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Content Update

July 07, 2023

Drug shortages and alternative therapy considerations in the critical care population: Medication shortages have been steadily rising over the past decade. With over 200 medications in short supply, patient care is often compromised. Providers are left to select non-preferred therapies, more costly agents, or less efficacious alternatives. The direct long-term impacts medication shortages have on patient care are unclear; however, immediate consequences can contribute to deviations from standards of care and lead to negative outcomes. Health systems often seek strategies, such as forming a shortage team, using an alerting function in electronic health records upon order entry, and creating medication use criteria, in efforts to slow the impacts of short medication supplies. Strategies that may be used in specific situations are outlined in this update.

Content Update

September 22, 2022

Supportive care for critically ill patients with COVID-19: Critically ill patients with acute respiratory distress syndrome secondary to COVID-19 have few proven therapies that improve patient morbidity and mortality. Of those, dexamethasone demonstrated improved survival in moderate to severely ill patients with COVID-19 with the greatest benefit in patients requiring mechanical ventilation. Other supportive care strategies include use of insulin for the treatment of hyperglycemia, heparin or low molecular weight heparin for venous thromboembolism prophylaxis, and routine sedation monitoring and vigilance to reduce delirium and long-term neuromuscular blockade adverse effects.



Upon completion of the chapter, the reader will be able to:

  1. Understand the function and role of an intensive care unit (ICU).

  2. List the healthcare members that comprise a critical care or intensive care unit team.

  3. Differentiate components that comprise an intensive care unit not seen on general floor.

  4. Identify key areas in which critical care healthcare providers have impact in patient care.

  5. Explain the differences in types of vascular access utilized in critically ill patients for administration of fluids and medications.

  6. Formulate a recommendation for nutrition as well as subsequent glycemic control management in the ICU.

  7. Discuss indications for neuromuscular blockade in the critically ill patients.

  8. Contrast mechanical ventilation modes and parameters of invasive mechanical ventilation.

  9. Identify risk factors and prevention strategies for stress ulcers.

  10. Design a pain management plan for the critically ill patients.


image The intensive care unit (ICU) is a designated place within an institution that is highly specialized and sophisticated, dedicated to managing critically ill patients with potentially recoverable diseases who would benefit from close observation and treatment. There are various types of ICUs including those dedicated to the management of patients with, but not limited to, medical, surgical, traumatic, pediatric, cardiac, or neurological conditions. Typically, the ICU is staffed and equipped for the highest level of acuity possible, given the illness of patients, with designated teams trained in critical care medicine.


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