Page numbers in italics represent fi gures, those in bold represent tables.
supportive care 388–9 treatment 388 acute lung injury/respiratory distress syndrome 338–45
burns patients 511–12 clinical presentation and pathophysiology
338–40, 339, 339
defi nitions 338 epidemiology 338 etiology 340–2, 340
fetal monitoring 342–4 corticosteroids 344
fl uid management 343 inhaled nitric oxide 343–4 mechanical ventilation 342–3 prone positioning 343 prognosis 344–5 surfactant therapy 344 acute respiratory distress syndrome, septic shock 584
ADAMTS-13, thrombotic thrombocytopenic purpura 408–12, 409–11, 412
adenosine, fetal effects 629 adnexal masses 708–9 adnexal torsion 363 ADP 286 adrenal crisis 434 adrenal glands, pregnancy adaptations 46 agitation 689–94
management 690–2, 691
pregnant and postpartum patients 692 air embolism 157, 241
airway chest trauma 497 obstruction 97 pregnancy adaptations 41 resuscitation 97–9, 98
airway pressure release ventilation 133, 134
albumin 70, 71, 72–3
indications 72 side effects 72–3 albuterol 331
alcohol see ethanol
alkalemia 54 alkalosis 54 metabolic 55, 64–5, 65
respiratory 55, 66, 66
Allen test 160–1 allergy, classifi cation 597
alteplase, ischemic stroke 246–7, 247
alveolar-arterial oxygen gradient 125 pulmonary embolism 291 American Nurses Association 16 amino acids 185
amiodarone, fetal effects 629–30 amniotic fl uid embolism 105, 241, 341–2, 466–72 clinical presentation 467–8, 468, 470–1, 470, 471
coagulopathy 468 hemodynamic alterations 467–8, 468
pulmonary manifestations 468, 468
diagnosis 471, 471
and DIC 401 experimental models 466–7, 467
history 466 pathophysiology 468–70, 469
treatment 471–2 amoxicillin, prophylaxis 641
amphetamine overdose 530–2 detection in urine 524
fetal considerations 531–2 lethal dose 531
management 532 maternal considerations 531, 531
metabolism 530–1 teratogenicity 531 toxicology 530 ampicillin, prophylaxis 641
amrinone, fetal effects 631 analgesia, ventilated patients 142–3, 144
anaphylactic shock 596–603 causative factors 596, 598–9
clinical presentation 597, 600
defi nitions 596 diagnosis 599, 600
differential diagnosis 602, 603
epidemiology 596
abdominal trauma
blunt 493–5, 494, 495
penetrating 495–6
ACE inhibitors, pre-eclampsia 445
acetaminophen overdose 524, 527, 528–30
antidotes 526
fetal/neonatal considerations 529–30
half-life 528
lethal dosage 528
management 530
maternal considerations 528–9, 529
metabolism 528
teratogenicity 530
toxicology 528
acetylcholinesterase inhibitors 735
acid-base balance
cardiopulmonary bypass 203
fetal 611–12
pregnancy adaptations 43, 54–5, 55
acid-base disorders 54–5, 55, 62–6
acidosis see acidosis
alkalosis see alkalosis
approach to 59–60, 60
graphic nomogram 59, 59
acid-base homeostasis 53–4
acidemia 54
acidosis 54
metabolic 55, 62–4, 63
respiratory 55, 65–6, 65
activated charcoal 525–6, 527
acute abdomen 358–63
adnexal torsion 363
appendicitis 359–61, 359, 360
bowel obstruction 362–3
cholecystitis 361–2
diagnostic imaging 359, 359
laparoscopy 358–9
acute fatty liver of pregnancy 380–1, 382, 385–9
clinical presentation 386–7, 386, 387, 388
diagnosis 387–8
and DIC 402–3
epidemiology 385
pathogenesis 385–6, 386
Trang 2management 599–603
acute 599–601
ongoing 601–2
pathophysiology 597
risk factors 596–7
exposure history 597
gender 596
history of atopy 597
type of exposure 597
timing/length of reaction 597, 599
anaphylactoid syndrome of pregnancy see amniotic
fl uid embolism
anaphylaxis, fetal distress 615
anemia 193
diabetic nephropathy 720
anesthesia 200–1
cardiac disease 639–53
mortality 560
anion gap 63–4
urinary 64
anthrax 731–2
antibiotics, prophylaxis 641
anticholinergics
antidotes 526
asthma 331
overdose 522
anticholinesterases, antidotes 526
anticoagulant therapy 648, 648
cardiopulmonary bypass 203
fetal effects 633
prosthetic heart valves 274–5
thromboembolic disease 293–300
antepartum management 297–8, 298
heparin 293–4, 293
intrapartum management 298–9
low molecular weight heparin 294–5, 294
postpartum management 299
prophylaxis 299–300
selective factor Xa inhibitors 297
warfarin 296–7, 296, 297
antidepressant overdose 532–4
fetal considerations 533
management 533–4
maternal considerations 533
teratogenicity 533
toxicology 532–3, 532
antidiuretic hormone 73
antifactor Xa 259
antiphospholipid syndrome 301, 479–82
catastrophic 481–2, 482
clinical features 480
pathogenesis 479–80
postpartum 481–2
treatment 480–1, 481
antithrombin 401
antithrombin III 259, 286–7
defi ciency 301
in DIC 405
antithymocyte globulin 658
aortic coarctation 263–4, 644
anesthesia 644
aortic dissection 567, 644
aortic insuffi ciency 267, 270
aortic stenosis 266
acquired 267, 269–70, 647
anesthesia 643–4, 647 congenital 643 Apgar score 110 apnea primary 109–10, 110
secondary 109–10, 110
appendicitis 359–61, 359, 360
diagnostic imaging 360 mortality and morbidity 360 preparation for surgery 360–1 presentation 359–60
arginine vasopressin see antidiuretic hormone arrhythmias see cardiac arrhythmias arterial blood gases see blood gases
arterial catheters, complications 156
arterial oxygen tension see PaO2
arteriovenous malformations 245–6 asphyxia 112
factors associated with 113 Hon pattern 613 aspirin overdose 534–6 fetal considerations 535 half-life 534
lethal dose 534 management 535–6 maternal considerations 534–5, 535
metabolism 534 teratogenicity 535 toxicology 534 asthma 327–35 arterial blood gases 328
assisted ventilation 143–4 diagnosis 327–8, 328
effect on pregnancy 329–30, 330
effect of pregnancy on 329 hospitalization rates 329
management 330–4, 333, 334
delivery 333–4 emergency 335
medications 331–4 postpartum 334 pregnancy 330–4 prepregnancy 330 severity 328
atracurium 143, 144
atrial fi brillation, mitral stenosis 647–8 atrial natriuretic peptide 36
atrial septal defect 260, 260
atropine, fetal effects 630 autologous blood transfusion 172–3 acute normovolemic hemodilution 172–3
intraoperative blood salvage 173 preoperative donation 172 automated external defi brillator 99 autonomic hyperrefl exia 232–3 confusion with pre-eclampsia 232 paradoxical bradycardia 232 prevention 232
severe systolic hypertension 232 treatment 232–3
autonomy, respect for 666 axillary artery, cannulation 161 azathioprine 658
azotemia, prerenal 377, 377
bacteremia 573
bacterial endocarditis 276 bacteriuria, asymptomatic 720
Bacteroides fragilis 577 barbiturate overdose 533, 536–8
detection in urine 524
fetal considerations 537 management 537–8 maternal considerations 536–7, 536
symptoms 536
teratogenicity 537 toxicology 536, 536
Bartter’s syndrome 79 basilizimab 658
battery 666 bedside nursing 13 benifi cence 666 benzodiazepine overdose 538–9 antidotes 526
detection in urine 524
fetal considerations 538–9 management 539 maternal considerations 538, 538
teratogenicity 539 toxicology 538 β-agonists, asthma 331 β-blockers, fetal effects 632 bicarbonate 62
biliary disease 366 biological agents 731–5, 731
anthrax 731–2 plague 733–4
Q fever 734 ricin 734–5 smallpox 732–3 viral hemorrhagic fevers 734 bioterrorism 729–37 biological agents 731–5, 731
general preparations 730 radiation exposure 735–7, 736
toxins/chemicals 735 birth depression 108–9, 113 blindness, temporary 455 blood collection/storage 165–6 blood component transfusion 165–78 autologous blood 172–3 blood inventory and ordering 170–1 cryoprecipitated antihemophilic factor 168 directed donation 173
disease transmission through 177–8 duration 169
fi lters 169 fresh frozen plasma and thawed plasma 168 intravenous solutions used with 169 massive 172
obstetric hemorrhage 171–2, 171
patient/donor identifi cation 169 platelets 168
red blood cells 167 frozen 167–8 leukocyte reduced 167 sickle cell crisis 398 washed 167 red cell antigen-antibody reactions 169–70, 170
separation 166–7
Trang 3transfusion reactions see transfusion reactions
warming of blood 169
whole blood 167
blood donation 165, 166
blood gas analysis 57–8
interpretation 58–9
mixed venous oxygenation 58
pulse oximetry 58
sample collection 57
blood gas analyzer 57–8
blood gases 53–66
asthma 328
bicarbonate 62
respiratory components 60–2
lung function assessment 61
oxygenation of peripheral tissues 61–2
PaCO2 62
PaO2 60–1, 61
blood loss, normal, physiologic changes 561
blood pH 58
blood pressure
diastolic 34
fetus, apnea 110
pregnancy adaptations 32, 32, 33
systolic 34
blood products, allergy to 599
blood transfusion see blood component transfusion;
exchange transfusion
blood volume, pregnancy adaptations 30–2, 31, 31
bone marrow transplantation 661–2
sickle cell crisis 398
bowel edema, crystalloid-induced 71
bowel obstruction 362–3
clinical management 363
diagnosis 362
presentation 362
brachial artery, cannulation 161
bradycardia, fetal 606, 606
brain death 675–8
criteria and tests 677
historical background 675–6
maintenance in vegetative state 676
management guidelines 676–8, 677
outcomes 676
perimortem cesarean delivery 103–4, 621–2, 621,
676
states of 677
brain injury
diffuse 500
focal 500–1
brain tumors 224
breast cancer 710–11
breathing, resuscitation 99
buffers 53
calcitonin, hypercalcemia 84
calcium, metabolic disturbances 81–5
hypercalcemia 83–5
hypocalcemia 82–3
calcium channel blockers
fetal effects 630
pre-eclampsia 444, 444
cancer 704–12
adnexal masses 708–9
breast 710–11
cervix 705–8 Hodgkin’s lymphoma 712 melanoma 711–12 ovarian 709–10 surgical principles 705 capnometry 210–11 carbamazepine 223
overdose 524
carbohydrates 185 carbon monoxide poisoning 539–41 antidotes 526
fetal considerations 540 management 540–1 maternal considerations 539–40, 540
teratogenicity 540 toxicology 539 carbonic acid-bicarbonate system 53 carboxyhemoglobin 524
cardiac arrest 95
cardiopulmonary resuscitation see
cardiopulmonary resuscitation pregnancy-specifi c conditions 95, 98
reversible causes 98
cardiac arrhythmias 566–7, 652 cardiac disease 256–77 acquired 267–70, 267
aortic insuffi ciency 267, 270
aortic stenosis 267, 269–70, 647
mitral insuffi ciency 267, 269
mitral stenosis 267, 268–9, 644–7, 645, 645–6
mitral valve prolapse 269 pulmonic and tricuspid lesions 267, 268
anesthesia 639–53 anticoagulation and prosthetic heart valves 274–5
bacterial endocarditis 276
cardiac transplantation see cardiac transplantation
congenital 259–66, 640–4, 640
aortic stenosis 266, 643 atrial septal defect 260, 260
coarctation of aorta 263–4, 644 Ebstein’s anomaly 263 Eisenmenger’s syndrome 261–3, 262, 642–3
functional single ventricle and Fontan procedure 266
left to right shunts 641–2, 641, 642
patent ductus arteriosus 261 pulmonary hypertension and Eisenmenger’s syndrome 261–3, 262
pulmonary stenosis 266, 643 tetralogy of Fallot 264–5, 642 transposition of great vessels 265–6 ventricular septal defect 260–1 dysrhythmias 276–7
epidemiology 639 fetal considerations 266–7, 267
functional classifi cation 257
hypertrophic obstructive cardiomyopathy 272 ischemic 648–9
Marfan syndrome 210, 272–3 maternal risk 257
myocardial infarction 273–4, 274
patient counselling 256–8, 257
peripartum cardiomyopathy 270–2, 271
physiologic considerations 258–9, 258, 258, 259
cardiac index 34
cardiac output 18–24, 34, 38, 39, 258–9
coronary artery disease 18–24, 20–3, 20, 21
non-invasive monitoring 207–8 pregnancy adaptations 34–5, 34, 35, 259
pulmonary artery catheterization 218 cardiac surgery, timing of 197–8 cardiac tamponade 497–8 cardiac transplantation 276, 277, 652–3, 661 anesthesia 652–3
cardiac trauma 498 cardiogenic shock 564–5, 572
pathogenesis 564–5 cardiomyopathy Doppler ultrasound 209–10 hypertrophic obstructive 272 mortality 560
peripartum 270–2, 271, 565–6, 651–2, 651
cardioplegia 202 cardiopulmonary bypass 196–204, 653 acid-base status 203
anesthesia and surgery 200–1 anticoagulation 203 avoidance of 197 duration 203 fetal monitoring 200 hematologic considerations 203 maternal and fetal risks 196–7 myometrial activity during 199–200 postoperative course 203
technique cardioplegia 202
fl ow and perfusion pressure 202 hypothermia 201–2
priming pump 201 pulsatility 202 timing of cardiac surgery 197–8 and uteroplacental perfusion 198–9, 199, 200
cardiopulmonary resuscitation 93–105, 96, 97, 653
airway 97–9, 98
breathing 99 circulation 99–100 complications and aftercare 103 current recommendations 93–4, 94
drugs 100–1 modifi cations for pregnancy 101–3, 102
neurological impairment after 104 perimortem cesarean delivery 103–4 pregnancy effects 100, 101, 102
thrombolytic therapy 103
cardiovascular accident see stroke, pregnancy-related
cardiovascular system pregnancy adaptations 30, 639–40, 640, 640
blood pressure 32, 32, 33
blood volume 30–2, 31, 31
cardiac output and stroke volume 34–5, 34, 35
central hemodynamic changes 39, 39
heart rate 32–4, 33
hemodynamic changes during labour 39–40,
39
hemodynamic changes postpartum 40–1, 40
postural effects 37–9, 37, 38
regional blood fl ow 36–7 systemic vascular resistance 35–6, 36
ventilator-associated complications 141
Trang 4cardioversion 647, 648
cathartics 526–7, 527
catheter-related infection 162
catheterization techniques 154–5, 156
Seldinger technique 154–5
catheters
central venous 153, 154
occlusion 176–7
vascular access 152–4, 153, 154
central nervous system, crystalloid effects
71–2
central venous access 17–18
associated infections 17–18
central venous catheters 154
peripherally inserted 153
central venous pressure 34, 38, 39
cephalic vein, cannulation 159
cerebral autoregulation 499
cerebral blood fl ow 237
cerebral edema 454–5
cerebral perfusion pressure, Doppler ultrasound
212–13
cerebral vasculopathy, postpartum 240
cerebral venous thrombosis 224, 239–40
cervical cancer 705–8
carcinoma 706–8
intraepithelial neoplasia 706
cesarean delivery
perimortem 103–4, 621–2, 621, 676
spinal injury 231
chemical burns 509
chest compressions 118–19
chest trauma 496–8
airway management 497
blunt cardiac injury 498
cardiac tamponade 497–8
classifi cation 496–7, 497
fl ail chest 498
hemothorax 497
open pneumothorax 497
tension pneumothorax 497
chest X-ray, pulmonary embolism 291
chlorhexidine gluconate 18
cholecystitis 361–2
diagnosis 361
management
clinical 361–2
medical 362
surgical 362
presentation 361–2, 361
cholestasis of pregnancy 388
cholinergics, overdose 522
cholinesterase 524
choriocarcinoma 241
Chvostek’s sign 83
circulation
resuscitation 99–100
spinal injury 229
cisatracurium 143, 144
Clostridium perfringens 573
coagulation, normal 440, 441
coagulation cascade, septic shock 585–6, 588
coagulation factors 259
pregnancy adaptations 45, 259
see also individual factors
cocaine poisoning 541–3 detection in urine 524
fetal considerations 542 management 542–3 maternal considerations 541–2 teratogenicity 542
toxicology 541 colloid osmotic pressure 39, 350
colloid solutions 72–3 albumin 72–3 hetastarch 73 competency 666–8 computed tomography, spiral, pulmonary embolism 292
congenital anomalies, neonatal resuscitation 122 continuous positive airway pressure (CPAP) 128 mask 116
neonate 115–16, 117
coronary artery disease 18–24, 20–3, 20, 21
diabetes mellitus 724–5 corticosteroids
acute lung injury/acute respiratory distress syndrome 344
asthma 331–2 complications 231 fetal effects 634 hypercalcemia 84
immunosuppression 658
pre-eclampsia/HELLP syndrome 239 septic shock 587–8
spinal injury 230–1 systemic lupus erythematosus 478 Couvelaire uterus 309
Creutzfeldt-Jakob disease, blood transmission 178 critical care nursing 16–29
cardiac output evaluation 18–24 central venous access 17–18 heparin fl ush 18
invasive haemodynamic monitoring 16–17 mechanical ventilation 24–9, 25, 26, 26, 28, 28
preparation for caring 29 standards of care 16, 17
technology 16 critical illness polyneuropathy 138 cromolyn sodium 331
cryoprecipitated antihemophilic factor 168 crystalloid solutions 70–2, 70
indications 87 isotonic crystalloids 70–1 side effects 71–2 Cullen’s sign 367 cyanide, antidotes 526
cyclosporine 658
cytomegalovirus, blood transmission 178 D-dimer 401
assay 290 daclizumab 658
dead space 125 deep venous thrombosis 288–90 clinical diagnosis 288, 288
ascending venography 289, 289
D-dimers and thrombin assay 290 impedance plethysmography 289 iodine 125 fi brinogen scanning 289–90
radionuclide venography 290 thermography 289 ultrasound 288–9 incidence 284
and route of delivery 285
delta gap 64 dependent moral status 666 depression 684–7 during pregnancy 684–5 perinatal risk factors 685–6 postpartum 685
treatment 686–7 dexamethasone, fetal effects 634 dexmedetomidine 143 dextrose 5% 71
diabetes insipidus cranial 77 transient of pregnancy 76 diabetes mellitus 717–25 coronary artery disease 724–5 diabetic ketoacidosis 425–7, 427, 721–4
clinical presentation 722 differential diagnosis 722–3 laboratory diagnosis 722, 722
management 723–4, 723
bicarbonate 723–4
fl uid and electrolytes 723 insulin 723
potassium 723 pathophysiology 721–2 precipitating factors 722 diabetic nephropathy 719–21 course in pregnancy 719–20 management 720–1, 721
prepregnancy evaluation 719 diabetic neuropathy 425 diabetic retinopathy 717–19 course in pregnancy 717 insulin effect 718 management 718–19
“pregnancy factor” 717–18 risk factors 718
dialysis 188–94, 721 antepartum management 193–4 fetal complications 192–3, 192
hemodialysis 189, 189, 190
indications 189
intensive 190–1 maternal complications 191–2, 192
modifi cation of prescription 191 overview 188–9
peritoneal 189–90, 190, 190
and pregnancy 190–3, 190
and uteroplacental perfusion 191 diaphragmatic hernia 121 diazepam 142, 226
diazoxide, pre-eclampsia 444
DIC see disseminated intravascular coagulopathy diet see nutrition
digital subtraction pulmonary angiography 293 digoxin
antidotes 526
fetal effects 631 overdose 524
diltiazem, fetal effects 630
Trang 5disseminated intravascular coagulopathy 400–5,
576
diagnosis
clinical 403
laboratory 403–4, 403
etiology 401–3, 401
acute fatty liver of pregnancy 402–3
amniotic fl uid embolism 401
eclampsia 402
intrauterine death 402
intrauterine infections 402
placental abruption 402
factor VIIa 405
fetal distress 615–17, 616
management 404–5
activated protein C 404
antithrombin III 405
blood/blood products 404
fl uid therapy 404
heparin 404
normal coagulation 400, 401
pathophysiology 400–1
septic shock 585–6
distributive (vasodilatory) shock 572
diuretics, fetal effects 631–2
dobutamine, fetal effects 631
dopamine
fetal effects 631
post-resuscitation 120
Doppler ultrasound
and cardiomyopathy 209–10
critical care 208–9
physiology of pregnnacy 208
pre-eclampsia 209
transcranial 211–13, 211
bias and confounders 211–12
cerebral perfusion pressure 212–13
transesophageal 210
dorsalis pedis artery, cannulation 161
drug reactions 598
drug-depressed infants 119
dysrhythmias 276–7
Ebstein’s anomaly 263
ECG, pulmonary embolism 291
eclampsia 224, 237–9, 455–7, 456
and DIC 402
fetal distress 615
maternal-fetal complications 456
see also pre-eclampsia
Eisenmenger’s syndrome 261–3, 262, 642–3
anesthesia 643
electrical burns 509
electrocardiogram see ECG
electrolyte balance see fl uid/electrolyte balance
electrolyte disorders 73–86
see also individual electrolytes
embolism
air 157, 241
amniotic fl uid 241
mortality 560
paradoxical 241
emesis, induction of 521, 523
enalapril, fetal effects 632
endocarditis, bacterial 276
endocrine emergencies 425–34 adrenal crisis 434 diabetic ketoacidosis 425–7, 427
hyperparathyroidism 432–3 hypoparathyroidism 433 pheochromocytoma 431–2, 432
thyroid dysfunction 428–31 hyperthyroidism 428–30, 429
hypothyroidism 430–1 thyroid storm 431
endocrine system pregnancy adaptations 45–6 endotracheal intubation 117–18, 118, 130
complications 131
endovascular occlusion therapy 245 envenomation 548–53
scorpion stings 553 snakebites 548–50, 549, 550
spider bites 551–3, 551, 552
epidemiology 1–10 epidural hemorrhage 494
epilepsy 222–7 etiology 222 gestational 224
new-onset in pregnancy 224–5, 224
prophylaxis 222–4 seizure classifi cation 223
status epilepticus 225–6, 226
subsequent management 226–7 treatment 225
epinephrine fetal effects 630 neonatal resuscitation 119 epistaxis 41
ergometrine, uterine atony 313 erythroblastosis 121–2 erythropoietin, sickle cell crisis 398 ethanol poisoning 524, 543–5
detection in urine 524
fetal considerations 544 management 544–5 maternal considerations 543–4 teratogenicity 544
toxicology 543 ethical issues 665–81 brain death 675–8 Jehovah’s Witnesses 678–80 letter of condolence 680–1
maternal-fetal confl ict see maternal-fetal
confl ict medical-legal cases 667 ethical principles 665–9 competency 666–8 court cases 670–1 fetal rights 670–1 maternal autonomy 670 Roe vs Wade 670 fetal status 668–9 informed consent 665–6 ethosuximide 223
ethylene glycol poisoning 524
antidotes 526
exchange transfusion, sickle cell crisis 397–8 expiratory reserve volume 42
external jugular vein, cannulation 158
extracellular fl uid 69 volume control 73–4 extracorporeal membrane oxygenation 135–6 face tent 129
factor V 259
factor V Leiden 288 factor VII 259
factor VIIa, recombinant 405 factor VIII 259
factor IX 259
factor X 259
factor Xa inhibitors 297 factor XI 259
factor XII 259
factor XIII 259
Fallot’s tetralogy 264–5, 642 fat emulsions 185 feeding, post-resuscitation 120 femoral artery, cannulation 161 femoral vein, cannulation 159, 160
fentanyl 144
fetal effects 628 fetal brain injury 612–15 acute 612–13, 613
Hon pattern of asphyxia 613–14 persistent non-reactive heart rate pattern 614 reactive admission test 612
fetal distress 605–22 detection of 605–6 maternal and surgical conditions 615–22 anaphylaxis 615
burns patients 617–18, 617, 618
disseminated intravascular coagulopathy
615–17, 616
eclampsia 615 maternal brain death/persistent vegetative state
618–21, 619–21
fetal effects of drugs 626–34, 627
cardiovascular drugs 629–33 endocrinologic emergencies 633–4 maternal analgesia and sedation 626–9
see also individual drugs
fetal heart rate 606–8 apnea 110
bradycardia 606, 606
brain damage 612–15 coronary artery disease 22, 23
maternal cardiopulmonary bypass 199
and maternal temperature 200
mechanical ventilation 26, 28
response to uterine contractions 609–11, 610
accelerations 609–10 late decelerations 611 variable decelerations 610 sinusoidal pattern 609 tachycardia 606–8, 607, 608
variability 608–9 fetal monitoring 614–15 fetoscopy 700–1 fetus
acid-base balance 611–12 blood pressure, apnea 110
circulation 109
hazards of radiography 231–2, 231
Trang 6medical-legal status 668–9
monitoring, during cardiopulmonary bypass 200
response to hypoxia 109, 109
fi brinogen 259, 401
fi brosing alveolitis 340
fl ail chest 498
fl uid dynamics, pregnancy effects 69–70
fl uid resuscitation 70–3, 70
acute lung injury/acute respiratory distress
syndrome 343
spinal injury 230
fl uid/electrolyte balance 69–86
ventilated patients 141–2
fl uids, post-resuscitation 120
fl umazenil, overdose 521
Fontan procedure 266
food allergies 598
formoterol 331
fosphenytoin 226
fractures, burns patients 512
functional residual capacity 42
furosemide, fetal effects 631
gabapentin 223
gallbladder, pregnancy adaptations 44
Gardnerella vaginalis 577
gastric contents, aspiration of 341
gastric lavage 523, 525
gastrointestinal haemorrhage 138
gastrointestinal system
pregnancy adaptations 43–4
anatomy 43–4
hepatobiliary 44
physiology 44
septic shock 586–7
genitourinary system, pregnancy adaptations 43
gentamicin, prophylaxis 641
glomerular fi ltration rate 69
glomerulonephritis, acute 377–8, 378
glucose, post-resuscitation 120
graft-vs-host disease, transfusion-associated
177
Graves’ disease 428–9
Grey Turner’s sign 367
gunshot wounds 495–6
haemodynamic monitoring, invasive 16–17
haloperidol 142
fetal effects 628
head trauma 499–503
brain injury mechanism 499
cerebral autoregulation 499
classifi cation 500
delivery considerations 502–3
diffuse brain injury 500
focal brain injury 500–1
general principles 501–2, 502
primary management 499–500
skull fractures 501
heart rate 34, 38, 39
fetal see fetal heart rate
pregnancy adaptations 32–4, 33
heavy metal poisoning 524
antidotes 526
Heimlich maneuver 97
HELLP syndrome 237–9, 380, 382, 417–19, 451–3,
452, 453
causes and pathogenesis 418 clinical features 417 differential diagnosis 419, 452
laboratory features 417–18 maternal outcomes 453
perinatal outcomes 453
treatment 238–9, 418–19 hematologic system pregnancy adaptations 44–5 coagulation factors 45 platelet count 45 red cell mass 44–5 white cell count 45, 45
hemodialysis 189, 189, 190, 190
hemodynamic changes central 39, 39
during labour 39–40, 39
postpartum 40–1, 40
hemolytic-uremic syndrome 381, 416–17 treatment 417
hemophilia 321 acquired 321 hemorrhage 171–2, 171, 308–22
bleeding disorders 319–22 causes 560, 561–2
clinical classifi cation 560
epidural 494
mortality 559, 560
placental abruption 308–9
postpartum see postpartum hemorrhage
uterine rupture 309–11
see also hypovolemic shock
hemostasis 285–7 pregnancy adaptations 287, 287
hemothorax 497 Henderson-Hasselbalch equation 53–4, 57, 62
heparin antidotes 526
antiphospholipid syndrome 481
fetal effects 633
low molecular weight see low molecular weight
heparin side effects 295–6, 295
thromboembolic disease 293–4, 293
heparin fl ush 18 hepatitis, acute 388
hepatitis B, blood transmission 177 hetastarch 70, 73
indications 73 side effects 73 high humidity mask 129
high-frequency oscillatory ventilation 133–4 Hodgkin’s lymphoma 712
Homan’s sign 288 hospitalization length of hospital stay 2 perterm labor 13 pregnancy-related 2, 3
delivery 3, 4
non-delivery 3, 4
human T-lymphotropic virus, blood transmission 177–8
hydralazine fetal effects 632 pre-eclampsia 443–4, 444
hydrochlorothiazide, fetal effects 631–2 hydrocortisone, fetal effects 634 hydromorphone 144
hydrops 121–2 hydroxychloroquine, systemic lupus erythematosus 478
hyperalimentation 181–6 normal nutrition 181–2, 182
weight gain 182
hypercalcemia 83–5 clinical presentation 84 diagnosis 84 etiology 83, 83
treatment 84–5, 84
hypercapnia, permissive 137–8 hypercoagulability 258, 259
hyperemesis gravidarum, and hyponatremia 74–5 hyperkalemia 79–81
clinical presentation 80 diagnosis 80–1 etiology 80, 80
management 81, 81
hypermagnesemia 86 hypernatremia 76–8 clinical presentation 77 diagnosis 77 etiology 76–7, 76
management 77–8 hyperparathyroidism 432–3 hypertension
pregnancy-induced 439
mortality 560
see also eclampsia; pre-eclampsia
hypertensive cardiomyopathy 449–50 hyperthyroidism 428–30, 429
hypertriglyceridemia 366–7 hypertrophic obstructive cardiomyopathy 272 hypocalcemia 82–3
clinical presentation 83 etiology 82–3, 82
treatment 83, 83
hypokalemia 78–9 clinical presentation 79 diagnosis 79 etiology 78–9, 78
management 79 hypomagnesemia 85–6, 85
hyponatraemia 74–6 clinical presentation 75–6, 75
etiology 74–5, 74
hypoparathyroidism 433 hypotension, spinal injury 230 hypothermia, cardiopulmonary bypass 201–2 hypothyroidism 430–1
hypovolemic shock 229, 559–64, 572
management 562–4 hemostasis 564 oxygenation 562 pharmacologic agents 564 volume replacement 562–4 hypoxemia 60, 128
treatment see mechanical ventilation
Trang 7hypoxia, fetal response to 109, 109
hypoxic ischemic encephalopathy 605
hysterectomy, postpartum hemorrhage 318–19
hysterotomy 699–700, 700
ibutilide, fetal effects 630
ICU see intensive care unit
idiopathic thrombocytopenic purpura 319–20
immune system, pregnancy adaptations 46–7
immunosuppression 657–9, 658
immunotherapy
anaphylaxis 598
asthma 332
septic shock 588
independent moral status 666
indium 111 platelet imaging 293
infection 573
catheter-related 162
central line-associated 17–18
mortality 560
intrauterine 402
inferior vena cava fi lter 300–1
informed consent 665–6
insect bites/stings 598
inspiratory capacity 42
insulin, fetal effects 634
intensive care unit 11–15
admission criteria 12
design of 14–15
patient population 11–12, 12
patient-centered care 12, 12
pregnancy-related admissions 6, 7
illnesses responsible for 6, 8
mortality causes 7–8, 9
rationale for 11
team members 12–14
nurses 13, 13
physicians 12–13
internal jugular vein, cannulation 157–8, 157,
158
International Normalized Ratio 168
interstitial nephritis 378, 378
intracerebral hemorrhage 241
intracranial hemorrhage 224
intracranial pressure, subarachnoid hemorrhage
244
intrauterine death, and DIC 402
intrauterine infection, and DIC 402
intravascular volume 258, 258
intubation, spinal injury 228–9
inverse ratio ventilation 132–3
iodine poisoning 527
ipratropium 331
iron poisoning 524, 527, 545–6
antidotes 526
fetal considerations 546
management 546
maternal considerations 545–6
teratogenicity 546
toxicology 545
ischemic heart disease 648–9
ischemic stroke 246–8, 247
prevention 248
symptoms 246
thrombolytic therapy 246
isoniazid, antidotes 526
isopropanol, overdose 524
isoproterenol, fetal effects 631 Jehovah’s Witnesses 678–80 guidelines for treatment 679–80 historical background 678 legal issues 678–9 justice 666 kallikrein 286 kidney, role in acid-base regulation 54 kininogen 286
labetalol 238 fetal effects 632 pre-eclampsia 444–5, 444
labor and delivery
cesarean see cesarean delivery
fetal heart rate 22, 23
fetal monitoring 614–15 hemodynamic changes 39–40, 39 preterm see preterm labor
spinal cord injury 233 transplant patients 662 laparoscopy 358–9 latex allergy 599
left to right shunts 641–2, 641, 642
anesthetic management 641–2, 642
left ventricular outfl ow tract obstruction 644 left ventricular stroke work index 38, 39
letter of condolence 680–1 leukotriene modifi ers 332 Libman-Sacks endocarditis 210 lidocaine, fetal effects 630–1 lithium, overdose 524
liver function, pregnancy adaptations 44 liver rupture 453–4
liver transplantation 660–1 lorazepam 142, 144, 226
fetal effectsd 627 losartan, fetal effects 632 low molecular weight heparin, thromboembolic disease 294–5, 294
Lowenberg test 288 lung function, assessment 61 lung injury, ventilator-induced 137 lung transplantation 661 lung volumes, pregnancy adaptations 42, 42,
329
magnesium, metabolic disturbances 85–6 hypermagnesemia 86
hypomagnesemia 85–6 magnesium sulfate 238 antidotes 526
pre-eclampsia 442
malnutrition 186–7 mania 692–4 treatment 693–4 mannitol fetal effects 634 subarachnoid hemorrhage 244 Marfan syndrome 210, 272–3 marijuana, detection in urine 524
maternal mortality 1, 2–5, 4
pregnancy-related 5
thermal injuries 512 maternal-fetal confl ict 669–70 compromise views 673–4, 673
fetal rights 669–70, 672 management of 674–5 maternal autonomy 669, 672 special considerations 671–3 fetal rights 672 forcible restraint with good outcome 672–3 maternal autonomy 672
maternal-fetal unit, transport of substances between
182
maximal sterile barriers 17 mean arterial pressure 34, 38, 39
mechanical ventilation see ventilation
meconium aspiration 120–1, 121
melanoma 711–12 Mendelson’s syndrome 577 mercury poisoning 527
metabolic acidosis 55, 62–4, 63
metabolic alkalosis 55, 64–5, 65
metaproteronol 331 methanol poisoning 524
methemoglobinemia 524
antidotes 526
methimazole, fetal effects 634 methylergonovine, uterine atony 313 methylxanthines, asthma 331 microalbuminuria 719–20 midazolam 142, 144
fetal effects 626–7 milrinone, fetal effects 631 minerals 186
misoprostol, uterine atony 314 mitral insuffi ciency 267, 269
mitral regurgitation 267
mitral stenosis 267, 268–9, 269, 566, 566, 644–7,
645, 645–6
anesthesia 646–7, 646
atrial fi brillation 647–8 mitral valve prolapse 269 mixed venous oxygenation 58, 128 monitoring
fetal, cardiopulmonary bypass 200 non-invasive 207–13
capnometry 210–11 Doppler ultrasound 208–10, 211–13 oximetry 210, 210
montelukast 332 morbidity, ICU admissions 8 morphine 144
fetal effects 628 mortality causes 560
ICU admissions 7–8, 9
maternal see maternal mortality perinatal see perinatal mortality
motor vehicle accidents 493 Moyamoya disease 241 muromononab-CD3 658
mycophenolate mofetil 658
myocardial infarction 273–4, 274, 565
myopathy 138
Trang 8naloxone, overdose 521
nasal cannula 129
negligence 666
neonatal lupus erythematosus 476–7
neonatal resuscitation 108–22
anticipation of 111–12
Apgar score 110
assisted ventilation 114–18
causes of birth depression 108–9
chest compressions 118–19
complications 120–2
diaphragmatic hernia 121
erythroblastosis/hydrops 121–2
meconium aspiration 120–1, 121
pneumothorax 121
congenital anomalies 122
drug-depressed infants 119
equipment 112
initial steps and evaluation 112–14
airway clearance 113–14
free-fl ow oxygen 114
tactile stimulation 114
thermal management 112–13, 114
medications 119
overview 110–11, 111
personnel 112
post-resuscitation care 120
primary and secondary apnea 109–10, 110
ventilation 111
nerve agents 735
neurogenic shock 229
neutralizing agents 526
nicotine poisoning 527
nifedipine 82
pre-eclampsia 444
nimodipine, subarachnoid hemorrhage 243–4
nitric oxide 136
inhaled 343–4
nitroglycerin
fetal effects 632
pre-eclampsia 444, 445
nitroprusside, fetal effects 632–3
non-malefi cence 666
non-steroidal anti-infl ammatory drugs see
NSAIDs
NSAIDs, systemic lupus erythematosus 478–9
nurses, ICU 13, 13
nutrition 181–2, 182
hyperalimentation 181–6
renal failure 193
septic shock 586–7
ventilated patients 140–1
nutritional assessment 183
nutritional support 183–4, 184, 186
amino acids 185
carbohydrates 185
fat emulsions 185
fl uids and electrolytes 185
total parenteral nutrition 184
obstetric critical care unit see intensive care unit
obstetric hemorrhage see hemorrhage
oliguria
diagnosis 71
pre-eclampsia 450–1
opiates antidotes 526
overdose 522
organ transplantation see transplant patients
organophosphate/carbamate poisoning 546–8 fetal considerations 547
management 547–8 maternal considerations 547 teratogenicity 547 toxicology 546–7 orotracheal intubation 228–9 orthopedic trauma 503 osmolarity, control of 73–4 ovarian cancer 709–10 overdose and poisoning 514–48 antidotes 526
decontamination procedures 520–7 gastrointestinal 521, 523, 525–7 skin 520–1
defi nitions 514 evaluation 515–27, 516, 517, 519–20
altered mental status 517, 521
initial 515, 517 secondary 517–19 toxic identifi cation 519–20, 524
incidence by substance 527
management 524
activated charcoal 525–6, 527
cathartics 526–7, 527
dialysis 525
emesis 521, 523 gastric lavage 523, 525 hemoperfusion 525
neutralizing agents 526 whole-bowel irrigation 527 medications 514, 515
physical signs 523
suicide attempts 528
toxic exposures 514 during pregnancy 514–15, 515
toxicologic considerations in pregnancy 515
see also specifi c agents
oximetry 210, 210
oxygen free-fl ow 114 toxicity 137 oxygen consumption 55–6, 56, 56, 125–7, 126,
126
and oxygen delivery 56–7, 127
in pregnancy 57, 127 oxygen delivery 55–6, 56, 56, 125–7, 126, 126
impaired 126
and oxygen consumption 56–7, 127
in pregnancy 57, 127 oxygen delivery systems 129
oxygen extraction ratio 56 oxygen therapy, sickle cell crisis 398 oxygenation 127–8, 127
impaired 128 mixed venous 128 pulse oximetry 127–8 oxyhemoglobin dissociation curve 56, 126
fetal 61
maternal 61
oxytocin and hyponatremia 74 uterine atony 313 PaCO2 62 pamidronate, hypercalcemia 84
pancreas, endocrine, pregnancy adaptations 46 pancreas transplantation 660
pancreatitis, acute 365–72 clinical manifestations 367 complications 368, 368
diagnosis 368–70 differential 369–70, 369
laboratory evaluation 368–9 radiologic evaluation 369, 369
epidemiology 365–6 etiology 366–7, 366
biliary disease 366 drugs 367 hypertriglyceridemia 366–7 management 371–2 pathology and pathophysiology 367
in pre-eclampsia 454 prognostic indicators 370, 370
pancuronium 143 fetal effects 628–9 PaO2 60–1, 61, 125
paralysis, ventilated patients 142–3, 144
parvovirus B19, blood transmission 178 patent ductus arteriosus 261
paternalism 666 patient-centered care 12, 12
PCO2 54, 57–8 percutaneous balloon mitral commissurotomy 197 perinatal mortality 5–6, 5
peripartum cardiomyopathy 270–2, 271, 565–6
peripheral edema, crystalloid-induced 71 peripheral vascular resistance 34, 38, 39
peritoneal dialysis 189–90, 190, 190
perterm labor, hospitalization 13 phenobarbital, overdose 524
phenytoin 223, 226
overdose 524
pheochromocytoma 431–2, 432
phosphates, hypercalcemia 84
physicians, ICU 12–13 physiologic adaptations to pregnancy 30–47 cardiovascular system 30
endocrine system 45–6 gastrointestinal system 43–4 hematologic system 44–5 immune system 46–7 respiratory system 41–3 physostigmine, overdose 527
pica 79 pituitary gland, pregnancy adaptations 45 placenta, substances crossing 182
placental abruption 308–9 and DIC 402 plague 733–4 plasma fresh frozen 168 thawed 168 plasminogen activator inhibitor 401
platelets, transfusion 168
Trang 9platelet count
normal values 401
pregnancy adaptations 45
pneumonia, ventilator-associated 139–40
pneumothorax
neonatal 121
open 497
tension 497
PO2 57–8
poisoning see bioterrorism; overdose and poisoning
polyneuropathy 138
positive end-expiratory pressure (PEEP) 115,
134–5, 135
positive-pressure ventilation
neonate 116–17, 117
non-invasive 128–9, 129
postpartum hemorrhage 311–12, 311
etiology 311–12
secondary 321–2
surgical management 314–19, 316, 317
arterial embolization 318
bilateral uterine artery ligation 316–17, 316
hysterectomy 318–19
uterine brace suture 315, 316
uterine devascularization 315–16
uterine tamponade 315
uterine inversion 312
postpartum period
agitation 692
depression 685
hemodynamic changes 40–1, 40
psychosis 692–4
renal failure 381, 382
suicidality 689
postpartum psychosis 694
postural changes in pregnancy 37–9, 37, 38
potassium, metabolic disturbances 78–81
hyperkalemia 79–81
hypokalemia 78–9
povidone iodine 18
pre-eclampsia 237–9, 438–58
abnormal cerebral hemodynamics 238
acute renal failure 380
analgesia-anesthesia 445–6
antihypertensive therapy 443–5, 444
ACE inhibitors 445
calcium channel blockers 444
diazoxide 444
hydralazine 443, 444
labetalol 444–5, 444
nitroglycerin 445
sodium nitroprusside 445
cardiopulmonary complications 341, 447–50
hypertensive cardiomyopathy 449–50
malignant ventricular arrhythmias 450
pulmonary edema 448–9
confusion with autonomic hyperrefl exia 232
defective cerebral autoregulation 238
diagnosis 440, 440
differential diagnosis 388
Doppler ultrasound 209
etiology 438–40, 439
HELLP syndrome see HELLP syndrome
hemodynamic monitoring 446–7, 446, 447
liver rupture 453–4
management 440–1, 440
fl uid therapy 441 seizure prophylaxis 441–3, 442
neurologic complications 454–5 cerebral edema 454–5 temporary blindness 455 pancreatitis 454
renal complications 450–1 oliguria 450–1 uteroplacental-fetal complications 457 prednisolone, systemic lupus erythematosus 479
pregnancy loss, burns patients 512 pregnancy-related mortality ratio (PRMR) 4 pressure support ventilation 132
pressure-regulated volume control ventilation 132
preterm labor, burns patients 512 procainamide, fetal effects 631 propofol 142, 144
fetal effects 627–8 propylthiouracil, fetal effects 634 prostacyclin 286
prostaglandins septic shock 588 uterine atony 313–14 prosthetic heart valves 274–5 protein C 287, 401
activated 404 defi ciency 301 protein S 287, 401
defi ciency 301 protein Z 401
prothrombin 259, 401
pseudohyperkalemia 79–80 pseudohyponatremia 75 pseudoseizures 224
psychiatric conditions, acute 684–94 agitation and psychosis 689–94 depression 684–7
suicidality 687–9 psychosis 689–94 management 690–2, 691
pregnant and postpartum patients 692, 693–4 postpartum 694
pulmonary arteriography, pulmonary embolism
292, 293
pulmonary artery catheterization 16, 215–19 cardiac output determination 218 catheter placement 216–18, 216, 217
catheter insertion 216–17, 216
sheath insertion 216 waveforms 217–18, 217
complications 218 non-invasive techniques 218–19 pulmonary embolism 292 pulmonary artery pressure 34
pulmonary capillary wedge pressure (PCWP) 27,
34, 38, 39
pulmonary edema 348–56, 349
clinical setting 349
crystalloid-induced 71 diagnosis 352, 354, 354, 355
literature reviews 353
lung mechanics and gas exchange 352 pathophysiology 349–52, 350
hydrostatic pulmonary edema 383–5 lymphatic insuffi ciency 351 permeability edema 350–1, 351
unknown causes 351–2 pre-eclampsia 448–9 prevention 356 tocolytic-induced 341 treatment 354, 356, 356
pulmonary embolism 290–3 clinical diagnosis 290–1, 290
diagnosis 291–3, 291
alveolar-arterial oxygen gradient 291 chest X-ray 291
digital subtraction pulmonary angiography 293
ECG 291 indium 111 platelet imaging 293 laboratory studies 291, 291
pulmonary arteriography 292, 293
pulmonary artery catheterization 292 spiral CT 292
ventilation-perfusion lung scan 291–2, 292
incidence 284
mortality 284
risk factors 285
and route of delivery 285
pulmonary hypertension 261–3, 262, 649–51, 649
pathophysiology 649, 649
perioperative management 650–1 pharmacologic therapies 649–50 pulmonary stenosis 266, 267, 643
anesthesia 643–4 pulmonary toxins 735 pulmonary vascular resistance 109
pulmonic insuffi ciency 267
pulse oximetry 58, 127–8 pulse pressure 34
purpura, post-transfusion 177 Purtscher’s angiopathic retinopathy 368 pyelonephritis 379–80, 382, 720
Q fever 734 quinine, overdose 527
radial artery, cannulation 159–61 radiation exposure 735–7, 736
radiocontrast media, allergy to 599
radiofrequency ablation 701–2 radiology
fetal exposure 231–2, 231
spinal injury 231 rapamycin 658
red cells antigen-antibody reactions 169–70, 170
transfusion 167 frozen 167–8 leukocyte reduced 167 washed 167 red cell mass 69 pregnancy adaptations 44–5 red cell volume, pregnancy adaptations 31
regional anesthesia, spinal cord injury 233 regional blood fl ow, pregnancy adaptations 36–7 renal cortical necrosis, bilateral 382, 382
Trang 10renal failure
acute 194, 376–83, 382
acute fatty liver of pregnancy 380–1
acute glomerulonephritis 377–8, 378
bilateral renal cortical necrosis 382
burns patients 511
etiology 376–7, 377
HELLP syndrome 380
interstitial nephritis 378, 378
intrinsic renal disease 377–9, 378
management 382
pre-eclampsia 380
prerenal azotemia 377, 377
prognosis 382–3
pyelonephritis 379–80
thrombotic thrombocytopenic purpura/
hemolytic uremic syndrome 381
tubular necrosis 378–9
urinary obstruction 379, 379
dietary guidelines 193
end-stage, incidence in pregnancy 188, 189
postpartum 381
signs and symptoms 189
ventilation-induced 139
see also dialysis
renal function
pregnancy effects 69–70
septic shock 586
renal physiology, pregnancy adaptations 43
renal tract, pregnancy adaptations 43
renal transplantation 659–60, 659, 721
renin–angiotensin-aldosterone system 73
reserve volume 42
reservoir mask 129
respiratory acidosis 55, 65–6, 65
respiratory alkalosis 55, 66, 66
respiratory failure 124–5, 125
alveolar-arterial oxygen tension gradient 125
arterial oxygen tension 125
dead space 125
defi nition of 130
shunts 124–5
ventilation/perfusion mismatch 124–5
respiratory system
pregnancy adaptations 41–3, 298, 299, 299
mechanics of respiration 41–2
physiologic changes 42–3, 42, 42
upper airways 41
resuscitation
cardiopulmonary see cardiopulmonary
resuscitation
neonatal see neonatal resuscitation
resuscitation devices 116, 117
rhinitis of pregnancy 41
ricin 734–5
Ringer’s lactate 70, 71
salicylates, overdose 524
saline 70, 71
salmeterol 331
schizophrenia 692–4
treatment 693–4
scorpion stings 553
sedation, ventilated patients 142–3, 144
sedatives, overdose 522
seizures see epilepsy
Seldinger technique 154–5 self-injurious behavior 688 sepsis 573
burns patients 511–12 severe 572, 573
septic shock 571–88, 572
clinical presentation 576–7 defi nition 573
diagnosis 579–80, 580
disseminated intravascular coagulopathy 585–6 gastrointestinal tract and nutrition 586–7 outcome 586
pathophysiology 572–6, 574
predisposing factors 577–8, 578
pregnancy-related factors 578–9, 578
renal function 586 systemic infl ammatory response syndrome 571–2 treatment 580–6
antimicrobial therapy 584–5 coagulation cascade 585–6, 588 corticosteroids 587–8 immunotherapy 588 oxygenation 583–4 prostaglandins 588 resuscitation 581 surgery 585 vasoactive drug therapy 582–3 volume expansion 581–2 serotonin 286
Sheehan’s syndrome 75 shock
anaphylactic 596–603 cardiogenic 564–5, 572
distributive (vasodilatory) 572
hypovolemic 229, 559–67, 572
septic 571–88 treatment, crystalloids 71 shunts
fetal 701–2 intrapulmonary 124–5 sickle cell crisis 391–8 diagnosis 392 epidemiology 391 management 394–6, 395, 396
chest syndrome 395–7 fetal assessment 395 hepatic crisis 397 pain management 397, 398
uncomplicated acute pain crisis 394–5 molecular basis 391–2, 392
pathophysiology 392–3 secondary organ system effects 393–4 cardiovascular 393
renal 394 respiratory 393–4 therapeutic options 398–9 bone marrow transplant 399 erythropoietin 399 exchange transfusion 398–9 hydroxyurea 399 oxygen therapy 398 simple transfusion 399 silver sulfadiazine 511 single ventricle 266
sinus thrombosis 239–40 sirolimus 658
skin, decontamination 520–1 skull fractures 501 smallpox 732–3 snakebites 548–50, 549, 550
sodium, metabolic disturbances 74–8 hypernatraemia 76–8
hyponatraemia 74–6 sodium nitroprusside, pre-eclampsia 444, 445
spider bites 551–3, 551, 552
spinal cord injury 228–33 fetal considerations 231–2 cesarean delivery 231 hazards of diagnostic radiography 231–2,
231
long-term concerns 232–3 autonomic hyperrefl exia 232–3 labor and delivery 233 maternal considerations 228–31, 229
circulatory system 229 corticosteroids 230–1 fetal status 230 hemodynamic status 230 hypotension and fl uid resuscitation 230 neurogenic vs hypovolemic shock 229 orotracheal intubation 228–9 pregnancy physiology 229 radiologic imaging 231 spinal immobilization 228 ultrasound 230 spinal immobilization 228 spinal trauma 503–4 stab wounds 496
Staphylococcus aureus 573 status epilepticus 225–6, 226
stenosis, catheter-related 176–7 stillbirth, burns patients 512
Streptococcus pyogenes 573 stroke, pregnancy-related 235–48 air embolism 157, 241 amniotic fl uid embolism 241 cardioembolism 241 causation and time of occurrence 235, 236
cerebral blood fl ow 237 cerebral venous and sinus thrombosis 239–40
choriocarcinoma 241 diagnosis 236–7 gestational hypertension 237–9 intracerebral hemorrhage 241 ischemic 246–8, 247
Moyamoya disease 241 paradoxical embolism 241 physiology and pathophysiology 235–6 postpartum cerebral vasculopathy 240 pre-eclampsia-eclampsia-HELLP syndrome 237–9
risk factors 236
subarachnoid hemorrhage 241–4 aneurysm 245
arteriovenous malformations 245–6 types of 236, 237
stroke volume 34
pregnancy adaptations 34–5, 34, 35