bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consequences of Acute Metabolic Changes to the Brain
Authors: Braksick Sherri A. , Hocker Sara E. 
Published: August 2019

Abstract
Acute hypertension is a common clinical problem that accounts for almost 25% of emergency department visits in the United States. It can occur in patients who have preexisting hypertension or in patients who were previously normotensive. This chapter provides an overview of cerebral autoregulation and the mechanisms of action and side effect profiles of different antihypertensive medications used to treat acute hypertension.
Consequences of Acute Hypertension to the Brain
Authors: Oshel Katherine M. , Wadei Hani M. 
Published: August 2019

Abstract
The components of consciousness are classically separated into 2 major groups: level of alertness (being awake) and content of thinking (being aware). Major acute neurologic disorders affect both components. These 2 components are interrelated but sometimes dissociated. Coma is often due to an extensive structural (anoxic-ischemic) injury or to diffuse physiologic dysfunction (eg, intoxication, seizures, or acute metabolic derangement).
Coma and Other Altered States of Consciousness
Authors: Wijdicks Eelco F. M. 
Published: August 2019

Abstract
Regardless of its cause, acute neuromuscular respiratory weakness leads to alveolar hypoventilation. Additional features that complicate the clinical presentation are upper airway muscle weakness and pulmonary complications (mostly due to aspiration). Having an understanding of basic ventilatory physiology and the pathophysiologic mechanisms underlying mechanical neuromuscular respiratory failure is essential for early recognition, initial evaluation, and further etiologic investigation of neuromuscular respiratory failure. Besides allowing for targeted treatment, identifying the cause has prognostic implications.
Neuromuscular Respiratory Failure
Authors: Hawkes Maximiliano A. , Wijdicks Eelco F. M. 
Published: August 2019

Abstract
Breathing is a continuous, rhythmic, to-and-fro movement that requires a close interplay between arterial PCO2, oxygen, and respiratory centers. Certain thresholds exist for respiratory drive, and these thresholds change with acute neurologic disease. Primary structural lesions to the brainstem are most common, but decreased levels of consciousness frequently trigger episodic breathing. This chapter discusses the essentials of the respiratory pacemaker and neurologic breathing patterns.
Neurogenic Breathing Patterns
Authors: Wijdicks Eelco F. M. 
Published: August 2019

Abstract
Abnormalities of cardiac function and cardiac electrophysiology are not uncommon in patients with acute injury to the central nervous system, and cardiac abnormalities may be the initial signs when these patients are first evaluated. Some patients have findings that suggest an acute coronary syndrome but disappear after the intracranial pressure surge subsides. The clinician must consider underlying neurologic disease when a patient presents with cardiac arrhythmias, new-onset pulmonary edema, hypotension, or cardiogenic shock with characteristics atypical for a primary cardiac event if the patient is in an otherwise unexplained comatose state.
Vascular Emergencies of the Aorta
Authors: Almerey Tariq , Moore January F. , Farres Houssam 
Published: August 2019

Abstract
Many serious conditions require emergent vascular intervention, but the most challenging conditions that typically require admission to an intensive care unit are ruptured abdominal aortic aneurysm (AAA) and acute aortic syndrome (ie, aortic dissection, intramural hematoma, and penetrating ulcers).
Pituitary Apoplexy
Authors: Braksick Sherri A. 
Published: August 2019

Abstract
Pituitary apoplexy is infarction of the pituitary gland by hemorrhage or ischemia. Although pituitary apoplexy is rare, it is a neurologic emergency and sometimes a neurosurgical and endocrine emergency that require rapid intervention to prevent severe and potentially life-threatening adrenal insufficiency, hydrocephalus, intracranial hemorrhage, or ischemic stroke.
Adrenal Insufficiency in Neurocritically Ill Patients
Authors: Venegas-Borsellino Carla P. , Naranjo-Sierra Santiago 
Published: August 2019

Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is a complex system that equilibrates blood levels of glucocorticoid hormones. Cortisol levels are dynamic and normally fluctuate in response to constant feedback; functional deficiency in this system results in adrenal insufficiency (AI). An elevated corticosteroid level is needed as a protective response to stress during acute illness or major surgery, but corticosteroid secretion can be altered by splanchnic and central nervous system influence, fever, acidosis, and proinflammatory cytokines. Critical illness–related corticosteroid insufficiency (CIRCI) is a relatively insufficient HPA response; often encountered in critical care patients, it can worsen outcomes.
Disseminated Intravascular Coagulation: Clinical Diagnosis and Management
Authors: Vishnu Prakash , Ailawadhi Sikander 
Published: August 2019

Abstract
Disseminated intravascular coagulation (DIC) is a phenomenon with the potential for causing thrombosis and bleeding. DIC, typically occurring in patients with critical illness, can manifest as an acute, life-threatening emergency or as a chronic, subclinical process depending on the influence of morbidity from the underlying cause. The presence of DIC increases the risk of mortality by twofold in patients with trauma and severe sepsis and is an independent predictor of mortality. The pathogenesis of DIC is not only related to abnormal coagulation activation and platelet consumption but also involves multiple mechanisms of the inflammatory system and innate immunity.
Sepsis and Septic Shock
Authors: Sims Charles R. , Comfere Thomas B. 
Published: August 2019

Abstract
Sepsis is the most common cause of admission to the intensive care unit (ICU). Although its incidence has increased during the past decade, its short-term mortality has decreased. Furthermore, organ dysfunction caused by dysregulated host immune response to infection resulting in systemic hypoperfusion and end-organ dysfunction is associated with long-term outcomes including frequent morbidity (secondary infections, hospital readmission, decreased quality of life) and mortality in the ICU.
Carotid Artery Disease
Authors: Mbabuike Nnenna , Tawk Rabih G. 
Published: August 2019

Abstract
Carotid artery disease is a common source of ischemic stroke due to ulcerated or hemorrhagic plaque. Risk factors for carotid artery disease include typical atherosclerotic disease risk factors, such as smoking, hyperlipidemia, and diabetes mellitus. This chapter reviews the diagnostic approach to symptomatic carotid artery disease (including stroke and transient ischemic attacks), the overall management approach for symptomatic carotid artery disease (including endovascular and open carotid endartectomy), and medical management options for asymptomatic carotid artery disease. Perioperative management after carotid artery intervention is discussed.
Traumatic Brain Injury and Spinal Cord Injury
Authors: Babu Maya A. 
Published: August 2019

Abstract
Traumatic brain injury (TBI) is one of the most common global disorders leading to neurologic morbidity, especially in the young. Spinal cord injury (SCI) can also occur with trauma and lead to paraparesis, tetraparesis, or paralysis with lifelong disability. This chapter reviews TBI and SCI risk factors, the initial approach to management and stabilization, and recent guidelines.
Guillain-Barré Syndrome
Authors: Wijdicks Eelco F. M. 
Published: August 2019

Abstract
The incidence of Guillain-Barré syndrome (GBS) is about 1 case per 100,000 per year, but it is twice that in elderly persons. Multiple antecedent events have been reported. GBS can become a major neurocritical illness. Admission to the intensive care unit is expected in 1 of 5 patients with GBS. Rapidly progressive limb weakness may extend to the oropharyngeal muscles or diaphragm, an effect that often leads to intubation and mechanical ventilation. Outcome in GBS is nearly always good, and severe disability remains in only a minority of affected patients.
Status Epilepticus
Authors: Robinson Christopher P. , Hocker Sara E. 
Published: August 2019

Abstract
Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting longer than 5 minutes or recurrent seizure activity without return to baseline between events. Several classifications exist. The Neurocritical Care Society recommends a simplified classification in which SE is dichotomized as convulsive or nonconvulsive, with nonconvulsive status epilepticus further stratified as focal or generalized.
Demyelinating Disorders of the Central Nervous System
Authors: Smith Aurelia A. , Weinshenker Brian G. 
Published: August 2019

Abstract
Patients with central nervous system (CNS) inflammatory demyelinating disease (IDD) usually have acute relapses of neurologic symptoms that frequently remit spontaneously or after corticosteroid administration; they may also present with a progressive neurodegenerative condition, either de novo or after 1 or more acute relapses. Most patients with acute relapses of demyelinating disease do not have severe disability and can be treated as outpatients. Most hospitalizations for patients with multiple sclerosis (MS), for instance, are for reasons unrelated to MS, such as infection. However, patients with CNS IDD occasionally present with serious, emergent complications caused directly by CNS inflammation or indirectly by secondary complications, either of which can require critical care management.
Autoimmune Encephalitis
Authors: Shosha Eslam , Pittock Sean J. 
Published: August 2019

Abstract
Autoimmune encephalitis is an increasingly recognized, life-threatening disorder that, because of its variable clinical presentations, poses a diagnostic challenge in the intensive care setting. Patients with autoimmune encephalitis often need to be in an intensive care unit for management of life-threatening complications commonly related to multifocal nervous system involvement that includes status epilepticus, cognitive decline and behavioral changes, psychosis, and autonomic instability.
Intensive Care After Spinal Surgery
Authors: Watridge Clarence B. 
Published: August 2019

Abstract
Spinal surgery is a relatively common surgical procedure in the United States. More than 600,000 spinal operations are performed each year, and many are performed as outpatient procedures. Although only a small percentage of spinal surgery patients require intensive care unit (ICU) admission, spinal surgery does carry a risk of death. In addition, the neurologic recovery is often limited by the nature of the condition, and surgical outcomes can be adversely affected postoperatively.
Ultrasonography
Authors: Naranjo-Sierra Santiago , Ng Tucker Lauren K. 
Published: August 2019

Abstract
Ultrasonography is the use of sound waves to create images and is used mainly for diagnostic purposes and for real-time guidance during procedures. Point-of-care ultrasonography is widely used in fields such as anesthesia, critical care, and emergency medicine, in which it is becoming an important part of the current standard of care because of its ability to provide accurate visual information about a patient, either to rapidly evaluate clinical status or to provide guidance for procedures, without requiring transfers to other areas. For patients in an intensive care unit, focused ultrasonography has been reported to result in management changes in more than 50%.
Transesophageal Echocardiography
Authors: Craner Ryan C. , Mookadam Farouk , Ramakrishna Harish 
Published: August 2019

Abstract
The use of ultrasound has revolutionized care in the intensive care unit (ICU). The use of critical care echocardiography, including transthoracic echocardiography (TTE), has become commonplace in ICUs worldwide. In North America, however, intensivists rarely perform transesophageal echocardiography (TEE) unless they have anesthesiology training or have received specialized training to be competent in TEE. In many centers, neurology critical care is provided within the general ICU, and many tertiary-care centers have a dedicated ICU for specialized cases that require advanced and intensive neurologic care.
Diagnostic and Interventional Bronchoscopy in the Intensive Care Unit
Authors: Keller Cesar A. 
Published: August 2019

Abstract
Shigeto Ikeda in Japan developed fiberoptic bronchoscopy (FOB), beginning a revolution in the diagnosis and treatment of diverse pulmonary conditions. FOB evolved with additional diagnostic and interventional tools. FOB has become an essential bedside tool for diagnosis and management in critically ill patients. FOB is safe, even in patients with respiratory failure and, if done cautiously, in patients with increased intracranial pressure.
Electroencephalography
Authors: Crepeau Amy Z. 
Published: August 2019

Abstract
Electroencephalography (EEG) in critically ill patients allows for monitoring of cerebral function when a clinical examination is limited because of altered mental status or coma. Continuous EEG (cEEG) has increasingly been used to monitor critically ill patients in the intensive care unit (ICU). Implementation of cEEG in the ICU presents a unique set of challenges, requiring special expertise and a multidisciplinary approach.
Effects of Targeted Temperature Management on Drugs
Authors: Ng Tucker Lauren K. 
Published: August 2019

Abstract
Hypothermia therapy, better known as targeted temperature management (TTM), has increased in popularity in the past several years and has only proven benefits in the setting of cardiac arrest. It has been unsuccessful or not sufficiently proven in traumatic brain injury,bacterial meningitis, cerebral hemorrhage and ischemic stroke. TTM has been shown to decrease intracranial pressure and is used in the management of refractory intracranial pressure despite recent evidence suggesting harm.
Communicating With Families
Authors: Ingram Cory 
Published: August 2019

Abstract
Professionalism guides how intensivists provide care, and communicating effectively is a core principle of professionalism. Communicating with families is common in intensive care units because patients may be in extremis or unable to understand their critical illness. Interpersonal and communication skills are core competency areas at all levels of medical training and practice. The Accreditation Council for Graduate Medical Education included interpersonal and communication skills as a general competence, and the American Board of Medical Specialties endorsed the same competencies for practicing physicians. Nonetheless, a physician must rely on experience to recommend certain options to patients’ families, guide them toward understanding, and proceed with the best professional choice.
Ethical Concerns and Care Before Organ Donation
Authors: McLaughlin Diane C. , Ng Tucker Lauren K. 
Published: August 2019

Abstract
Organ donation usually proceeds smoothly and compassionately without raising any ethical concerns, and the involved family members are usually very satisfied. When concerns do arise, they typically involve 3 issues: consent for organ donation, critical care of the potential organ donor with brain death, and donation after cardiac death.
Preoperative Optimization of the Chronic Pain Patient
Authors: McAnally Heath B. , Freeman Lynda Welton , Darnall Beth 
Published: August 2019

Abstract
Elective surgery on poorly prepared patients suffering with chronic pain and comorbid substance dependence is increasingly shown to confer suboptimal outcomes—both clinical and economic. Achieving biopsychosocial “fitness for surgery” for these patients often requires a process similar to preoperative optimization of cardiac and other chronic diseases, with modification/elimination of risk factors (in many cases shared with those diseases). These risk factors are not so much genetic or uncontrollable, but rather behavioral, and comprise toxic thoughts and toxic habits. The preoperative optimization program for chronic pain patients presented in this book focuses on high-yield modifiable targets that are supported by the literature and the authors’ clinical experience. These comprise tobacco cessation, preoperative opioid reduction or elimination, slow-wave sleep enhancement, nutritional and exercise “prehabilitation,” and reduction of anxiety and pain catastrophization.
Rationale and Process Overview for Preoperative Optimization of Chronic Pain
Authors: McAnally Heath B. 
Published: August 2019

Abstract
The previous chapter demonstrated that preoperative chronic pain and its many associated comorbidities pose significant risk of suboptimal and adverse outcomes after surgery. Morbidity and economic data clearly indicate room for improvement in the arena of preoperative preparation/optimization of these factors prior to elective surgery. Many have called for a better system of identifying patients at risk and intervening at various stages (preoperative, intraoperative, and postoperative) with multidisciplinary/multimodal approaches in an attempt to mitigate this growing problem. Principles of evidence-based standards of care and wise allocation of resources/fiscal responsibility require that in high-impact and high-prevalence conditions such as chronic pain, benefits clearly outweigh risks and justify the costs. The federal government is increasingly implementing drastic overhaul to the reimbursement system and one of those changes particularly relevant to the perioperative arena is the advent of bundled and capitated payments which further incentivizes quality care with minimization of both postoperative complications and costs involved in preventing and treating them.
The Primacy of Motivation in Preoperative Optimization
Authors: McAnally Heath B. , Darnall Beth 
Published: August 2019

Abstract
Surgical patients with chronic pain frequently neglect basic health behaviors (e.g., maintenance of appropriate diet, sleep hygiene, exercise patterns) while engaging in harmful ones (e.g., tobacco use, alcohol excess, chronic opioid consumption) all of which have been shown to confer poor postoperative outcomes. Effective preoperative optimization of patients suffering with chronic pain requires at least a basic understanding of the complex and heterogeneous motivation behind deliberative (and subconscious) behaviors, and the application of interventions supporting self-determined elimination of toxic cognitive-behavioral patterns and their replacement with healthy ones. This chapter begins with an overview of motivational interviewing and select positive literature reviews addressing the utility of the method in modifying behaviors pertinent to this program. A survey of the development of our understanding of core common elements of human motivation is presented, followed by a biopsychosocial-spiritual framework for considering interpersonal variance; the chapter concludes with a brief consideration of dynamic intrapersonal variables affecting motivation within the individual.
The Pragmatism of Habit in Preoperative Optimization
Authors: McAnally Heath B. , Darnall Beth 
Published: August 2019

Abstract
As stated in the previous chapter’s introduction, effective preoperative optimization of patients suffering with chronic pain depends on behavioral modification. Chronic pain is largely influenced if not mediated by omission of healthy biopsychosocial-spiritual behaviors (e.g., healthy diet, sleep, exercise, and stress management patterns) and commission of unhealthy ones (e.g., pro-inflammatory diet, toxin consumption). This chapter explores the critical role of habit in directing behavior in general and, in particular, health behaviors. It examines what is currently known about the psychology and neurobiology of habit formation and maintenance. It then turns to a brief overview of the application of these concepts to the perioperative optimization of patients with chronic pain.
Sleep Optimization
Authors: Freeman Lyn 
Published: August 2019

Abstract
Sleep deprivation is arguably the single most compromising event that prevents pain patients from changing behavior. To get the sleep-deprived patient to take action to improve their sleep and become more capable of healthy change, healthcare practitioners must approach the patient with the evidence of “what works,” but on his or her own terms, in a language that he or she can understand and cognitively retain, and in a psychological manner that will inspire hope and increase motivation. This chapter endeavors to accomplish the following: (1) review the scope of the problem; (2) clarify the frame of reference of the author; (3) explain how humans function as living rhythm machines; (4) define circadian rhythms, chronobiology, and clock genes; (5) describe the challenges of improving sleep hygiene in a patient population; and (6) identify the methods of change used clinically, including motivational interviewing.
On the triple-star origin of the planetary nebula Sh 2-71
Authors: Jones David , Pejcha Ondřej , Corradi Romano L M 
Published: August 2019

ABSTRACT
Recent studies have indicated that triple-star systems may play a role in the formation of an appreciable number of planetary nebulae, however, only one triple central star is known to date (and that system is likely too wide to have had much influence on the evolution of its component stars). Here, we consider the possibility that Sh 2-71 was formed by a triple system that has since broken apart. We present the discovery of two regions of emission, seemingly aligned with the proposed tertiary orbit (i.e. in line with the axis formed by the two candidate central star systems previously considered in the literature). We also perform a few simple tests of the plausibility of the triple hypothesis based on the observed properties (coordinates, radial velocities, distances, and proper motions) of the stars observed close to the projected centre of the nebula, adding further support through numerical integrations of binary orbits responding to mass loss. Although a number of open questions remain, we conclude that Sh 2-71 is currently one of the best candidates for planetary nebula formation influenced by triple-star interactions.
ESTE ANNUAL IMPACTS—SYSTEM FOR ASSESSMENT OF RADIOLOGICAL IMPACTS OF OPERATIONAL DISCHARGES FROM NUCLEAR FACILITIES
Authors: Lipták Ľudovít , Fojcíková Eva , Krpelanová Monika , Chylý Miroslav , Čarný Peter 
Published: August 2019

Abstract
Described are models and approaches of the software tool ESTE Annual Impacts, a system for analyzes of radiological impacts of operational discharges to the atmosphere and hydrosphere from nuclear facilities. As a result, evaluated are radiological impacts to the population (to representative person and collective doses) and the environment (plants and animals). Described are models applied for calculation of dispersion in the atmosphere and hydrosphere (river, dam, sea). Method of application of sea currents for dispersion calculation in marine environment is also presented. The system is used by operators of the operated and decommissioned nuclear facilities at the site Bohunice (Slovakia), by regulatory authority of the Czech Republic for facilities at the sites Dukovany and Temelín and by operator of the Bushehr Nuclear Power Plant (Iran). In addition, the system is tool for analyses of environmental impacts assessments, applied in environmental impacts assessments process for newly prepared nuclear sources in Slovakia and Czech Republic.