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Группа авторов. Emergency Management of the Hi-Tech Patient in Acute and Critical Care
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Emergency Management of the Hi‐Tech Patient in Acute and Critical Care
List of Contributors
Preface
Acknowledgments
1 Using and Troubleshooting Enteral Feeding Devices
Introduction
Equipment/Device
Temporary Feeding Devices
Gastric Decompression Devices
Long‐term Feeding Devices
Basic G‐tube Anatomy
Standard G‐Tube
Low‐Profile G‐Tube
Jejunal Tubes
Indications
Management. Routine Care
Routine Replacement. Temporary Tubes
G‐tubes and GJ tubes
Complications/Emergencies. Tube Dislodgment
Peristomal Skin Irritation
Peristomal Leakage
Stomal Cellulitis
Stomal Candidiasis
Necrotizing Fasciitis
Stomal Bleeding
Clogged Tubing
Ulceration
Peritonitis
Gastric Outlet Obstruction
Buried Bumper Syndrome
Intussusception
Colocutaneous Fistula
Consultation
Further Reading
2 Gastrointestinal Diversions : Colostomies, Ileostomies, Mucous Fistulas, and Spit Fistulas
Introduction
Equipment/Device
Indications
Management
Complications/Emergencies
Early Stomal Complications
Late Stomal Complications
Cutaneous Complications
Metabolic Derangements
Consultation
Further Reading
3 Management of the Bariatric Surgery Patient in the Emergency Department
Introduction
Surgical Procedures
Indications
Complications
Further Reading
4 Transjugular Intrahepatic Portosystemic Shunt
Introduction
Equipment/Device
Indications
Contraindications
Management
Complications. Hepatic Encephalopathy
Infection
Bleeding
Stent Obstruction
Hemolytic Anemia
Consultation
Further Reading
5 Indwelling Central Venous Catheter Devices
Introduction
Central Venous Catheter Types
Catheter Anatomy
Routine Management and Use
Accessing and Drawing Blood from an Externalized CVC (Broviac, Hickman, PICC)
Accessing and Drawing Blood from a Fully Implanted Catheter (“Port”)
Complications
Infection
Catheter Breakage and Dislodgement
Catheter Occlusion
Air Embolism and Other Rare Complications
Further Reading
6 Vascular Access for Hemodialysis
Introduction
Equipment/Device
Hemodialysis Catheters
Arterio‐Venous Access
Indications
Management. Hemodialysis Catheters
Arterio‐venous Access
Complications/Emergencies. Hemodialysis Catheters
Arterio‐venous Access
Consultation
Further Reading
7 Peritoneal Dialysis Catheters
Introduction
Equipment Device
Indications
Management
Complications
Infusion Pain
Bleeding
Leakage
Pleuroperitoneal Leakage
Obstruction/Outflow Failure
Infection
Hernia
Catheter Cuff Extrusion
Further Reading
8 Orthopedic Devices
Introduction
Splints and Casts. Indications
Equipment/Devices
Complications, Emergencies, and Their Management. Compartment Syndrome
Deep Vein Thrombosis
Nerve Palsy
Skin Breakdown, Irritation, and Infection
Muscle and Joint Complaints
Screws, Pins, Plates, and Wires
Equipment/Devices
Complications, Emergencies, and their Management. Infection
Loosening, Migration, or Catastrophic Failure
Intramedullary Rods or Nails
Equipment/Devices
Complications, Emergencies, and Their Management. Pain
Nonunion and Malalignment
Late Fracture
Hardware Prominence
Anchors
Equipment/Devices
Complications, Emergencies, and Their Management. Failure of the Anchor or Suture
External Fixators
Equipment/Devices
Complications, Emergencies, and Their Management. Vascular Injury
Pressure Necrosis
Pin Tract Infection
Broken Components
Pain
Compartment Syndrome
Joint Replacements
Equipment/Devices
Complications, Emergencies, and Their Management. Infection
Deep Vein Thrombosis
Periprosthetic Fracture
Joint Instability
Joint Dislocation
Hardware Failure
Prosthetic Limbs
Further Reading
9 Spine Devices
Introduction
Devices
Growing Constructs
Interbody Cages
Halo Orthosis
Indications
Growing Constructs
Interbody Cages
Halo Orthosis
Management
Complications
Infection
Pseudoarthrosis
Junctional Complications
Implant‐related Complications
Halo‐specific Complications
Consultation
Summary
Further Reading
10 Facial Distractors : Cranial Vault, Midface, and Mandibular
Introduction
Equipment/Device. Midface Distraction (Halo)
Mandibular Distraction
Cranial Vault Distraction
Cranial Springs
Indications. Midface Distraction (Halo)
Mandible Distraction
Cranial Vault Distraction
Cranial Springs
Management. Midface Distraction (Halo)
Complications/Emergencies. Midface Distraction (Halo)
Cranial Springs
Cranial Vault and Mandible Distraction
Consultation
Further Reading
11 Management of Facial Fractures in Adults and Children
Introduction
Anatomy
Evaluation. Primary Survey
Secondary Survey
Indications and Equipment/Devices. Mandible Fractures
Midface (Maxillary, Nasal, Tripod, Orbital, and NOE) Fractures
Orbital Roof, Cranial Base, and Vault Fractures
Complications
Mandible
Midface
Superior Orbit, Cranial Base, and Vault
Conclusions
Further Reading
12 Cranial Orthotics and Ear Molding
Introduction
Indications. Positional Plagiocephaly
Craniosynostosis
Protective Helmets
Equipment/Device
Management
Complications/Emergencies
Ear Molding. Introduction
Indications
Equipment/Device
Management
Complications/Emergencies
Further Reading
13 Ear, Nose, and Throat Devices
Introduction
Ear Devices
Myringotomy Tubes. Indications
Device Placement and Management
Complications, Emergencies, and Consultation
Conventional Hearing Aids. Indications, Device Placement, and Management
Complications, Emergencies, and Consultation
Cochlear Implants. Indications and Device Placement
Management
Complications, Emergencies, and Consultation
Bone‐Anchored Hearing Aids (BAHA) Indications
Device Placement and Management
Complications, Emergencies, and Consultation
Auricular Prosthesis. Indications and Device Placement
Complications, Emergencies, and Consultation
Nasal Devices
Nasal Packing. Indications
Device Placement
Management
Complications, Emergencies, and Consultation
Septal Buttons. Indications/Management
Complications, Emergencies, and Consultation
Sinus Stents. Indications
Device Placement and Management
Complications, Emergencies, and Consultation
Nasolacrimal Duct Stents. Indications
Device Placement and Management
Complications, Emergencies, and Consultation
Throat
Palatal Implants. Indications and Device Placement
Complications, Emergencies, and Consultation
Further Reading. Ear
Nose
Throat
14 Cerebral‐ventricular Shunts
Introduction
Equipment/Device
Indications
Complications/Emergencies
Shunt Obstruction
Shunt Infection
Consultations and Management
Head Imaging
Shunt Radiographic Series
Abdominal Ultrasound
Shunt Tap
Ancillary Investigations
Further Reading
15 Initial Evaluation and Management of Patients with Neurosurgical Devices
Introduction
Neuromodulatory Devices
Deep Brain Stimulators. Indications and Device Description
Complications and Management
Spinal Cord Stimulators. Indications and Device Description
Complications and Management
Vagus Nerve Stimulators. Indications and Device Description
Complications and Management
Other Peripheral Nerve Stimulators
Intrathecal Infusion Pumps. Indications and Device Description
Complications and Management
Further Reading
16 Ophthalmic Devices
Introduction
Eyelid
Nasolacrimal Duct (NLD)
Orbit
Eye
17 Breast Implants
Introduction
Devices
Indications
Management
Complications/Emergencies
Infection
Exposure/Dehiscence
Hematoma
Skin Necrosis
Seroma
Rupture
Rotation/Malposition
Capsular Contracture
Lymphoma
Mondor's Disease
Consultation
Further Reading
18 Cutaneous Delivery Systems/Patches
Introduction
Indications
Management. Equipment/Device
Vapor Patch
Application of the Transdermal Patch
Removal of the Transdermal Patch
Advantages of the Cutaneous Route of Drug Administration Are
Disadvantages of Use
Complications/Emergencies. Drug overdose
Management
Burns
Defective packaging
Skin complications
Further Reading
19 Dental Emergencies Involving Oral Hardware
Introduction
Dental Braces. Indications
Complications/Emergencies. Loose Bracket
Indications for Immediate Specialist Consultation
Protruding/Broken Archwire
Indications for Immediate Specialist Consultation
Dental Implants. Implications
Complications/Emergencies
Indications for Immediate Specialist Consultation
Dental Crowns and Bridges. Implications
Complications/Emergencies
Indications for Immediate Specialist Consultation
Dental Fillings. Implications/Management
Complications/Emergencies
Indications for Immediate Specialist Consultation
Further Reading
20 Emergency Management of Patients with Negative Pressure Wound Therapy Devices (NPWTD)
Introduction
Mechanisms of Action
Equipment/Device
Clinical Use
Indications and Contraindications
Morbidity and Mortality
Approach to the ED Patient with an NPWTD. General Considerations
Troubleshooting Alarms
Pain
Bleeding
Infection
Special Considerations
Further Reading
21 Emergency Management of Patients with Wound Infections
General Considerations
Further Reading
22 Emergency Management of Patients with Genitourinary Prostheses
Introduction
Artificial Urinary Sphincter
Penile Prostheses
InterStim
Physical Exam Findings in Patients with Genitourinary Implants
Management of Genitourinary Prosthesis Complications. Infections
Erosion
Mechanical Malfunction
Imaging in Patients with Urologic Implants
Further Reading
23 Management of Prosthetic Valve Complications
Introduction
Patient Populations
Equipment/Device
Indications
Management
Anticoagulation and Antiplatelet Therapy
Complications/Emergencies
Infective Endocarditis
Supratherapeutic International Normalized Ratio and Anticoagulation Reversal
Hemolytic Anemia
Prosthetic Valve Thrombosis, Thromboembolism, and Valve Obstruction
Consultation. Infectious Disease
Cardiothoracic Surgery
Cardiology
Hematology
Further Reading
24 Emergency Management of Patients with Vascular Occlusion Devices, Stents, or Filters
Introduction
Congenital Heart Defect Management and Occlusion Devices
Atrial Septal Defect Occlusion Devices
Devices
Types of Complications
Ventricular Septal Defect (VSD) Occlusion Devices
Devices
Types of Complications
Patent Ductus Arteriosus (PDA) Occlusion Devices
Devices
Complications
Arterial Stents
Device Examples
Stent Thrombosis or Stenosis
Coarctation of the Aorta Stenting
Devices
Complications
Inferior Vena Cava (IVC) Filters
Indications
Complications
Left Atrial Appendage Devices
Devices
Complications
Further Reading
25 The Emergency Department Approach to the Patient with an Implantable Mechanical Circulatory Support Device
Further Reading
26 Emergency Management of the Patient with an Implantable Pacemaker or Defibrillator
Introduction
The Structure and Functions of Implanted Cardiac Devices (ICD’s)
Indications for Placement of Pacemakers and Defibrillators
Routine Management of Implanted Cardiac Devices
Complications and Emergencies of Patients with Implanted Cardiac Devices. Emergency Department Evaluation
CIED Emergencies
Consultation
Further Reading
27 Invasive Ventilation : A Discussion of Equipment and Troubleshooting
Introduction
Background Components of the Patient Ventilator System and Their Uses
The Ventilator
The Circuit
Humidification
The Patient Interface or Artificial Airway
Case Vignette
Troubleshooting. General
Ventilator
Circuit
Humidification
Artificial Airway
Patient and Ventilator Relationship: Synchrony
Trigger Asynchrony
Flow Asynchrony
Cycle Asynchrony
Ventilator Alarms
High Pressure Alarms
Low Pressure Alarms
High Exhaled Minute Volume Alarm
Low Exhaled Minute Volume Alarm
Apnea Alarm
Disconnect Alarm
Low Power/Low Battery Alarm
Conclusion
Further Reading
28 Respiratory Medication Devices
Introduction
Equipment/Device and Interface Options
Jet Nebulizers
Breath‐Actuated/Enhanced Nebulizers
Ultrasonic and Vibrating Mesh Nebulizers
Inhalers
Accessory Devices
Breath‐Actuated pMDIs
Dose Counters
Interface. Mouthpiece and Mask
Nasal Cannula
Mechanical Ventilation
Noninvasive Ventilation
High‐frequency Oscillation
Management. Dosing Strategies for Aerosols
Bronchodilators
Device Selection
Complications/Emergencies
Infection Risks and Maintenance
Further Reading
29 Secretion Clearance Devices
Cough Augmentation. Mechanical insufflation/exsufflation
Intermittent Positive Pressure Breathing
Peripheral Mucus Mobilization
Manual Chest Physiotherapy – Chest Physiotherapy (CPT or Chest PT)
Handheld Devices
Pharmacotherapy
Further Reading
30 Non‐invasive Ventilation
Components of Non‐Invasive Ventilation. Interfaces
Ventilator and Circuit
The Practice of Non‐invasive Ventilation
Further Reading
31 Tracheostomy Tubes
Introduction
Tracheostomy Tube Basics
Tracheostomy Tube Sizing
Shiley Tracheostomy Tubes
Tracoe Tracheostomy Tubes
Bivona and Portex Tracheostomy Tubes by Smiths‐Medical
Tracheostomy Cuffs
Air‐Filled Cuff
Water‐Filled Cuff
Foam Cuff
Adult tracheostomy features. Inner cannulas
Fenestrations
Subglottic suction and talk ports
Evaluation of Tracheostomy Tube Positioning. Chest Radiograph
Tracheoscopy
Routine Tracheostomy Care. Tracheostomy Site Care
Trach Stoma Dressings
Securement Devices
Tracheostomy Tube Suctioning. Suction Catheter Size
Suction Catheter Depth
Suction Frequency
Tracheostomy Emergencies
Mucus Plugging
Accidental decannulation
False tract
Inability to Insert Same‐Size Tracheostomy Tube
Further Reading
Index
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