335(3) White Blood Cell Count (Leukocyte Count) and Differential 338(4) White Blood Cell Count 338(1) Differential 339(2) Platelet Count (Thrombocytes) 341(1) Coagulation Studies 342(3) Prothrombin Time and Partial Thromboplastin Time or Activated Partial Thromboplastin Time 344(1) Disseminated Intravascular Coagulation and Associated Laboratory Tests 344(1) Electrolyte Studies 345(6) Sodium (Na+) 345(1) Potassium (K+) 346(1) Chloride (Cl-) 347(1) Serum Bicarbonate (HCO3, CO2 Content, and Serum CO2) 347(1) Glucose 348(1) Calcium, Magnesium, and Phosphorus 348(2) Blood Urea Nitrogen and Creatinine 350(1) Bilirubin 350(1) Enzymes 351(4) Creatine Kinase (Creatine Phosphokinase) and Isoenzymes 351(1) Lactate Acid Dehydrogenase 351(1) Serum Glutamic-Oxaloacetic Transaminase (Aspartate Aminotransferase) and Serum Glutamic-Pyruvic Transaminase (Alanine Aminotransferase) 352(1) Alkaline Phosphatase and Acid Phosphatase 352(1) Amylase and Lipase 352(1) Summary 352(3) Blood Gas and Acid-Base Measurement 355(50) George H. Hicks Invasive Measurement Techniques 355(32) Indications for Invasive Sampling and Analysis 355(1) Knowledge of the Patients Condition 356(2) Blood Sampling Techniques 358(11) Blood Sample Analysis: Measured and Derived Values 369(11) Ensuring the Accuracy of Invasive Blood Analysis 380(7) Noninvasive Monitoring 387(18) Transcutaneous and Transconjunctival Blood Gas Monitoring 388(2) Pulse Oximetry 390(2) Capnometry and Capnography 392(4) Summary 396(9) SECTION III THERAPEUTIC TECHNIQUES Cardiopulmonary Resuscitation 405(17) Nicholas G. Bircher Emergency Airway Control 405(2) Manual Methods Without Equipment 405(1) Manual Methods with Equipment 406(1) Emergency Ventilation and Oxygenation 407(2) Ventilation Patterns 407(1) Mouth-to-Mouth or Mouth-to-Nose Ventilation 407(1) Mouth-to-Adjunct Ventilation 408(1) Bag-Value-Mask Ventilation with Oxygen 408(1) Mechanical Ventilators 408(1) High-Frequency Jet Ventilation 409(1) Emergency Circulation 409(5) Causes of Cardiac Arrest 409(1) Recognition of Cardiac Arrest 409(1) Closed-Chest Cardiopulmonary Resuscitation 410(1) Combinations of Ventilations and Chest Compressions 411(1) Monitoring the Effectiveness of Cardiopulmonary Resuscitation 412(1) Mechanical Cardiopulmonary Resuscitation 413(1) Pharmacology 414(8) Routes for Drugs and Fluids 414(1) Drugs 414(4) Summary 418(4) Bronchial Hygiene 422(17) Eric D. Bakow Respiratory Mucus 422(3) Postural Drainage Therapy 425(7) Turning 426(2) Postural Drainage 428(2) Cough 430(2) Positive Expiratory Pressure 432(7) Hypoxemia 433(1) Hemodynamic Effects 434(1) Neurologic Effects 434(1) Wheezing 434(1) Pulmonary Hemorrhage 434(1) Summary 435(4) Mechanical Ventilatory Support 439(16) Neil R. MacIntyre Ventilatory Failure and the Need for Ventilatory Support 439(1) Conventional Mechanical Ventilator Design Principles 439(4) Gas Delivery System 440(2) Subsystem of Mechanical Ventilators 442(1) Effects of Positive Pressure Ventilation 443(3) Alveolar Ventilation and Ventilation Distribution 443(3) Complications of Positive Pressure Ventilation 446(5) Hazards Associated with Endotracheal Tubes 446(1) Mechanical Malfunctions 447(1) Patient-Ventilator Dyssynchrony 447(1) Air Trapping or Intrinsic Positive End-Expiratory Pressure 447(1) Barotrauma 448(2) Infections 450(1) Cardiovascular 450(1) Noninvasive Techniques for Ventilatory Support 451(4) Negative Pressure Approaches 452(1) Positive Pressure Mask Approaches 452(1) Summary 453(2) Oxygenation Support 455(11) Neil R. MacIntyre Techniques to Increase PA02 455(2) Techniques to Improve Alveolar-Arterial Oxygen Transport 457(5) Manipulation of Baseline of Expiratory Pressures 457(3) Manipulation of the Positive Pressure Breath to Improve V/Q Mismatch and Shunt 460(2) Nonrespiratory Support Techniques to Improve Oxygen Transport 462(2) Patient Position 462(1) Reduce Oxygen Consumption 462(2) Increase Oxygen-Carrying Capacity 464(1) Improve Alveolar Stability Through Surface-Active Material 464(1) Summary 464(1) Goals of Oxygenation Support 464(2) Unconventional Support Techniques for Ventilation and Oxygenation 466(11) Neil R. MacIntyre R. Alan Leonard High-Frequency Ventilation 466(4) Mechanisms of Gas Transport 467(2) Applications 469(1) Complications 469(1) Apneic Ventilation and Oxygenation 470(1) Liquid Lung Ventilation 471(1) Extracorporeal Systems 471(6) Venoarterial Bypass 471(3) Venovenous Bypass 474(1) Intravascular Oxygenation 475(1) Summary 475(2) Nosocomial Respiratory Tract Infection: Perspectives for Prevention and Respiratory Care 477(22) Donald E. Craven Kathleen A. Steger Epidemiology 477(1) Etiologic Agents 478(1) Diagnosis 479(1) Pathogenesis 480(3) Pulmonary Aspiration and Intubation 480(1) Colonization of the Oropharynx 480(2) Gastric Colonization 482(1) Immune Defenses in the Lung 483(2) Antibiotic Prophylaxis Against Colonization 485(1) Aerosolized Antibiotics 485(1) Antibiotic Prophylaxis 485(1) Infection Control 486(1) Devices and Procedures 487(12) Tracheal Suctioning 487(1) Endotracheal Tube 487(1) Nasogastric Tube Use and Tube Feeding 488(1) Resuscitation Bags 488(1) Spirometers and Oxygen Analyzers 489(1) Wall Oxygen Humidifiers 489(1) Nebulization Equipment 489(1) Mist Tents 490(1) Mechanical Ventilators With Heated Humidifiers 490(1) Tubing Colonization and Condensate 491(1) Humidifier Colonization 491(1) Heat and Moisture Exchangers or Hygroscopic Condenser Humidifiers 492(1) Small-Volume Nebulizers 492(1) Outflow Traps and Filters 493(1) Summary 493(6) Oxygen Therapy 499(21) Rich Malloy Margarete Pierce Oxygen: History and Chemistry 499(1) Manufacture of Oxygen 499(1) Oxygen Cylinders and Regulators 499(1) Cylinders 499(1) Regulators 500(1) Flowmeters 500(2) Oxygen Analyzers 502(1) Clinical Oxygen Therapy 503(5) Basic Concepts 503(2) Clinical Indications 505(2) Goals of Therapy 507(1) Weaning From Oxygen 507(1) Adverse Effects 508(2) In the Patient With Chronic Obstructive Pulmonary Disease 508(1) Oxygen Toxicity 509(1) Cellular Toxicity or the Free Radical Theory 509(1) Other Adverse Effects 509(1) Low-Flow Devices 510(6) Nasal Catheter 511(1) Nasal Cannula 511(1) Venturi Masks 512(1) Simple Oxygen Mask 512(1) Partial Rebreathing and Nonrebreathing Masks 513(1) Humidification 514(1) Special Oxygen Delivery Alternatives 514(1) Elongated Cannulas 514(1) Oxygen Concentrators 515(1) Portable Liquid System 515(1) Reservoir Cannulas 515(1) Demand Systems 515(1) Transtracheal Oxygen Therapy 515(1) Monitoring the Patient on Oxygen 516(1) Home Oxygen Therapy 516(1) Managing the Patient on Oxygen Therapy 517(3) Branching Logic 517(1) Open Loop or Care Plan 517(1) Summary 518(2) Hyperbaric Oxygen Therapy 520(19) Richard E. Moon Principles of Hyperbaric Oxygen Therapy 520(1) Indications 521(3) Gas Bubble Disease 521(1) Carbon Monoxide 521(2) Infections 523(1) Ischemic Wounds 524(1) Osteoradionecrosis and Soft Tissue Radiation Necrosis 524(1) Other Conditions 524(1) The Hyperbaric Environment 524(3) Altered Gas Physical Properties 525(1) Increased Partial Pressure of Nitrogen 525(1) Increased Partial Pressure of Oxygen 526(1) Hyperbaric Chamber Operations 527(12) Ventilators 529(2) Monitoring 531(3) Intravenous fluid Administration 534(1) Atmosphere Control 535(2) Summary 537(2) Aerosol Therapy 539(22) Dean Hess Factors Affecting Aerosol Penetration and Deposition 539(1) Nebulizers 540(4) Technical Aspects 540(1) Effectiveness of the Small-Volume Nebulizer 541(1) Clinical Application 542(2) Inhalers 544(5) Technical Aspects 544(1) Effectiveness of Metered Dose Inhalers 545(1) Clinical Application of Metered Dose Inhalers 546(1) Metered Dose Inhalers With Auxiliary Spacing Devices 547(2) Dry Powder Inhalers 549(1) Choice of Aerosol Delivery Device in Adult Ambulatory Patients 549(3) Aerosol Administration to Infants and Children 552(1) Aerosol Delivery During Adult Mechanical Ventilation 552(2) Use of Small-Volume Nebulizers in Intubated Patients 552(2) Use of Metered Dose Inhalers in Intubated Patients 554(1) Aerosol Delivery for Parenchymal Lung Disease 554(7) Ribavirin 555(2) Pentamidine 557(2) Summary 559(2) Airway Management 561(28) Michael S. Gorback Airway Anatomy 561(3) Upper Airway 561(2) Lower Airway 563(1) Airway Management 564(25) Simple Maneuvers to Relieve Airway Obstruction 564(1) Artificial Airways 565(2) Intubation 567(16) Cricothyroidotomy 583(1) Changing Endotracheal Tubes 584(1) Summary 584(5) SECTION IV CLINICAL PROBLEMS Nutrition 589(14) James R. Mault Nutritional Assessment 589(8) General Survey of Baseline Nutritional State 589(2) Measurement of Energy Metabolism 591(6) Measurement of Protein Metabolism 597(1) Strategies of Nutritional Management 597(6) Composition, Route, and Timing of Nutritional Support 598(1) Balance of Nutrition 599(1) Summary 599(4) Myocardial Ischemia 603(8) James R. Bengston J. Peter Longabaugh Mark E. Hamer Pathophysiology of Myocardial Ischemia 603(1) Myocardial Ischemia Syndromes 603(1) Stable Angina 604(1) Unstable Angina 604(1) Myocardial Infarction 604(1) Approach to the Patient with Myocardial Ischemia 604(7) Antiplatelet Agents 605(1) Antithrombotic Agents 606(1) Nitrates 607(1) Beta-Adrenergic Blockers 607(1) Calcium Channel Antagonists 607(1) Thrombolytic Therapy 608(1) Cardiac Catheterization and Percutaneous Transluminal Coronary Angioplasty 609(1) Coronary Artery Bypass Surgery 609(1) Summary 609(2) Acute Renal Failure 611(19) John D. Wagner Physiology and Pathophysiology 611(7) Prerenal Failure 614(1) Intrinsic Renal Failure 615(2) Postrenal Failure 617(1) Diagnosis 618(3) History 618(1) Physical Examination 619(1) Laboratory Testing 619(2) Management 621(9) General Approach 621(1) Uremia 622(1) Dialysis 622(1) Hemodialysis 623(1) Hemofiltration 623(2) Peritoneal Dialysis 625(1) Choosing a Dialytic Therapy 626(1) Renal Recovery 627(1) Summary 628(2) Trauma 630(22) Michael Rhodes Epidemiology 630(1) Prehospital Care 630(3) Resuscitation 633(4) Airway 633(1) Ventilation 634(1) Circulation 635(1) Monitoring 636(1) Diagnostic Imaging 637(1) Surgery 638(1) Critical Care 639(5) Oxygen Transport 639(2) Ventilatory Support 641(2) Tracheostomy Versus Prolonged Endotracheal Intubation 643(1) Nutrition 643(1) Additional Strategies 644(1) Specific Injuries 644(3) Head Injury 644(1) Thoracic Injury 645(1) Abdominal Injury 646(1) Pelvis and Extremities 646(1) Spine 647(1) Outcome 647(5) Summary 648(4) Barotrauma in Mechanical Ventilation 652(21) Wayne M. Samuelson David K. Handshoe William K. Fulkerson Background 652(2) Incidence of Barotrauma 654(1) Anatomic Considerations 655(1) Forms of Barotrauma Other Than Pneumothorax 655(4) Identifying Impending Barotrauma 659(2) Structural Events in the Development of Barotrauma 661(2) Effects of Barotrauma at the Cellular Level 663(3) Adult Respiratory Distress Syndrome 666(1) Positive End-Expiratory Pressure 667(2) Therapy for Pulmonary Barotrauma 669(4) Summary 670(3) Atelectasis: Pathophysiology and Treatment 673(19) Eric D. Bakow Pathophysiology 673(6) Risk Factors 679(1) Routine Preoperative Spirometry Testing 680(1) Clinical Findings 680(1) Clinical Sequelae 681(1) Treatment 682(10) Summary 688(4) Obstructive Lung Disease 692(22) David R. Dantzker Upper Airway Obstruction 692(2) Treatment 693(1) Lower Airway Obstruction 694(20) Pathophysiologic Principles 694(2) Specific Entities 696(7) Treatment 703(8) Summary 711(3) Congestive Heart Failure 714(12) Scott L. Roth Compensatory Mechanisms 714(2) Pathophysiology 716(3) Diagnostic Approach 719(3) Management of Acute Pulmonary Edema 722(4) Summary 725(1) Respiratory Failure 726(9) David R. Dantzker Ventilatory Pump Failure 727(1) Diaphragmatic Weakness and Paralysis 727(1) Spinal Cord Injury 727(1) Guillain-Barre Syndrome 728(1) Myasthenia Gravis 728(1) Kyphoscoliosis 728(1) Obesity 728(1) Management of Ventilatory Pump Failure 728(3) Diagnosis 728(1) Treatment 729(2) Inefficient Pulmonary Gas Exchange 731(4) Diagnosis 731(1) Treatment 732(2) Summary 734(1) Weaning Mechanical Ventilatory Support 735(8) Neil R. MacIntyre Who Needs Weaning? 735(1) Currently Available Partial Support Modes (Weaning Modes) 736(3) Spontaneous Breathing Trials Alternating With Total Support (T Tube Weaning) 736(1) Intermittent Mandatory Ventilation 737(1) Pressure-Supported Ventilation 738(1) Spontaneous Breathing During Pressure-Controlled Inverse Ratio Ventilation 738(1) Comparing Approaches 739(1) Initiating and Monitoring Weaning 739(4) Summary 741(2) Gastrointestinal Emergencies in the Intensive Care Unit 743(25) Isaac Raijman Larry D. Scott Acute Abdominal Pain 743(2) Jaundice 745(2) Nausea and Vomiting 747(1) Abdominal Distention 747(4) Intestinal Distention 748(1) Ascites 749(2) Gastrointestinal Bleeding 751(2) Diarrhea 753(1) Esophageal Perforations 754(1) Gastrointestinal Disorders 755(1) Peptic Ulcer Disease 755(1) Disorders of the Biliary Tract and Pancreas 755(4) Acute Cholecystitis 756(1) Acute Suppurative Cholangitis 757(1) Acute Pancreatitis 757(2) Hepatic Failure 759(2) Hepatorenal Syndrome 761(1) Acute Colonic Diverticulitis 761(1) Mesenteric Ischemia 762(6) Summary 764(4) General Management Principles of Poisoning and Overdose 768(16) R. Phillip Dellinger Toxicities 768(1) Differential Diagnosis 768(1) Clinical Presentation 769(1) Initial Management 769(2) Clinical Pearls 771(1) Specific Poisoning and Overdose Problems 772(12) Cocaine 772(1) Carbon Monoxide 773(1) Antidepressants 774(1) Opioids 775(1) Beta-Adrenergic Blockers 775(1) Calcium Channel Blockers 776(1) Hydrocarbons 776(1) Phencyclidine 776(1) Theophylline 777(1) Organophosphates 777(1) Barbiturates 778(1) Methanol and Ethylene Glycol 778(1) Acetaminophen 779(1) Salicylates 779(1) Toluene 780(1) Amphetamines 780(1) Benzodiazepines 781(1) Warfarin Compounds 781(1) Summary 782(2) Pulmonary Thromboembolic Disease 784(20) Gilbert E. DAlonzo Deep Venous Thrombosis 785(1) Pathophysiology of Pulmonary Embolism 786(1) Diagnosis of Pulmonary Embolism 787(5) Signs and Symptoms 787(1) Arterial Blood Gas Measurement 788(1) Chest Radiography 789(1) Electrocardiography 789(1) Ventilation-Perfusion Lung Scanning 789(1) Detection of Lower Extremity Venous Thrombosis 790(1) Pulmonary Angiography 791(1) Diagnostic Work-Up 791(1) Prevention and Treatment of Venous Thromboembolism 792(5) Complications of Acute Thromboembolic Disease 797(1) Other Forms of Pulmonary Embolism 797(7) Venous air Embolism 797(1) Fat Embolism 798(1) Amniotic Fluid Embolism 799(1) Septic Embolism 800(1) Other Embolic Processes 800(1) Summary 801(3) Sleep and Sleep-Disordered Breathing 804(15) Karl Yang Normal Sleep Physiology 804(1) Respiratory Physiology During Sleep 805(3) Sleep Apnea 808(11) Obstructive Sleep Apnea 808(7) Central Sleep Apnea 815(2) Summary 817(2) Respiratory Tract Infections 819(16) Victor F. Tapson Peter S. Kussin Community-Acquired Pneumonia 819(5) Etiology and Predisposing Conditions 819(2) Clinical Presentation and Diagnostic Approach 821(2) Treatment 823(1) Pneumococcal Vaccine 824(1) Nosocomial Pneumonia 824(11) Pathogenesis and Risk Factors 825(1) Etiology 826(1) Clinical Presentation and Diagnostic Approach 827(4) Treatment 831(2) Summary 833(2) Aspiration Pneumonia 835(11) Amal Jubran Pathophysiology 835(1) pH and Non-pH Effects 835(1) Bland Versus Infected 836(1) Inert Substances 836(1) Clinical Features 836(1) Predisposition 837(1) Treatment 838(2) Local Therapy 838(1) Antibiotics 838(1) Corticosteroids 839(1) Supportive Care 840(1) Approach to Preventing Aspiration 840(2) Drowning and Near-Drowning 842(4) Pathophysiology 842(1) Clinical Features 842(1) Treatment 843(1) Summary 844(2) Cough 846(21) Leonard J. Rossoff Physiology of Cough 846(1) Cough: A Reflex Defense Mechanism 847(1) Ineffective Cough: A Compromised Reflex Defense Mechanism 848(2) Cough: An Index of Air Pollution 850(1) Cough: A Sign of Disease 851(6) History 851(4) Physical Examination 855(1) Diagnostic Clinical Approach 856(1) Common Causes of Cough 857(2) Postnasal Drip 857(1) Asthma 857(1) Gastroesophageal Reflux 858(1) Chronic Bronchitis 858(1) Other Causes of Cough 859(1) Neuropsychological Causes 859(1) Pneumonia 859(1) Bronchiectsis 860(1) Neoplasm 860(1) Treatment of Cough 860(7) Specific Therapy 860(1) Nonspecific Therapy (Cough Suppression) 861(2) Cough Induction and Enhancement (Protussive Therapy) 863(1) Summary 863(4) Cor Pulmonale and Pulmonary Hypertension 867(12) David R. Dantzker Physiologic Considerations 867(4) Pulmonary Hypertension 871(1) Specific Causes of Pulmonary Hypertension 872(2) Chronic Obstructive Pulmonary Disease 872(1) Hypoventilation Syndromes 872(1) Restrictive Lung Diseases 872(1) Pulmonary Vasculitis 873(1) Primary Pulmonary Hypertension 873(1) Pulmonary Thromboembolism 874(1) Signs and Symptoms of Pulmonary Hypertension 874(1) Treatment of Pulmonary Hypertension 874(5) Oxygen Therapy 875(1) Vasodilators 875(1) Other Drugs 876(1) Lung Transplantation 877(1) Summary 877(2) Neuromuscular Disorders 879(30) Michael A. DeVita Sunil Hegde Effects of Neuromuscular Disorders on Muscles 879(1) Primary Disorders of Neuromuscular Function 880(11) Disorders of the Central Nervous System 881(4) Disorders of the Peripheral Nervous System 885(3) Disorders of the Neuromuscular Junction 888(2) Disorders of the Muscles 890(1) Respiratory Management of Patients With Neuromuscular Weakness 891(11) Assessment 892(1) Electrodiagnostic Studies 893(1) Mechanical Ventilatory Assistance 894(1) Intermittent Positive Pressure Ventilation 894(1) Continuous Positive Airway Pressure 895(1) Respiratory Muscle Training 896(1) Rest and Noctural Ventilation 896(2) Mask Ventilation 898(1) Negative Pressure and Body Ventilation 898(1) Home Mechanical Ventilation 899(1) Diaphragm Pacing 900(2) Diaphragmatic Inotropic Support 902(1) Ethical Issues in Neuromuscular Disease 902(7) Summary 904(5) Pleural Effusion 909(16) Rodolfo Morice Physiology of the Pleural Space 909(1) Clinical Considerations 909(1) Diagnostic Procedures 910(3) Specific Entities 913(12) Transudative Pleural Effusions 913(1) Exudative Pleural Effusions 914(8) Summary 922(3) Pulmonary Rehabilitation 925(24) Nelson E. Leatherman Definition of Pulmonary Rehabilitation 925(1) Mechanisms of Functional Deterioration in Chronic Lung Disease 926(1) Goal of Pulmonary Rehabilitation 927(1) Program Structure 927(2) Intensive Program 928(1) Graduate Program 928(1) The Sequence of Pulmonary Rehabilitation 929(14) Patient Selection 929(1) Patient Assessment 930(7) Implementing the Program 937(6) Evidence That Pulmonary Rehabilitation Programs Reverse Functional Deterioration 943(2) Psychological Changes 944(1) Physiologic Changes 945(1) Mechanisms Whereby Pulmonary Rehabilitation Accomplishes the Reversal in Functional Deterioration 945(4) Exercised Training 946(1) Increased Motivation 947(1) Decreased Hyperventilation 947(1) Increased Efficiency 947(1) Summary 948(1) Home Care 949(23) Susan McInturff Benefits and Goals 949(1) Patient Selection 950(4) The Discharge Process 951(1) The Home Environment 951(1) Reimbursement Issues 952(1) Customizing the Program 953(1) Equipment Selection 954(14) Oxygen Therapy 954(4) Oxygen-Conserving Devices 958(3) Aerosol Therapy 961(3) Ventilatory Assistance Devices 964(4) Patient Assessment and Long-Term Care 968(4) Plan of Care 969(1) Summary 970(2) Respiratory Care Pharmacology 972(32) E. Neil Schachter Theodore J. Witek, Jr. Beta-Adrenergic Agonists 972(3) Mechanism of Action 972(3) Clinical Utility of Adrenergic Agonists 975(1) Methylaxanthines 975(4) Mechanisms of Action 976(1) Clinical Utility of Methylxanthines 977(2) Antimuscarinic Agents 979(4) Mechanism of Action 980(1) Clinical Utility of Antimuscarinic Agents 981(2) Glucocorticoids 983(3) Mechanisms of Action 983(1) Clinical Utility of Glucocorticoids 984(2) H1-Receptor Antagonists and Other Mediator-Modifying Agents 986(1) H1-Receptor Antagonists 987(1) Mechanism of Action 987(1) Clinical Utility of Antihistamines 987(1) Mediator-Modifying Compounds 988(1) Mechanism of Action 988(1) Clinical Utility of SCG 988(1) Mucokinetic Agents and Antitussives 989(4) Antimicrobial Agents 993(11) Mechanism of Action 993(2) Clinical Utility of Antimicrobials 995(6) Summary 1001(3) Pediatric Respiratory Care 1004(29) Shekhar T. Venkataraman A. Saville Drew Wiltsie John Frank Charles W. Boig, Jr. Developmental Issues 1004(1) Physiology of Inflation and Deflation 1005(1) Mechanical Ventilation of Infants and Children 1006(4) Indications for Mechanical Ventilation 1006(1) Principles of Pediatric Mechanical Ventilation 1006(4) Unconventional Modes of Mechanical Ventilation 1010(5) Pressure Support Ventilation 1010(1) Independent Lung Ventilation 1010(1) High-Frequency Ventilation 1011(1) Extracorporeal Cardiorespiratory Support 1012(3) Special Techniques of Respiratory Support 1015(1) Altering Inspired Oxygen and Carbon Dioxide Concentration 1015(1) Helium-Oxygen Mixture 1016(1) Inhaled Nitric Oxide 1016(1) Aerosol Therapy 1016(6) A Dosing Paradigm 1016(2) Delivery Devices 1018(1) Aerosols Delivered Through Ventilators 1019(3) Interhospital Transports 1022(3) Indications 1022(1) Composition of the Transport Team 1023(1) Utility of a Therapist During Transport 1023(1) Responsibility of the Respiratory Therapist During Transport 1024(1) Training 1024(1) Home Care 1025(8) Indications for Home Respiratory Care 1026(1) Home Location and Atmosphere 1027(1) Medical Support and Caretaker Training 1028(1) Equipment and Supplies 1028(1) Summary 1029(4) Pathophysiology-Based Approach to Neonatal Respiratory Care 1033(57) Jon N. Meliones Barbara G. Wilson R. Alan Leonard Alan R. Spitzer Neonatal Respiratory Development 1033(4) Fetal Lung Fluid 1036(1) Developmental Considerations 1037(1) Respiratory Rate 1037(1) Tidal Volume 1037(1) Inspiratory Flow 1037(1) Total Respiratory Compliance 1038(1) Total Respiratory Conductance 1038(1) Respiratory Interventions 1038(31) Inhaled Medical Gases 1038(2) Classification of Positive Pressure Ventilators 1040(14) Nonconventional Modes of Ventilation 1054(11) Surfactant Replacement Therapy 1065(1) Extracorporeal Membrane Oxygenation in the Neonate 1066(2) Liquid Ventilation 1068(1) Respiratory Evaluation of the Neonatal Patient 1069(2) Noninvasive Evaluation 1069(2) Invasive Evaluation 1071(1) Respiratory Support for Specific Neonatal Syndromes 1071(10) Initial Care and Stabilization of the Infant With Respiratory Disease 1072(2) Initiation of Ventilatory Assistance in the Symptomatic Neonate With Respiratory Distress (Continuing Care Phase) 1074(1) Mechanical Ventilation 1074(2) Goals of Respiratory Support 1076(1) Application of Positive Pressure Ventilation 1077(4) Complications of Respiratory Interventions 1081(4) Oxygen Toxicity 1081(1) Retinopathy of Prematurity 1082(1) Barotrauma 1083(1) Bronchopulmonary Dysplasia 1084(1) Weaning From Positive Pressure Ventilation 1085(5) Noninvasive Monitoring 1085(1) Physiology of Weaning 1086(1) Criteria for Weaning 1086(1) Ventilator Adjustments 1086(2) Failure to Wean 1088(1) Summary 1088(2) Prehospital Respiratory Care 1090(29) Jay A. Johannigman Indications for Airway Management 1091(3) Absolute Indications 1091(1) Strong Relative Indications 1092(1) Relative Indications 1093(1) Simple Techniques for Airway Management 1094(1) Oxygen Administration 1095(3) Oxygen Therapy 1095(3) The Assisted Airway 1098(5) Mouth-to-Mouth Ventilation 1099(1) Mouth-to-Mask Ventilation 1099(1) Bag-Value-Mask Ventilation 1099(1) Esophageal Obturator Airway 1100(1) Pharyngotracheal Lumen Airway 1100(3) Advanced Airway Techniques 1103(3) Endotracheal Intubation 1103 Needle Thoracentesis and Chest Thoracostomy 1005(101) The Pharmacology of Airway Control 1106(1) Capnography 1107(1) Transport Ventilation 1107(12) Operational Characteristics 1108(5) Summary 1113(6) SECTION V RESPIRATORY THERAPY DEPARTMENT MANAGEMENT Managing Organizational Change 1119(13) Delorese Ambrose External Driving Forces for Change 1120(1) Technology 1120(1) Competition and Marketplace Trends 1120(1) Legal and Regulatory Pressures 1120(1) Internal Driving Forces for Change 1120(2) Rising Costs and Decreasing Profits 1120(1) Reorganization for Greater Efficiency and Effectiveness 1121(1) Employee Activism 1121(1) Demographic Trends 1121(1) What Is ``Organizational Change? 1122(1) Developmental Change 1122(1) Transformational Change 1122(1) Systemic Barriers to Change 1123(2) The Philosophy Behind the Change 1124(1) The Structure and Resources that Support the Change 1125(1) Human Barriers to Change 1125(1) Reducing Resistance to Change 1126(2) Managing Planned Organizational Change 1128(4) Stage One: Awareness 1129(1) Stage Two: Proaction (Planning) 1129(1) Stage Three: Action (Implementation) 1130(1) Stage Four: Reaction (Feedback) 1130(1) Summary 1130(1) Unfreezing 1130(1) Transitioning 1130(1) Refreezing 1131(1) Managing Quality in Health Care 1132(21) Philip B. Crosby Thomas H. Breedlove Ann Parks Linn The Need for Quality Management 1132(1) Progress Report 1133(1) Administrations Fresh Look at Systems Reduces Overtime $50,000 / Month; Receivables Down by 10 Days 1133(1) Progress Report 1134(1) Purchasing Communication Buys Pacemaker Savings 1134(1) What is Quality? 1134(1) Progress Report 1135(1) Respiratory Therapy Eliminating Outdated Procedures Saves Dollars, Improves Care 1135(1) Total Commitment to Quality 1136(1) Progress Report 1137(1) Pharmacy Brainstorming Sessions Result in Reduction in Medication Errors 1137(1) What Are The Customers Requirements? 1138(1) Progress Report 1139(1) Seniors Served Required Diet on Time and `Right the First Time 1139(1) Progress Report 1139(1) Emergency Room Diversion Hours Drop from 350 to Zero in 1 Year 1139(1) The Road to Wellness 1140(2) Progress Report 1142(1) Short-Stay Surgery Updating Charging Procedure Results in Six-Figure Savings 1142(1) A Common Focus 1143(1) Progress Report 1144(1) Radiology Measurement Helps Film Library and Staff Shine 1144(1) Common Knowledge 1145(1) Quality Management Strategy 1145(1) Commitment of Top Management 1146(1) Progress Report 1146(1) CEOs Office Show `Em Responsibility Starts at the Top 1146(2) Education 1148(1) How Much Does It Cost To Do Things Wrong? 1148(1) Progress Report 1149(2) Cardiology Clinic Identifying PONC Brings Attention to Patient No-Show Problem 1149(1) Summary 1150(1) Progress Report 1151(2) Hospital-wide Employee Recognition Puts on a Happy Smile 1151(2) Ethics and Patient Care 1153(29) Joseph E. Vincent Stephen E. Lammers Ethical Theories 1153(2) Teleologic Theories and Utilitarianism 1153(1) Deontologic Theories 1154(1) Ethical Principles 1155(3) Respect for Persons-Autonomy 1155(1) Nonmaleficence 1155(1) Beneficence 1156(1) Justice 1157(1) Professional and Patient Issues 1158(10) Medical Uncertainty, including Risk-Benefit Assessments 1158(1) Truthfulness 1159(1) Informed Consent 1160(2) Surrogacy 1162(1) Advance Directives 1163(2) Confidentiality 1165(1) Belief Systems 1166(1) Professional Roles and Team Membership 1166(1) Patient Advocacy 1167(1) Selected Topics 1168(9) Brain Death 1168(1) Persistent Vegetative State 1169(2) Judgments of Futility and Hopeless Illness 1171(1) Withholding and Withdrawing Medical Therapy 1171(1) `Do Not Resuscitate Orders 1172(1) Withholding and Withdrawing Ventilator Therapy 1173(1) Witholding and Withdrawing Artificial Nutrition and Hydration 1174(1) Resource Allocation 1175(1) Euthanasia 1176(1) Experimentation on Human Beings 1177(1) Significant Court Cases 1177(5) Quinlan 1177(1) Bartling 1178(1) Satz vs. Perlmutter 1179(1) Cruzan 1179(1) Summary 1180(2) Legal Aspects of Clinical Care 1182(9) Vincent F. Maher History 1182(1) Governmental Structure 1182(1) Professional Accountability 1183(1) Legal Framework for Practice 1183(1) Contract Law 1183(2) Negligence 1185(1) Assault and Battery 1186(1) Informed Consent 1187(1) Durable Power of Attorney-Health Care Proxy 1187(1) Staffing 1187(1) Defamation 1187(1) Privacy 1188(1) Acquired Immunodeficiency Syndrome 1188(3) Summary 1190(1) Patient, Community, and Staff Education 1191(27) David D. Rice Why Education is an Essential Professional Skill 1191(3) Education Is An Essential Component of Professional Life 1191(1) Education Is An Essential Component of Clinical Practice 1192(1) Education is a Central Component of Organizational Life 1192(1) Education is An Essential Component of Personal Development 1193(1) Conclusion-Education Should Not Be Left to the Specialists 1193(1) How Learning Occurs 1194(11) Change of Behavior 1194(1) Stimulus-Response and Chaining 1194(2) Behavioral Theory 1196(1) Systems Theory 1197(1) Communication Theory 1198(3) Adult Learning Theory 1201(2) The Methodology-Pedogogy, ``Androgogy, and ``Appropriogogy 1203(2) Classifying Learning Outcomes 1205(6) The Cognitive or Intellectual Skills Domain 1206(1) The Psychomotor Domain 1207(2) The Affective Domain 1209(2) How Teachers Influence Learning 1211(7) Common Elements of Significant Models 1211(2) Recommendations for Establishing the Conditions for Learning 1213(1) Summary 1214(4) Management Principles 1218(18) Eric D. Bakow Health Care in the 1990s 1218(1) Health Care Finances 1219(8) Productivity 1223(2) Budgeting 1225(2) Leadership 1227(3) Management Style 1230(6) Research and Statistics for the Clinician 1236(39) Robert L. Chatburn Dean Hess Science and the Scientific Method 1236(1) Why Clinicians Need to Know About Research Methodology 1237(1) Research Methodology: Components of Clinical Research 1238(8) Generate an Idea 1238(1) Develop the Study Question 1239(1) State the Null Hypothesis 1239(1) Search the Literature 1239(1) Consult An Expert 1240(1) Design the Experiment 1240(3) Write the Protocol 1243(1) Obtain Permission 1244(1) Collect the Data 1244(1) Reject or Concede the Hypothesis 1244(1) Write the Paper or Abstract 1245(1) Incorporate the Findings into Practice 1246(1) Perform Another Study 1246(1) Basic Statistics for Data Analysis 1246(1) Descriptive Statistics 1247(8) Inferential Statistics 1255(20) Summary: Communicating the Research Results 1270(5) Index 1275
