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 PC02 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,

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

Atelectasis (absorption collapse) 32, 34, 58, 77, 83-4, 172,276, 297, 306, 348, 355, 370, 470

Bacteraemia 45, 229, 264, 278, 358, 410-11

effects of 228 in haemodialysis 457 initial management of suspected

227-8 in shock 175

Bacteria modes of spread of 218-9

Bacterial infections 277-80 in acute poisoning 370 in acute renal failure 411-3 in shock 194

Bacterial monitoring, and diagnostic problems 220-2

Bacterial pneumonia 32, 355 Bacterial toxaemia 68, 264, 266, 267,

352-3,355,357,410,412,489 Bacteriuria 426 'Bagging and suction' 62-3, 84, 254,

255, 276, 346, 372 Banked blood 100 Barbiturates, in acute poisoning 366,

378-9 Bence-Jones protein 415,429 Benzyl penicillin 226, 227, 280 Bird ventilator 15,61,81,269,298,

308,310,313,329,348,370,470, 475

controls of 243-5 nebulizer 358 principles of 240-6

Bird ventilator-continued. use of for assisted IPPV 245-6 use of for IPPB 244, 245, 324

Blood

493

analysis of arterial 48-55 analysis in metabolic disturbances

125-30 banked 100 carbon dioxide in 52 chemistry, some abnormalities of

129 culture in bacteriological monitoring

222 -gas machine 93, 309, 320, 322, 326 gas measurement in shock 186-7,

475,476 oxygen in 49-50 pH of 54 sugar 129,130,279,486 taking of samples 93 tests, chart for recording 127,477 transfusions and intravenous

infusions in shock therapy 188-90

urea 126-8, 137,409,486-7 whole clotting time 488

'Blue bloater' 95,317,318,319,325, 331

Bradycardia, sinus 213-4 Brain

damage in acute poisoning 375-7 damage after cardiac arrest 173-4 death 5,6,376 changes, in shock 179

Breathing patterns 41-4 Bronchi 336

damage to in tracheostomy 299 Bronchiectasis 40 Bronchitis, chronic 32,40,63,80,95,

317,318 ventilator programme for 258

Bronchodilator 63, 64, 308-9, 472 Bronchoscopy 59,341,342 Bumetamide 143, 173 Bypass tube 361

Calcium gluconate/ dextrose/insulin 147

Caloreen 145,148-152,314,377,418, 430,479

modifications to feed 160 Candida 358 Cannula 181, 184,439

nasal 78

494

Cannulating blood vessels, percutaneous method of 21

Cannulation, subclavian, equipment for 182

Cape ventilator 15,61,269,298,311, 312,313,329,344,348,370, 372, 475

methods used to control ventilation 251-2

principles of 239-41 Carbon dioxide 87, 98

in the blood 52 narcosis 82-3

Carbon monoxide poisoning 382 Cardiac arrest 76, 146, 475

brain damage after 173-4 coma following 173 diagnosis of 166-7 dysrhythmias in 174, 199,203-9 respiratory failure in 174 treatment of 167-172

metobolic disturbances in 170-1 Cardiac asthma 78, 80, 81 Cardiac rhythm, restoring 169-70 Cardiogenic shock 176, 199,202-3 Cardiological methods 483-4 Cardioversion 204-5 Carriers (disseminators), of infecting

organisms 215 Catheter

and bacteria 218-9 femoral 438, 439, 443

equipment for 440 Pinkerton's lSI, 276, 299, 372 suction 41,60,208,296,300,415,

464 in spreading bacteria 218-9 urethral 219

Central cyanosis 78 Central venous pressure (CVP) 56,

172,344,424 interpretation of 185-6 in shock 181-6, 373 technique of 181-5

Chest equipment of drainage 340 injuries 17, 95

anaesthesia in 343 haemorrhage in 335,337,338 infectionsin 355-8 initial assessment and resuscitation

337-42 lungs in 336 pathological processes in 334-7 rupture of diaphragm 337

Chest -continued. shock in 335 IPPV in 343, 345 radiograph 57-8,306

INDEX

ventilator treatment for 260, 342-8, 358

wall injuries 336 Chronic bronchitis 32,40,63,80,95,

317,318 ventilator programme for 259

Chronic glomerulonephritis 124,431, 467

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

Defibrillation 169-70 Dehydration (saline depletion) 112-3,

126, 135, 142-3, 415 'Demand pacing' 206 Dextrose 146,154,203,377,461

heparinized 185 injection 142, 153

insulin/calcium gluconate 147 'Dextrostix' 486 Diabetic acidosis 26, 42, 144

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

syndrome) 455 maintenance 121 peritoneal 144, 194,424,429,431,

435,437

Dialysis-continued. in renal failure 422-5

principles of 422 programme 423-5

Diaphragm injury 362 rupture of in chest injuries 337

Diarrhoea 98, 131, 134, 152 Diazepam (Valium) 200 Diet

Caloreen 145, 148-52,314,377, 418, 430, 481

495

Complan 145, 152,314,325,476 Complan-glucose 150 liquid 149-53 ward 148 Whiston standard intravenous and

intragastric 17, 138, 145, 146, 160,331,353,419

Dietary requirements, per adult, per day 109

Digitalis and diuretics, in coronary care 202

Disequilibrium syndrome (encephalopathy) 455

Disseminated intravascular coagulation (DIC) 413-4

Diuresis 144, 154, 354 forced alkaline (FAD) 365, 379,

382,390 forced cocktail (FCD) 391

Diuretics 111, 202, 203 Doctor, essential knowledge for 19 Doctor-nurse relationship 13, 14,27 Doctor-patient relationship 5 Drugs

acting on the circulation in shock therapy 191-2

causing acute renal failure 406 to increase cardiac output in shock

therapy 191-2 screening in poisoning 487-8

Dyspnoea (breathlessness) 26, 37, 38-9,42,264,338

grading of in disease of the heart or lungs 39

Dysrhythmias in cardiac arrest 174, 199, 203-9 computer for 488 and shock in acute poisoning 372-4 supraventricular 204

ECC (electrocardiac compression) 167-9

496

ECG 56-8 monitoring and recording in

coronary care 203, 208, 483-4, 490

oscilloscope for 488 Edinburgh mask 81, 309 Elapsed time 92 Electrical pacing, indications for

205-9 Electrolyte

disturbances in balance 421 in intravenous feeding 153 output of 110 supplements in liquid diets 150

Electrophoresis, counter-immune (CIE) 222

Elixir cascara, in paraquat poisoning 381

Emphysema 32,80,317,318,338,349 mediastinal 337 surgical, in tracheostomy 289

Encephalopathy, dialysis 455 Endocardial pacing, equipment for

207 failures and complications of 209

transvenous 170 Endogenousinfection 214 Endotoxaemia 194,267,280,453,

454,457 clinical and laboratory signs of 356

Endotracheal suction 41,294,295-7, 313,327,370,371

apparatus for 295-6 indications for 296-7 methods for 296

Endotracheal tube (ET) 59, 66, 150, 151, 172,254,270,272,276,289, 300, 312, 314, 367, 369

Entonox 187 Epilepsy 69 Erythromycin 226, 227 Escherichkl coli 301, 355 Facilities necessary for patient

accommodation in lCU 24-5 Fat emulsions, intravenous 101, 155-7 Fibrillation, ventricular 164, 169,206,

209 First aid, therapy in shock 187 Flail segment 335, 336, 339, 342, 343,

344, 346 Fluid balance and nutrition, assessment

of 123-38 chart for 482-3

INDEX

Fluid therapy, intravenous 2,19,111, 141-7

in diabetic acidosis 397-9 during asthma 308 during IPPV, in chronic lung disease

331 and food 153-7 overall plan for 141 in renal failure 418-21

Food supplements 148-9 Forced vital capacity (FVC) 46-7 Forced vital capacity one second

(FEV l ) 47 Frusemide 121, 123, 143, 173,202,

407,431,434

Gas, and blood machine 92, 309, 320, 322,326

Gas, and blood measurement in shock 186-7,475-8

Gas exchange, in respiratory failure 44

Gas gangrene 225 Gastric aspirate 131, 133 Gastric lavage, in poisoning 364, 367,

380,381,389 Gastric suction (intestinal obstruction)

98, 131 Gastrografin swallow 362 Gastrointestinal diseases, as cause of

acid-base disturbances 97-8 Gelofusine 154 Glasgow Coma Scale 179,367 Glomerulonephritis, chronic 122,431,

468 Glucose

intolerance 120, 154, 161,419 Complan diet 150 Gram-negative infections 280 Gram-positive infections 280

Haematomas, 92 pulmonary 81, 335

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

Haemodynamic measurements, in shock 187

Haemoglobin 75, 189 Haemophilus inJIuenzae 214, 219,

225,226,319 Haemorrhage 187-8

in chest injuries 335, 337, 338 gastrointestinal 457 subarachnoid 45 surgical arrest of 193-4 and the thoracic surgeon 360-1 in tracheostomy 289

Handley Injector 428 Heart block 205 Heart disease 164

congenital 156 rheumatic 69, 78

Henderson-Hasselbalch equation 54, 88-9

Heparin 49,92,195,428,448 therapy in haemodialysis 450-1

Hormone therapy in Addison's disease 195

Hospital infection, prevention of 253 Humidification 61-2

in tracheostomy care 298 Humidifier 314

hot water 298 Hycal 148, 418 Hydrion (cH) 88, 89 Hydrocortisone 372 Hygiene standards

cleaning, disinfectant and laundry 223-4

of equipment 224 of instruments 224 in microbial infections 222-4 patient 223 staff 222-3

Hypercalcaemia 129 Hypercapnia 52, 55, 82, 91, 129, 304,

306,318,323,327,339,342,370 Hypercatabolism 111, 119, 128, 159,

378, 424, 453 Hyperglycaemia 115, 120, 143, 154,

15S, 161,394,400,447,470 Hyperkalaemia 91,99, 116-8, 123,

129,146-7,395,461,465,467 Hypematraemia 104-5, 112, 115, 128,

129,142-3,153,387,470 Hyperosmolar non-keto-acedotic coma

400-1

497

Hyperosmolar syndromes 115-6, 487 Hyperosmolarity 129 Hypertension

in acute renal failure 409,413,424, 426-7

intracranial 173 Hyperuricaemia 428 Hyperventilation 37, 38, 42, 65, 95,

250, 269, 343, 345 Hypoalbuminaemia 69, 352, 425 Hypocalcaemia 129,391,415,447 Hypocapnia 30,44,46,63,91, 129,

250,264,371 Hypoglycaemia, in acute poisoning

375,381 Hypokalaemia 106, 116-7, 129, 170,

387,390,391,399 Hypomagnaemia 391 Hyponatraemia 112, 115, 128, 129 Hypoproteinaemia 462 Hypoprothrombinaemia 377 Hypotension 101, 175,307,426-7,

454-5,470 Hypothermia 170

in acute poisoning 374-5 treatment in hypoxaemia 65-6

Hypotonic saline 143 Hypovoiaemia 56, 373 Hypovoiaemic shock 143, 175, 177,

185, IS6, 188, 189, 190,406 Hypoxaemia 30,31,44,46,50,76,

77-8,83,165,186,199,202,262, 264,265,303,304,306,307,317, 322,327,339,340,342,370,395, 470,489

treatment of 64-5 Hypoxia 40, 76, 92, 165, 202, 382

cerebral 179 conditions causing generalized tissue

77. stagnant 192

Ileostomy fluid 131, 133 Impramine 488 Immunological tests on serum 222 Injury, metabolic response to IIS-2O Insulin 154,393,401,419 dextrose/calcium gluconate 197

therapy in diabetic acidosis 396-7 Intensive care

definitions of 4-5 essentials of required by unit 14 examples of 7 five essentials for 10-27 monitoring 486-8

498

Intensive care-continued. origins and evolution of 1-4 units for 3,23-6

Intermittent positive pressure breathing (IPPB) 15,63,69,90,308,310

in chronic lung disease 324-5 use of Bird ventilator for 244-5,

324 Intermittent positive pressure

ventilation (lPPV) 19,21,65,66, 101, 102, 114,237,240,291,313, 325,351,372,376

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

327-30 use of Bird ventilator for assisted

245-6 Intracranial hypertension 173 Intragastric feeding 159 Intragastric sugar solutions 148

See also Intravenous and intragastric diets, Whiston standard

Intralipid 155, 157, 161 Intraperitoneal nutrition 148 Intravascular coagulation 192 Intravenous acid therapy 106-7 Intravenous fat emulsions 101, 155-6 Intravenous fluid therapy 2, 19, 111,

141-7 during asthma 308 in diabetic acidosis 397-9 and food 153-7 during IPPV in chronic lung disease

331 overall plan for 141 in renal failure 308

Intravenous infusions and blood transfusions in shock therapy 188-90

Intravenous and intragastric diets, Whiston standard 17, 138, 145, 146, 160, 331, 353,419

Intravenous nutrition 16-7, 100, 157-8

indications for 158-9 isolation, in spreading bacteria 219 learning programme on 17

INDEX

Isoprenaline 170,324,374

Joint Board of Clinical Nursing Studies (JBCNS) 4

outline syllabus of 14-15

Keto-acidosis, diabetic 98, 130 Ketonuria 395 Kidney 114

flow in shock 179-80 Kolff-Travenol artificial 423, 426,

436,441-9 Kiil membrane 444 Klebsiella spp. 215, 216, 221, 278,

300,318,319,355,418 Kolff -Travenol artificial kidney 423,

426,436,441-9 dialysate for 449 priming and testing 448-50

Lactic acidosis 462 Laparotomy 410 Laryngoscope 40, 294 Larynx, pharynx and trachea

complications in ventilator treatment 272-3

Liquid diets 149-53 complications of tube feeding in

152-3 composition of 149 electrolyte supplements in 150 standard 149-50

Liver damage, in acute poisoning 377 Lorraine Smith effect 281 Lung disease, chronic 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 intermittent

positive pressure ventilation (IPPV) 331

functions in asthma 305 IPPB in 324-5 metabolic care in 325 pathological processes in 317-8 techniques of IPPV in 327-30

Macaulay and Wright method 206 McGill's forceps 150, 151 Manley Lung Ventilator Performance

Analyser

Index

Mannitol 121, 123, 173,408,434 MC mask 74, 78, 202, 309, 343 Mediastinal emphysema 337 Medical team 18-23 Meningococci 214 Metabolic acidosis 96,99, 103-6, 118,

147,166, 169, 172, 187,203,375, 377, 387, 421

Metabolic alkalosis 98,99, 106 Metabolic balance 23, lOS, 479-83

abnormal 110-23 blood analysis in 125-30 causes of III indications for 132, 159 maintenance of 157-62

choice of methods in 158-60 measurements 132-8 symptoms and signs in disturbances

of 124-5 Metabolic care, in asthma 310

in chronic lung disease 325 Metabolic response to injury 118-20 Minute volume ventilation (VE) 45-6,

92,473-4 'Multistix' 485 Muscle relaxants 250 Myasthenia gravis 69

Nasal cannulae 78 Nasogastric tube 148, 159, 156 Natriuresis 134, 298, 358 Nebulizer 61,298,358 Needle biopsy 21 Negus tube 348 Nephritis, acute interstitial 457 Nephrogram 416 Nephropathy, obstruction 126,411 Neurogenic shock 176 Neuroleptanalgesia (NLA) 251 Nitrogen

in amino acids 156 balance 134, 135, ISO disturbance 421 output of 110

Noseworthy connector 296,300, 312, 371

Nurse-doctor relationship 13, 14,27 Nurse-patient relationship 12, 13 Nursing officer, responsibilites of 12 Nursing team 10-17 Nutrition 19,22,23, III

assessment of with fluid balance 123-38

chart for 480

499

Nutrition-continued. foods or beverages to supplement

149 intraperitoneal 148 intravenous 16-17, 100, 157-8, 159 materials for 147-57 overall plan for 141

Oedema 106, 119, 124, 147, 174,264, 467

cerebral 399 pulmonary 32,34,35,58,63,64,

69,95,113, 190,257,260-1, 267,268,325,336,349-55,385, 387,388,409,424,469

Oesophagus injury 362 reflex 152

Oliguria 106, 112, 121, 130, 143, 174, 179, 181,387

investigation and treatment of 122, 180,405-11,413,434

'Opportunistic'infections 217 Oscilloscope, for ECG display 488 Overhydration (saline excess) 105,

113, 119, 143-4, 266,415 Overtransfusion (acute circulatory

overload) 113, 190 Oxygen

in blood 49-50 high concentrations of during

spontaneous respiration 78-9 inspired concentration of 485-6 pressure 72-5 pulmonary toxicity 84,266,281-2 therapy 19, 23, 337

apparatus for 80-1 in asthma 309 in chronic lung disease 322-4 complications of 82-4 contrplled, during spontaneous

respiration 79-80 in coronary care 202 face masks for 74 indications for 77-8 during mechanical ventilation of

the lungs 81-2 methods of 78-9

transport 73-6

PaCO 2 (arterial CO 2 tension) 30, 31, 52,73,77,83,92,93, 101, 102, 103,104,236,250,300,306,308, 317,327,338,394,476

500

Pain, relief of in coronary care 199 Pancreatic fistula 102 Pancreatitis, acute 194,414,469 Pa02 (arterial oxygen tension) 30,49,

50,52,74,77,83,107,197,202, 236,300,306,317,327,339,476

Paradoxical breathing 42 Paraquat 365,377,381-2,488 Paralytic respiratory failure, ventilator

programme for 259 Patient accommodation in ICU 24-5 Patient care, revised philosophy of

26-7 Patient-nurse relationship 12, 13 Patient selection

in acute poisoning 367-9 for coronary care 198 for Stage II therapy in chronic lung

disease 326-7 PC0 2 , pH and plasma bicarbonate,

relationship between 90 Peak Expiratory Flow (PEF) 47-8,

473 Pendelluft (to-and-fro rebreathing)

336 Penetrating injuries, and the thoracic

surgeon 359-60 Percutaneous method of cannulating

blood vessels 21 Percutaneous Seldinger technique

157, 181-2 Pericardial tamponade 176, 193,334 Peritoneal dialysis 144, 194, 424, 429,

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

Peritonitis, generalized 32, 470 pH 90,92,93, 101,476

of the blood 54 high 103 low 102 normal 102

Pharynx, larynx and trachea complications in ventilator treatment 272-3

'Phenistix' 485 Phenothiazine metabolites 487-8 Physiotherapy

in prolonged ventilator treatment 254-5

in respiratory failure 62

INDEX

Pinkerton's catheter 151,276,299, 372

Plasma 100 bicarbonate, PC02 and pH,

relationship between 90,91 expanders 188, 189 potassium (~p) 129 sodium (Nap) 128 lurine values 123

Pneumonia, bacterial 32, 355 Pneumoperitoneum, diagnostic 337 Pneumothorax 209, 289, 306, 334,

335,336,338,339-42,344,348, 362

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

Polyuria 395, 420, 424 Polyuric renal failure 410 Positive end-expired pressure (PEEP)

262 Potassium 146, 150,202

chloride 161 depletion (hypokaIaemia) 116-7,

126, 135, 144-6 replacement in diabetic acidosis 398 wasting 123

Progressive Patient Care (pPC) 2 Prophylaxis in antimicrobial therapy

225-6

Index

Protein Bence-Jones 415, 429 sparing 120

Proteus spp. 355,418, 426 Prothrombin time 428 Pseudomonas aeruginosa 215, 216,

221,279,300,301,319,355,357, 418

Pulmonary collapse 371-2 Pulmonary embolism 45, 56, 77, 95

shock following 194-5 Pulmonary haematomas 81,335 Pulmonary oedema 32, 34, 45, 58, 63,

64,69,95, 113, 190,257,260-1, 267,268,325,336,349-55,385, 388,409,424,470

ventilator treatment for 260-1 Pulmonary oxygen toxicity 84, 266,

281-2 Pulse and blood pressure, in shock

177-8 Pulsus paradoxus 56, 307 Pump failure 186, 188, 190 Pureed food 148 Pyelonephritis 431,468

QRS complexes 166, 167,208,306

Radcliffe cuffed tracheostomy tube 293

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,

472-5 Resuscitation, assessing response to

171 Rheumatic heart disease 69,78 Ryle's tube 133, ISO-I, 152, 153, 186,

231,248,305,311,313,314,327, 358,367,370,372,396,479

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,

126, 135, 142-3, 415 Saline excess (overhydration) 105,

113, 119, 143-4, 266 in renal failure 144, 415

Scribner shunt (Teflon-silastic) 437, 438-40, 443, 450

clotting and declotting in 455,456 Sedation, in coronary care 200 Sedative poisoning 45 Seldinger technique, percutaneous

157, 181-2 Semi-starvation 98, III Septicaemia 218 Septic shock 175 Serum

creatinine 403 immunological tests on 222 therapy 2

Shock 45,96,102 assessment of 176-87 bacteraemic 175 brain changes in 179 cardiogenic 176, 199,202-3 central venous pressure (CVP) in

181-6,373 in chest injuries 335 definition, classification and causes

174-6 due to dehydration 175 first aid therapy in 187 gas and blood measurement in

186-7,475-8 haemodynamic measurements in

187 hypovolaemic 143,175,177, 185,

186, 188, 189, 190,406 kidney flow in 179-81 neurogenic 176 septic 175 skin examinations in 178-9 therapy 188-96

steroids in 193 Sinus bradycardia 203-4 Sodium

chloride injection 142 lactate 297 plasma (Nap) 128

Sodium-continued. retention 123 wasting 123

INDEX

'Specialing' of patients 2, 12 Sphygmomanometer 177,448,490 Spirometer, Wright's 45, 172,272,

366, 472, 473, 475 Spirometry 473 Stage I treatment 7, 8

in asthma 308-10 for chronic lung disease 321-5

Stage II treatment 7, 8 in asthma 310-4 in chronic lung disease 325-31

Standardizing methods in the lCU 23-6

Staphylococcus aureus 214-5,217, 221,225,278,300,319,358

Starvation 116 Steroids, in shock therapy 193 Stimulation, in poisoning 364 Stokes-Adams attacks 170, 198,205 Streptococcus pyogenes 213, 214 Stress ulcer, in renal failure 428 Subclavian cannulation, equipment for

182 Sugars

blood 129-30,279,486 intragastric solutions 148 in intravenous feeding 153-5

Supraventricular dysrhythmias 204

Tachycardia 305, 306 Tachypnoea 38, 45 Tension pneumothorax 193 Tetany 106, 107, 390 Thoracic surgeon, role of 358-63

and air leakage 361-2 and haemorrhage 360-1 and penetrating injuries 359-60

Thrombocytopaenia 377 Thrombophlebitis 154, 157,209,218 Toxaemia, bacterial 69,264,265,267,

352-3,355,357,410,412,489 Trachea, and bronchi, damage to in

tracheostomy 299 pharynx and larynx complications in

ventilator treatment 272-3 Tracheostomy 1,61,62,254,326,

345,371 airway obstruction in 299 complications of 289,299-301 damage to bronchi and trachea in

299 equipment for 286

Index

Tracheostomy-continued. haemorrhage in 289 incision for 285 infection in 299-300

sources of and prevention 300-1 surgical emphysema in 289 tube 285,287,288,289,291-4,299,

348 uses of 291 wound care of 294-5

Tranquillizers and antidepressants 373 Transvenous endocardial pacing 170 Trinder's reagent 487 Tube feeding

complications of in liquid diets 152-3

methods of 150-2

Ultrafiltration 144,437,445 pressure 443-4

Unit laboratory 484-8 Uraemia 42, 106, 115, 129, 400, 403,

405,414,418,429,430,432,466 Urea, blood 126-8, 137,409, 186-7 Urine-plasma values 123

analysis in metabolic balance 130 Urinometer 179

Valium (diazepam) 200 Valsalva manoeuvre 232, 233, 234

260,261,262,273 Vamin 157, 161,430 Vasoconstriction 191, 192 Ventilation (artificial respiration)

15-6, 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

Ventilation/perfusion (V /Q) ration 31,64,76, 199,306

Ventilator automatic mechanical 66 Bird 15,61,81,269,298,308,310,

313,329,348,370,470,475 Cape 15,61,81,269,298,311,312,

313,329,348,379,472,475

503

Ventilator-continued. East-Radcliffe 298 programmes 257-68,328 therapy 66, 67, 281

in chest injuries 347 treatment

analgesics 25 1 antibiotic therapy in 279 apparatus in 253-4 basic hygiene in 252-3 in chest injuries 260, 342-8, 358 circulatory complications in

273-4 complications during in chest

injuries 348-58 evalution of in chronic lung disease

326 lung complications in 274-82 mechanical complications in 272 monitoring in 255-6 patient accommodation in 252 pharynx, larynx and trachea

complications in 272-3 physiotherapy in 254-5 for pulmonary oedema 260-1 weaning in 268-70

Ventilatory failure 30 Venti mask 62, 64, 74, 80, 84, 202, 309 Ventricular ectopic beats 204 Ventricular fibrillation 164, 169, 206,

209 Vibration and percussion, of chest wall

254 Vomit 131

treatment of inhalation of 60, 372

Ward diet 148 Water

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.