Index Abdominal distension 42 Absorption collapse, see Atelectasis Acid-base balance 15,22,86 in acute salicylate poisoning 387 circulatory failure in 96, 97 dialysis in 106 diseases causing disturbed 94-101 disturbances of caused by treatment 99-101,476 drugs disturbing 100 effects of disturbed on body functions 91 measurements in 475-6 prevention of 103-4 in renal failure 421-2 respiratory failure in 94, 96 treatment of disturbances of 103-7 Acid therapy, intravenous 106-7 Acidosis (acidaemia) 55,88,90-1, 102, 129, 187,475 diabetic, see Diabetic acidosis harmful effects of 91 lactic 462 metabolic, see Metabolic acidosis respiratory 95, 103, 118 Acute circulatory overload (overtransfusion) 113, 190 Acute myocardial infarction 32, 55, 199,202 Acute pancreatitis 194,414,471 Acute tubular necrosis (ATN) 121, 123, 130, 406, 457 Addison's disease, hormone therapy in 195 Adrenaline 170 Adult Respiratory Distress Syndrome (ARDS) 35-6,58,84,257,475 natural history of 36, 350, 488 ventilator treatment in 262-8,281 349-55 Air leakage, and the thoracic surgeon 361-2 Airway, upper and bronchi 59-60 equipment for cleaning and maintaining 60 long-term tracheal 60-1 obstruction, generalized 32 in tracheostomy 299 pharyngeal 59 492 Aldosterone 352 Alkali therapy, intravenous 104-5 in diabetic acidosis 398 oral 105 in shock 192 Alkalosis 55,88,91,95, 103, 105, 129, 387, 391 harmful effects of 92 metabolic 98-9, 106 Alveolar/arterial pressure gradient 50-2, 74 Alveolar PC0 2 30 Alveolar ventilation (VA) 31,52,63, 64,65,76,95,107,304,306,308, 385 Amino acids 156 Aminophylline 309 Anaemia 425 Anaesthesia in chest injuries 343 in IPPV 248, 343 Analgesics, in ventilator treatment 251 Anaphylaxis 195 Angiogram 360 Anorexia nervosa 159 Antacids 99 Antibiotics in asthma 309-10 in chronic lung disease 322, 330-1 in diabetic acidosis 399, 400 effects of (superinfection) 214-5 during IPPV in chronic lung disease 330-1 therapy, in ventilator treatment 279 Anticoagulants, in coronary care 202 Antidepressants and tranquillizers 373 Antimicrobial therapy 224-9 prophylaxis in 225-6 Anuria 130, 179,411 Apnoea 31, 36, 76 expiratory time for 242, 246 Arterial blood analysis 48-55 Artificial respiration (ventilation) 15-16,26,65-6, 168-9 alveolar (VA) 31,52,63,64,65,76, 95,107,304,306,308,385 learning programme on 16 methods of giving 66 Asthma 20,22,26,32,40,63,64,69,
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Index
Abdominal distension 42 Absorption collapse, see Atelectasis Acid-base balance 15,22,86
in acute salicylate poisoning 387 circulatory failure in 96, 97 dialysis in 106 diseases causing disturbed 94-101 disturbances of caused by treatment
99-101,476 drugs disturbing 100 effects of disturbed on body
functions 91 measurements in 475-6 prevention of 103-4 in renal failure 421-2 respiratory failure in 94, 96 treatment of disturbances of 103-7
in asthma 309-10 in chronic lung disease 322, 330-1 in diabetic acidosis 399, 400 effects of (superinfection) 214-5 during IPPV in chronic lung disease
330-1 therapy, in ventilator treatment 279
Anticoagulants, in coronary care 202 Antidepressants and tranquillizers 373 Antimicrobial therapy 224-9
prophylaxis in 225-6 Anuria 130, 179,411 Apnoea 31, 36, 76
expiratory time for 242, 246 Arterial blood analysis 48-55 Artificial respiration (ventilation)
95,107,304,306,308,385 learning programme on 16 methods of giving 66
Asthma 20,22,26,32,40,63,64,69,
Index
Asthma-continued. 158, 165,236,257,475
in acid-base disturbances 96 antibiotics in 309-10 assessment of 307-8 cardiac 78,80,81 corticosteroids in 309 intensive therapy in 306-14 intravenous fluid therapy during
308 lung function in 305 metabolic care in 310 method for grading the severity of
38,56,305 natural history of 304-5 patient in 304-5 pathological processes in 303-4 results of intensive care in 314-5 ventilator programme for 258-9
Chronic lung disease 26, 56 acute respiratory failure in 317-31 antibiotics in 322, 330-1 assisted cough in 324-5 and chest wall complications
348-52 complications in ventilator treatment
274-82 fluid therapy during IPPV 331 functions in asthma 305 IPPB in 324-5 metabolic care in 325 techniques of IPPV in 327-30 pathological processes in 317-8
Circulatory failure, in acid-base balance 96-7
Clinistix test 396 Clostridium welch;; 225 Clotting, and declotting, in Scribner
shunt 455-6 whole clotting time 488
Coagulation, intravascular 192 Coagulopathy 155,427-8 Cobalt edetate, in cyanide poisoning
382 Colloids 188 Coma
assessment of 368-9 following cardiac arrest 173 Glasgow scale 179,367 hyperosmolar non-keto-acedotic
400-1 Complan 145, 152, 314, 325, 479
-glucose diet 150 modifications to diet 160-1
Coronary care after care 209-10 anticoagulants in 202 digitalis and diuretics in 202 ECG monitoring and recording in
203,208,481-2,488 nursing in 201 pathological processes in 199
Index
Coronary care-continued. patient selection for 198 programme for 200 relief of pain in 199 sedation in 200
Corticosteroids, in asthma 309 Cough or sputum 40-1
assisted in asthma 310 in chronic lung disease 324-5
causes of ineffective 41, 275 Coumand needle 183,207 Crystalloids 188 Cuff inflation, in tracheostomy 293 Cyanide poisoning 382 Cysteamine 380
antibiotics in 397 cause of 393 complications in 400 fluid therapy in 397-8 insulin therapy in 396-7 intensive therapy in 396-400 laboratory investigations for 395-6 pathological processes in 394-5 recovery phase in 400 rehydration in 397 symptoms and signs of 395
Diabetic keto-acidosis 98, 130 Dialysate
circulation of 445-7 composition of 447-8 for Kolff -Travenol kidney 449 leakage of 468 for peritoneal dialysis 462
choice of 465 Dialyser 441-6 Dialysis 21, 23, III
in acid-base balance 106 in acute poisoning 379 encephalopathy (disequilibrium
Haemodialysis 144,355,417,418,431 in acute salicylate poisoning 390 air embolism in 455 bacteraemia in 457 chart for recording 446 comparison of with peritoneal
dialysis 424 complications of 454-7
circulatory 454-5 heparin therapy in 450-1 principles of 436-7
Index
Haemodialysis-continued. programme for 452-4 techniques for 451-2
anaesthesia in 247, 343 chart for recording 248 in chest injuries 343, 345 to induce sleep during 271 measurements during 475 physiology for practice of 231-7 practice of 246-70 pulmonary complications of 275 results of 235 techniques of in chronic lung disease
431,435,437 comparison with haemodialysis 424 complications of 468-71 design of the cycle in 465-7 dialysate for 462, 465 positive balance in 469 principles of 458-62
Poisoning, acute bacterial infections 370 barbiturates in 378-9 blood concentrations of barbiturates
in 366 brain damage in 375-7 carbon monoxide 382 diagnosis in 365-6 dialysis in 379 gastric lavage in 364,367,380,381,
389 history of treatment in 364-6 hypoglycaemiain 375,381 hypotherntiain 374-5 initial assessment and treatment of
366-9 intensive care and therapy in
369-78 liver damage in 377 renal failure in 377-8 respiratory failure in 370-2 salicylate 75, 145,485 screening of drugs in 487-8 sedative 45, 261 selection of patients in 367-9 specific treatment of 383 stimulation in 364
Rehydration, in diabetic acidosis 397 Renal biopsy, indications for 417 Renalfailure 118
acute 404-14 cause of 405
polyuric 410 in acute poisoning 377-8 bacterial infection in 411-13 chronic 102,106,414-7
causes of 416 definition and classification of
403-4 dialysis 422-5 in disturbances of acid-base balance
98-9,421-2 in disturbances of metabolic balance
121, 162 drugs and poisons causing 406 duration of treatment in 468 fluid therapy and nutrition in
418-21 hyperkalaernia in 147,415, 424, 429 hypertension and hypotension in
409,413,424,426-7 infection in 425-6
Renal failure--continued. intensive therapy in 417-32 obstruction in 428-9 oliguric 405-10 prevention of 433-4 respiratory failure in 427-8 results of treatment in 432-3 saline excess (overhydration) in
144,415 stress ulcer in 428
Renal transplantation 121, 414 Respiratory acidosis 95, 103, 118 Respiratory care, in prevention of
501
respiratory failure 69 Respiratory Distress Syndrome of the
newborn 35, 84, 281 Respiratory failure
in acid-base balance 94-5 in acute poisoning 370-2 in cardiac arrest 174 causes of 31-6 in chronic lung disease 318-9 circulation in 55-7 clinical signs in 44 consolidation in 34, 58 definitions of 30-1 diagnosis and assessment in 36-58,
319-21 gas exchange in 44 physiotherapy in 62 prevention of 68 principles of treatment in 58-68 in renal failure 428-9 structure of the lung in acute 31 treatment of cause 67-8
Respiratory fatigue, conditions leading to 43
Respiratory frequency 45 Respiratory infection 371-2 Respiratory measurements 44-8,
Salicylate poisoning 75, 145,487 acid-base balance in 387 assessment of 388-9 cardiovascular, reSpiratory and
gastrointestinal features in 386-7
central nervous system in 386
502
Salicylate poisoning-continued. haemodialysis in 390 intensive therapy in 389-91 'jag' 386 removal of drugs in 390-2 renal, haematologica1 and metabolic
features in 387 Saline depletion (dehydration) 112-3,
given intravenously 153 output of llO symptoms of intoxication 114, 115,
144 Weaning, in ventilator treatment
268-70
Ackno\\lledgements
My largest debt is to the nursing team of the unit, especially W. Atkinson, SRN who was head nurse from 1962 to 1973. lowe much to my colleagues in internal medicine, anaesthesia and surgery, both for referring patients and sharing in the day-to-day work. Most of the information collected in this book was obtained by the devoted efforts of my junior colleagues in medicine and anaesthesia who have also been joint authors of publications from the unit. Without their efforts no real progress would have been possible; it has been an additional pleasure to count them as my friends and to follow their careers. A great deal of encouragement and guidance was given by the late Professor Andrew Wilson, Joint Director of the Clinical Pharmacology Unit based at Whiston Hospital from 1964-1975. Indispensible practical help was also given by Dr. D. V. Roberts, Senior Lecturer in Physiology.
Financial aid for research was obtained from the Research Committee of the United Liverpool Hospitals, the Asthma Research Council, Prescot Round Table, Prescot Rotary, The Widnes Kidney Unit Fund and from out patients.
I am especially indebted to Dr. D. B. McWilliam, for a critical reading of the manuscript, which was typed by Mrs. Margaret Attwood and Mrs. Joan Challoner.