- •ICU Protocols
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •1: Airway Management
- •Suggested Reading
- •2: Acute Respiratory Failure
- •Suggested Reading
- •Suggested Reading
- •Website
- •4: Basic Mechanical Ventilation
- •Suggested Reading
- •Suggested Reading
- •Websites
- •Suggested Reading
- •Websites
- •7: Weaning
- •Suggested Reading
- •8: Massive Hemoptysis
- •Suggested Reading
- •9: Pulmonary Thromboembolism
- •Suggested Reading
- •Suggested Reading
- •Websites
- •11: Ventilator-Associated Pneumonia
- •Suggested Readings
- •12: Pleural Diseases
- •Suggested Reading
- •Websites
- •13: Sleep-Disordered Breathing
- •Suggested Reading
- •Websites
- •14: Oxygen Therapy
- •Suggested Reading
- •15: Pulse Oximetry and Capnography
- •Conclusion
- •Suggested Reading
- •Websites
- •16: Hemodynamic Monitoring
- •Suggested Reading
- •Websites
- •17: Echocardiography
- •Suggested Readings
- •Websites
- •Suggested Reading
- •Websites
- •19: Cardiorespiratory Arrest
- •Suggested Reading
- •Websites
- •20: Cardiogenic Shock
- •Suggested Reading
- •21: Acute Heart Failure
- •Suggested Reading
- •22: Cardiac Arrhythmias
- •Suggested Reading
- •Website
- •23: Acute Coronary Syndromes
- •Suggested Reading
- •Website
- •Suggested Reading
- •25: Aortic Dissection
- •Suggested Reading
- •26: Cerebrovascular Accident
- •Suggested Reading
- •Websites
- •27: Subarachnoid Hemorrhage
- •Suggested Reading
- •Websites
- •28: Status Epilepticus
- •Suggested Reading
- •29: Acute Flaccid Paralysis
- •Suggested Readings
- •30: Coma
- •Suggested Reading
- •Suggested Reading
- •Websites
- •32: Acute Febrile Encephalopathy
- •Suggested Reading
- •33: Sedation and Analgesia
- •Suggested Reading
- •Websites
- •34: Brain Death
- •Suggested Reading
- •Websites
- •35: Upper Gastrointestinal Bleeding
- •Suggested Reading
- •36: Lower Gastrointestinal Bleeding
- •Suggested Reading
- •37: Acute Diarrhea
- •Suggested Reading
- •38: Acute Abdominal Distension
- •Suggested Reading
- •39: Intra-abdominal Hypertension
- •Suggested Reading
- •Website
- •40: Acute Pancreatitis
- •Suggested Reading
- •Website
- •41: Acute Liver Failure
- •Suggested Reading
- •Suggested Reading
- •Websites
- •43: Nutrition Support
- •Suggested Reading
- •44: Acute Renal Failure
- •Suggested Reading
- •Websites
- •45: Renal Replacement Therapy
- •Suggested Reading
- •Website
- •46: Managing a Patient on Dialysis
- •Suggested Reading
- •Websites
- •47: Drug Dosing
- •Suggested Reading
- •Websites
- •48: General Measures of Infection Control
- •Suggested Reading
- •Websites
- •49: Antibiotic Stewardship
- •Suggested Reading
- •Website
- •50: Septic Shock
- •Suggested Reading
- •51: Severe Tropical Infections
- •Suggested Reading
- •Websites
- •52: New-Onset Fever
- •Suggested Reading
- •Websites
- •53: Fungal Infections
- •Suggested Reading
- •Suggested Reading
- •Website
- •55: Hyponatremia
- •Suggested Reading
- •56: Hypernatremia
- •Suggested Reading
- •57: Hypokalemia and Hyperkalemia
- •57.1 Hyperkalemia
- •Suggested Reading
- •Website
- •58: Arterial Blood Gases
- •Suggested Reading
- •Websites
- •59: Diabetic Emergencies
- •59.1 Hyperglycemic Emergencies
- •59.2 Hypoglycemia
- •Suggested Reading
- •60: Glycemic Control in the ICU
- •Suggested Reading
- •61: Transfusion Practices and Complications
- •Suggested Reading
- •Websites
- •Suggested Reading
- •Website
- •63: Onco-emergencies
- •63.1 Hypercalcemia
- •63.2 ECG Changes in Hypercalcemia
- •63.3 Superior Vena Cava Syndrome
- •63.4 Malignant Spinal Cord Compression
- •Suggested Reading
- •64: General Management of Trauma
- •Suggested Reading
- •65: Severe Head and Spinal Cord Injury
- •Suggested Reading
- •Websites
- •66: Torso Trauma
- •Suggested Reading
- •Websites
- •67: Burn Management
- •Suggested Reading
- •68: General Poisoning Management
- •Suggested Reading
- •69: Syndromic Approach to Poisoning
- •Suggested Reading
- •Websites
- •70: Drug Abuse
- •Suggested Reading
- •71: Snakebite
- •Suggested Reading
- •72: Heat Stroke and Hypothermia
- •72.1 Heat Stroke
- •72.2 Hypothermia
- •Suggested Reading
- •73: Jaundice in Pregnancy
- •Suggested Reading
- •Suggested Reading
- •75: Severe Preeclampsia
- •Suggested Reading
- •76: General Issues in Perioperative Care
- •Suggested Reading
- •Web Site
- •77.1 Cardiac Surgery
- •77.2 Thoracic Surgery
- •77.3 Neurosurgery
- •Suggested Reading
- •78: Initial Assessment and Resuscitation
- •Suggested Reading
- •79: Comprehensive ICU Care
- •Suggested Reading
- •Website
- •80: Quality Control
- •Suggested Reading
- •Websites
- •81: Ethical Principles in End-of-Life Care
- •Suggested Reading
- •82: ICU Organization and Training
- •Suggested Reading
- •Website
- •83: Transportation of Critically Ill Patients
- •83.1 Intrahospital Transport
- •83.2 Interhospital Transport
- •Suggested Reading
- •84: Scoring Systems
- •Suggested Reading
- •Websites
- •85: Mechanical Ventilation
- •Suggested Reading
- •86: Acute Severe Asthma
- •Suggested Reading
- •87: Status Epilepticus
- •Suggested Reading
- •88: Severe Sepsis and Septic Shock
- •Suggested Reading
- •89: Acute Intracranial Hypertension
- •Suggested Reading
- •90: Multiorgan Failure
- •90.1 Concurrent Management of Hepatic Dysfunction
- •Suggested Readings
- •91: Central Line Placement
- •Suggested Reading
- •92: Arterial Catheterization
- •Suggested Reading
- •93: Pulmonary Artery Catheterization
- •Suggested Reading
- •Website
- •Suggested Reading
- •95: Temporary Pacemaker Insertion
- •Suggested Reading
- •96: Percutaneous Tracheostomy
- •Suggested Reading
- •97: Thoracentesis
- •Suggested Reading
- •98: Chest Tube Placement
- •Suggested Reading
- •99: Pericardiocentesis
- •Suggested Reading
- •100: Lumbar Puncture
- •Suggested Reading
- •Website
- •101: Intra-aortic Balloon Pump
- •Suggested Reading
- •Appendices
- •Appendix A
- •Appendix B
- •Common ICU Formulae
- •Appendix C
- •Appendix D: Syllabus for ICU Training
- •Index
Appendices |
|
|
|
851 |
|
|
|
|
|
|
|
Appendix C |
|
|
|
|
|
Reference ranges for selected clinical laboratory tests |
|
|
|||
Substance |
Fluida |
Traditional units × |
k |
= SI units |
|
Acetoacetate |
P, S |
0.3–3.0 mg/dL |
97.95 |
3–30 mmol/L |
|
Alanine aminotransferase |
S |
7–41 U/L |
0.016 |
0.12–0.70 mkat/L |
|
(ALT, SGPT) |
|
|
|
|
|
Albumin |
S |
|
|
|
|
Female Albumin |
S |
4.1–5.3 g/dL |
10 |
41–53 g/L |
|
Male Albumin |
S |
4.0–5.0 g/L |
10 |
40–50 g/L |
|
Albumin |
CSF |
11–48 mg/dL |
0.01 |
0.11–0.48 g/L |
|
Aldolase |
S |
1.5–8.1 U/L |
17.33 |
26–138 nkat/L |
|
Alkaline phosphate |
S |
(F) 30–100 U/L |
0.016 |
0.5–1.92 mkat/L |
|
|
|
|
(M) 45–115 U/L |
|
0.75–1.92 mkat/L |
|
|
|
|
|
|
Alpha fetoprotein (adult) |
S |
0–8.5 ng/mL |
1 |
0–8.5 mg/L |
|
Ammonia, as NH3 |
P |
19–60 mg/dL |
0.587 |
11–35 mmol/L |
|
Amylase (method |
S |
20–96 U/L |
0.016 |
0.34–1.6 mkat/L |
|
dependent) |
|
|
|
|
|
Anion gap |
S |
7–16 mmol/L |
1 |
7–16 mmol/L |
|
Arterial blood gases |
|
|
|
|
|
[HCO –] |
|
22–30 mEq/L |
1 |
22–30 mmol/L |
|
|
3 |
|
|
|
|
PCO2 |
|
32–45 mmHg |
0.134 |
4.3–6.0 kPa |
|
Ph |
|
|
7.35–7.45 |
1 |
7.35–7.45 |
PO2 |
|
72–104 mmHg |
0.134 |
9.6–13.8 kPa |
|
Aspartate aminotrans- |
S |
12–38 U/L |
0.016 |
0.20–0.65 mkat/L |
|
ferase (AST, SGOT) |
|
|
|
|
|
B-type natriuretic peptide |
P |
Age and gender |
1 |
Age and gender |
|
(BNP) |
|
specific: <167 pg/ |
|
specific: |
|
|
|
|
mL |
|
<167 ng/L |
Bilirubin |
S |
|
|
|
|
Total (Bilirubin) |
|
0.3–1.3 mg/dL |
17.1 |
5.1–22 mmol/L |
|
Direct (Bilirubin) |
|
0.1–0.4 mg/dL |
17.1 |
1.7–6.8 mmol/L |
|
Indirect (Bilirubin) |
|
0.2–0.9 mg/dL |
17.1 |
3.4–15.2 mmol/L |
|
b-Hydroxybutyrate |
S |
<1.0 mg/dL |
96.05 |
<100 mmol/L |
|
Bicarbonate |
S |
22–26 mEq/L |
1 |
22–26 mmol/L |
|
Blood urea nitrogen |
P, S |
8–18 mg/dL |
0.367 |
3.0–6.5 mmol/L |
|
(BUN) |
|
|
|
|
|
Calcium-Total |
S |
8.7–10.2 mg/dL |
0.252 |
2.2–2.6 mmol/L |
|
Calcium Ionized |
WB |
4.5–5.3 mg/dL |
0.25 |
1.12–1.32 mmol/L |
|
Carboxyhemoglobin |
WB |
>20% |
0.01 |
>0.2 proportion |
|
(carbon monoxide |
|
|
|
of 1 |
|
content) |
|
|
|
|
|
– |
Nonsmokers |
|
0–4% |
0.01 |
0–0.04 |
– |
Smokers |
|
4–9% |
0.01 |
0.04–0.09 |
– |
Onset of symptoms |
|
15–20% |
0.01 |
0.15–0.20 |
– |
Loss of consciousness |
|
>50% |
0.01 |
>0.50 |
|
and death |
|
|
|
|
852 |
|
|
|
|
Appendices |
|
|
|
|||
Reference ranges for selected clinical laboratory tests |
(continued) |
|
|||
Substance |
Fluida |
Traditional units × |
k |
= |
SI units |
Chloride |
S |
102–109 mEq/L |
1 |
|
102–109 mmol/L |
|
CSF |
120–130 mEq/L |
1 |
|
120–130 mmol/L |
|
U |
10–200 mEq/L |
1 |
|
10–200 mmol/L |
Cholinesterase |
S |
5–12 U/mL |
1 |
|
5–12 kU/L |
Complement |
|
|
|
|
|
C3 |
S |
83–177 mg/dL |
0.01 |
|
0.83–1.77 g/L |
C4 |
S |
16–47 mg/dL |
0.01 |
|
0.16–0.47 g/L |
Cortisol |
|
|
|
|
|
Fasting, 8 a.m.–12 noon |
S |
5–25 mg/dL |
27.588 |
|
138–690 nmol/L |
12 noon–8 p.m. |
|
5–15 mg/dL |
27.588 |
|
138–414 nmol/L |
8 p.m.–8 a.m. |
|
0–10 mg/dL |
27.588 |
|
0–276 nmol/L |
Cortisol, free |
U |
20–70 mg/24 h |
2.758 |
|
55–193 nmol/24 h |
C-reactive protein |
S |
0.2–3.0 mg/L |
1 |
|
0.2–3.0 mg/L |
Creatine kinase (total) |
S |
|
|
|
0.66–4.0 mkat/L |
Females |
|
39–238 U/L |
0.017 |
|
|
Males |
|
51–294 U/L |
0.017 |
|
0.87–5.0 mkat/L |
Creatine kinase-MB |
S |
|
|
|
|
Mass |
|
0.0–5.5 ng/mL |
1 |
|
0.0–5.5 g/L |
Fraction of total activity |
|
0–4.0% |
0.01 |
|
0–0.04 |
(by electrophoresis) |
|
|
|
|
|
Creatinine |
S |
|
|
|
44–80 mmol/L |
Female |
|
0.5–0.9 ng/mL |
88.4 |
|
|
Male |
|
0.6–1.2 ng/mL |
88.4 |
|
53–106 mmol/L |
Creatinine |
U |
15–25 mg/kg/24 h |
0.009 |
|
0.13–0.22 mmol/ |
|
|
|
|
|
kg/24 h |
Cyanide: Nontoxic |
WB |
<mg/dL |
3.8 |
|
<19 mmol/L |
Cyanide: Lethal |
|
>30 mg/dL |
|
|
>114 mmol/L |
|
|
|
|
||
|
|
|
|
|
|
Erythropoietin |
S |
4–27 U/L |
1 |
|
4–27 U/L |
Fatty acids, free |
P |
<8–25 mg/dL |
0.0355 |
|
<0.28– |
(nonesterified) |
|
|
|
|
0.89 mmol/L |
Ferritin |
S |
|
|
|
10–150 mg/dL |
Female |
|
10–150 ng/dL |
1 |
|
|
Male |
|
29–248 ng/mL |
1 |
|
29–248 mg/L |
Fibrinogen |
P |
150–350 mg/dL |
0.01 |
|
1.5–3.5 g/L |
Fibrin split products |
S |
<10 mg/mL |
1 |
|
<10 mg/L |
Glucose |
P |
|
|
|
|
Glucose (fasting) |
P |
70–100 mg/dL |
0.06 |
|
3.9–6.1 mmol/L |
Glucose |
CSF |
50–80 mg/dL |
0.06 |
|
2.8–4.4 mmol/L |
Impaired glucose |
|
111–125 mg/dL |
0.056 |
|
6.2–6.9 mmol/L |
tolerance |
|
|
|
|
|
Diabetes mellitus |
|
>125 mg/dL |
0.056 |
|
>7.0 mmol/L |
Glucose, 2 h postprandial |
P |
70–120 mg/dL |
0.056 |
|
3.9–6.7 mmol/L |
Hemoglobin (Hb) |
P |
0.6–5.0 mg/dL |
10 |
|
6–50 mg/L |
Adult males (Hb) |
WB |
13.3–16.2 g/dL |
10 |
|
133–162 g/L |
Adult females (Hb) |
WB |
12–15.8 g/dL |
10 |
|
120–158 g/dL |
Appendices |
|
|
|
|
853 |
|
|
|
|||
Reference ranges for selected clinical laboratory tests |
(continued) |
|
|||
Substance |
Fluida |
Traditional units × |
k |
= |
SI units |
Mean corpuscular |
WB |
26–34 pg/cell |
1 |
|
26–34 pg/cell |
hemoglobin (MCH) |
|
|
|
|
|
Mean corpuscular |
WB |
33–37 g/dL |
10 |
|
330–370 g/L |
hemoglobin concentra- |
|
|
|
|
|
tion (MCHC) |
|
|
|
|
|
Mean corpuscular |
WB |
80–100 mm3 |
1 |
|
80–100 fL |
volume (MCV) |
|
|
|
|
|
Hemoglobin Alc |
WB |
4.0–6.0% |
0.01 |
|
0.04–0.06 Hb |
|
|
|
|
|
fraction |
Homocysteine |
P |
4.4–10.8 mmol/L |
1 |
|
4.4–10.8 mmol/L |
Iron |
S |
41–141 mg/dL |
0.178 |
|
7–25 mmol/L |
Iron-binding capacity |
S |
251–406 mg/dL |
0.179 |
|
45–73 mmol/L |
Lactate |
P, |
4.5–14.4 mg/dL |
0.111 |
|
0.5–1.6 mmol/L |
|
arterial |
|
|
|
|
|
P, |
4.5–19.8 mg/dL |
0.111 |
|
0.5–2.2 mmol/L |
|
venous |
|
|
|
|
Lactate: Resting |
P |
<2.0 mEq/L |
1 |
|
<2 mmol/L |
Exercise |
|
<4.0 mEq/L |
|
|
<4 mmol/L |
Lactate dehydrogenase |
S |
115–221 U/L |
0.0171 |
|
2.0–3.8 mkat/L |
Lipase |
S |
3–43 U/L |
0.166 |
|
0.5–0.73 mkat/L |
Magnesium |
S |
1.5–2.3 mg/dL |
0.413 |
|
0.62–0.95 mmol/L |
Methemoglobin |
WB |
0–1% of total Hb |
0.01 |
|
0.0–0.01 |
|
|
|
|
|
proportion of total |
|
|
|
|
|
Hb |
Microalbumin urine |
U |
|
|
|
|
24-h urine |
|
0–30 mg/24 h |
0.001 |
|
0.0–0.03 g/day |
Spot urine |
|
0–30 mg/mg |
0.001 |
|
0.0–0.03 g/g |
|
|
creatinine |
|
|
creatinine |
Myoglobin |
S |
19–92 mg/L |
|
|
19–92 mg/L |
Male |
|
1 |
|
||
Female |
|
12–76 mg/L |
1 |
|
12–76 mg/L |
Osmolality |
P |
275–295 mOsm/ |
1 |
|
275–295 mOsm/kg |
|
|
kg serum water |
|
|
serum water |
|
U |
500–800 mOsm/ |
1 |
|
500–800 mOsm/kg |
|
|
kg water |
|
|
water |
Phosphatase, alkaline |
S |
33–96 U/L |
0.0169 |
|
0.56–1.63 mkat/L |
Phosphorus, inorganic |
S |
2.5–4.3 mg/dL |
0.324 |
|
0.81–1.4 mmol/L |
Potassium |
S |
3.5–5.0 mEq/L |
1 |
|
3.5–5.0 mmol/L |
Prealbumin |
S |
17–34 mg/dL |
10 |
|
170–340 mg/L |
Prolactin |
S |
0–20 ng/mL |
1 |
|
0–20 g/L |
Prostate-specific antigen |
S |
|
|
|
|
(PSA) |
|
|
|
|
0.0–2.0 mg/L |
<40 years male |
|
0.0–2.0 ng/mL |
1 |
|
|
>40 years male |
|
0.0–0.40 ng/mL |
1 |
|
0.0–0.4 mg/L |
PSA, free; in males |
S |
>25% associated |
0.01 |
|
>0.25% associated |
45–75 years, with PSA |
|
with benign |
|
|
with benign |
values between 4 and |
|
prostatic |
|
|
prostatic |
20 g/mL |
|
hyperplasia |
|
|
hyperplasia |
854 |
|
|
|
|
Appendices |
|
|
|
|||
Reference ranges for selected clinical laboratory tests |
(continued) |
|
|||
Substance |
Fluida |
Traditional units × |
k |
= |
SI units |
Protein fractions |
S |
|
|
|
|
Albumin |
|
3.5–5.5 g/dL |
10 |
|
35–55 g/L |
|
|
(50–60%) |
|
|
|
Globulin |
|
2.0–3.5 g/dL |
10 |
|
20–35 g/L |
|
|
(40–50%) |
|
|
|
Alpha1 |
|
0.2–0.4 g/dL |
10 |
|
2–4 g/L |
|
|
(4.2–7.2%) |
|
|
|
Alpha2 |
|
0.5–0.9 g/dL |
10 |
|
5–9 g/L |
|
|
(6.8–12%) |
|
|
|
Beta |
|
0.6–1.1 g/dL |
10 |
|
6–11 g/L |
|
|
(9.3–15%) |
|
|
|
Gamma |
|
0.7–1.7 g/dL |
10 |
|
7–17 g/L |
|
|
(13–23%) |
|
|
|
Total protein |
P, S |
6.0–8.0 g/dl/L |
10 |
|
60–80 g/L |
|
CSF |
<40 mg/dL |
0.01 |
|
<0.40 g/L |
|
U |
<150 mg/24 h |
0.01 |
|
<1.5 g/24 h |
Sodium |
S |
136–146 mEq/L |
1 |
|
136–146 mmol/L |
Thyroid-stimulating |
S |
0.34–4.25 mIU/ |
1 |
|
0.34–4.25 mIU/L |
hormone |
|
mL |
|
|
|
Thyroxine, free (fT4) |
S |
0.8–1.7 ng/dL |
12.871 |
|
10.3–21.9 pmol/L |
Thyroxine, total (T4) |
S |
5.4–11.7 mg/dL |
12.871 |
|
70–151 nmol/L |
Triiodothyronine (T3) |
S |
75–220 pg/dL |
0.015 |
|
12–3.4 pmol/L |
Troponin I |
S |
|
|
|
0–0.08 mg/L |
Normal population, |
|
0–0.08 ng/mL |
1 |
|
|
99% tile |
|
|
|
|
>0.4 mg/L |
Cutoff for MI |
|
>0.4 ng/mL |
1 |
|
|
Troponin T |
S |
|
|
|
0–0.1 mg/L |
Normal population, 99% |
|
0–0.01 ng/mL |
0.1 |
|
|
tile |
|
|
|
|
0–0.1 mg/L |
Cutoff for MI |
|
0–0.1 ng/mL |
1 |
|
|
Urea nitrogen |
S |
7–20 mg/dL |
0.357 |
|
2.5–7.1 mmol/L |
Uric acid |
S |
|
|
|
0.15–0.33 mmol/L |
Females |
|
2.5–5.6 mg/dL |
0.06 |
|
|
Males |
|
3.1–7.0 mg/dL |
0.06 |
|
0.18–0.41 mmol/L |
Urobilinogen |
U |
1–3.5 mg/24 h |
1.7 |
|
1.7–5.9 mmol/d |
Adapted from the New England Journal of Medicine SI Unit Conversion Guide. Waltham, MA: Massachusetts Medical Society, 1992
aP plasma, S serum, U urine, WB whole blood, CSF cerebrospinal fluid, RBC red blood cell
Reference ranges for vitamins and trace elements |
|
|
|||
Substance |
Fluida |
Traditional units |
× |
k |
= SI units |
Chromium |
S |
0.14–0.15 ng/mL |
|
17.85 |
2.5–2.7 nmol/L |
Copper |
S |
70–140 mg/dL |
|
0.16 |
11–22 mmol/L |
Folate |
RBC |
140–960 ng/mL |
|
2.26 |
317–2,196 nmol/L |
Iron |
S |
(M) 80–180 mg/dL |
|
0.18 |
(M) 14–32 mmol/L |
|
|
(F) 60–160 mg/dL |
|
|
(F) 11–29 mmol/L |