Irwin & Rippe’s Ultrasonography for Management of the Critically Ill

 

Description:

Enhancing and adding to ultrasonographic text and video content in Irwin & Rippe’s Intensive Care Medicine, Eighth Edition, this easy-to-follow volume provides expert guidance on the optimal use of ultrasound in the critical care environment. Irwin & Rippe’s Ultrasonography for  Management of the Critically Ill covers a wide variety of critical care procedures, explaining how to perform them and how ultrasound can be used to support evaluation and management services to patients with life-threatening illnesses or injuries. 

 

Table of Contents:

 

SECTION 1 Introduction to Ultrasonography

1 Point-of-Care for Critical Care Ultrasonography

COMPETENCE

Machine Requirements

Machine Controls and Scanning Technique

Scope of Practice

Limitations of Critical Care Ultrasonography

CONCLUSIONS

REFERENCES

SECTION 2 Neurological Procedures

2 Neurologic Multimodal Monitoring

GOALS OF BRAIN MONITORING

CEREBRAL ISCHEMIA AND BLOOD FLOW

TECHNIQUES OF NEUROLOGIC MONITORING

Neurologic Examination

Systemic Monitoring

Electroencephalography/Electrocorticography

Evoked Potentials

Intracranial Pressure Monitoring

Cerebral Blood Flow Monitoring

Transcranial Doppler Ultrasound

Jugular Venous Bulb Oxygen Saturation

Brain Tissue Oxygen Tension

Neurochemical Monitoring

Near-Infrared Spectroscopy

Neuroimaging

MULTIMODAL MONITORING STRATEGIES

REFERENCES

3 Cerebrospinal Fluid Aspiration

INTRODUCTION

CEREBROSPINAL FLUID ACCESS

Diagnostic Objectives

Therapeutic Interventions

TECHNIQUES OF CEREBROSPINAL FLUID ACCESS

Lumbar Puncture

Utility of Ultrasonography for Performance of Lumbar Puncture

TECHNIQUE FOR ULTRASONOGRAPHIC GUIDANCE OF LUMBAR PUNCTURE

Patient Positioning

Transducer Selection and Indicator Positioning

Localization of the Target Lumbar Interspace for Lumbar Puncture

Summary

Lateral Cervical (C1-C2) Puncture

Cisternal Puncture

Aspiration of Reservoirs and Shunts

VENTRICULOSTOMY

Lumbar Drainage

Summary

REFERENCES

SECTION 3 Airway and Respiratory Procedures

4 Airway Management and Endotracheal Intubation

INTRODUCTION

ANATOMY

Nose

Mouth and Jaw

Nasopharynx

Oropharynx

Hypopharynx

Larynx

Trachea

EMERGENCY AIRWAY MANAGEMENT

Airway Obstruction

Use of Face Mask and Bag Valve Device

Airway Adjuncts

INDICATIONS FOR INTUBATION

Preintubation Evaluation

Education and Intubation Management

EQUIPMENT FOR INTUBATION

Laryngoscopes

Endotracheal Tubes

Endotracheal Tube Cuff

ANESTHESIA BEFORE INTUBATION

TECHNIQUES OF INTUBATION

Specific Techniques and Routes of Endotracheal Intubation

Management of the Difficult Airway

Airway Management in the Intubated Patient

COMPLICATIONS OF ENDOTRACHEAL INTUBATION

Complications During Intubation

Complications While the Tube Is in Place

Complications After Extubation

EXTUBATION

UTILITY OF ULTRASONOGRAPHY FOR AIRWAY MANAGEMENT

Identification of Gastric Fluid

Identification of Endotracheal Tube Position

REFERENCES

5 Tracheostomy

INTRODUCTION

INDICATIONS

CONTRAINDICATIONS

TIMING OF TRACHEOSTOMY

PROCEDURES

Emergency Tracheostomy

Cricothyrotomy

TRACHEOSTOMY PROCEDURES IN THE INTENSIVE CARE UNIT

Open Surgical Tracheostomy

Percutaneous Dilational Techniques

TUBES AND CANNULAS

POSTOPERATIVE CARE

Wound and Dressing Care

Inner Cannulas

Humidification

Suctioning

Tracheostomy Tube Changes

Oral Feeding and Swallowing Dysfunction Associated with Tracheostomies

Discharging Patients With Tracheotomies From the ICU to the General Ward

COMPLICATIONS

Obstruction

Tube Displacement/Dislodgment

Subcutaneous Emphysema

Pneumothorax and Pneumomediastinum

Hemorrhage

Tracheoinnominate Artery Fistula

Misplacement of Tube

Tracheal Cartilage Fracture

Stomal Infections

Tracheoesophageal Fistula

Tracheal Stenosis

Tracheomalacia

Dysphagia and Aspiration

Persistent Tracheocutaneous Fistula

CONCLUSIONS

REFERENCES

6 Lung Ultrasonography

BASIC PRINCIPLES OF LUS

MACHINE REQUIREMENTS

PERFORMANCE OF LUS

IMAGING PATTERNS IN LUS

Main LUS Patterns

CLINICAL APPLICATIONS OF LUS

Clarification of the Ambiguous Chest Radiograph

Differentiation of ARDS from Cardiogenic Pulmonary Edema

Prediction of Extubation Failure

Measurement of Lung Recruitment with PEEP

Diagnosis of Pneumonia

Algorithmic Diagnosis of Respiratory Failure

Estimates of Left Atrial Pressure

Combination of LUS with Echocardiography

Diagnosis of Pulmonary Embolism

Timing of Chest Tube Removal

LUS for Guidance of Procedures

Utility of LUS for Airway Management

SUMMARY

REFERENCES

7 Thoracentesis

INTRODUCTION

INDICATIONS

CONTRAINDICATIONS

COMPLICATIONS

THORACENTESIS PROCEDURE

Steps in the Procedure

TECHNIQUE FOR REMOVAL OF AIR FROM A PTX SPACE

Steps in the Procedure

UTILITY OF ULTRASONOGRAPHY FOR GUIDANCE OF THORACENTESIS

Equipment

Scanning Technique

Interpretation of Pleural Fluid Analysis

TRANSUDATES VERSUS EXUDATES

SELECTED TESTS THAT ARE POTENTIALLY HELPFUL TO ESTABLISH ETIOLOGY FOR A PLEURAL EFFUSION

pH

Glucose

Protein, Lactate Dehydrogenase, and Protein Gradient

Amylase

Triglyceride and Cholesterol

Adenosine Deaminase

Cell Counts and Differential

Cultures, Polymerase Chain Reaction, and Stains

Cytologic Evaluation

REFERENCES

8 Chest Tube Insertion and Care

PLEURAL ANATOMY AND PHYSIOLOGY

CHEST TUBE PLACEMENT

Indications

CONTRAINDICATIONS

TECHNIQUE

COMPLICATIONS

CHEST TUBE MANAGEMENT AND CARE

CHEST TUBE REMOVAL

RELATED SYSTEMS

Utility of Ultrasonography for Chest Tube Insertion and Care

Pneumothorax

SUMMARY

REFERENCES

9 Discontinuation of Mechanical Ventilation

INTRODUCTION

UNDERSTANDING THE PROBLEM

Who Are the Patients and What Are Their Outcomes?

What Is Wrong with Patients on Prolonged Ventilator Support?

What Factors Lead to Respiratory Muscle Fatigue and Weakness?

PREDICTING SUCCESSFUL DISCONTINUATION

When Is It Appropriate to Begin the Discontinuation Process?

Predictive Indices for Total Discontinuation of Mechanical Ventilation (Weaning Indices)

When Is It Appropriate to Extubate the Patient?

How Long Should Discontinuation Trials Last?

MANAGING DISCONTINUATION FAILURE

Protocol-Based Weaning

Once-Daily Attempts at Liberation from Mechanical Ventilation

Addressing Factors That Perpetuate Respiratory Muscle Fatigue

Utility of Ultrasonography for Assessment of Diaphragmatic Function for Discontinuation of Mechanical Ventilation

Clinical Applications of Ultrasonography Assessment of Diaphragmatic Function

REFERENCES

SECTION 4 Cardiac Procedures

10 Echocardiography for the Evaluation of Shock and Cardiac Arrest

EFFICACY

EXPERIMENTAL AND ALTERNATIVE TECHNIQUES OF CARDIOPULMONARY RESUSCITATION

INFECTIOUS DISEASES AND CARDIOPULMONARY RESUSCITATION

Implications for Rescuers With Known or Potential Infection

STANDARD PROCEDURES AND TEAM EFFORT

BASIC LIFE SUPPORT FOR ADULTS WITH AN UNOBSTRUCTED AIRWAY

Respiratory Arrest

Cardiac Arrest

Assessment and Determination of Unresponsiveness and Alerting of Emergency Medical Services

Opening the Airway and Determining Breathlessness

Rescue Breathing

Chest Compressions

Two-Rescuer Cardiopulmonary Resuscitation

Complications of Basic Life Support Procedures

Monitoring the Effectiveness of Basic Life Support

PEDIATRIC RESUSCITATION

OBSTRUCTED AIRWAY

ADVANCED CARDIAC LIFE SUPPORT IN ADULTS

Airway and Ventilatory Support

Circulatory Support

Advanced Cardiac Life Support: Defibrillation and Rhythm-Based Therapies

Defibrillation

Ventricular Fibrillation and Pulseless VT

Pulseless Electric Activity and Asystole

Correction of Hypoxia

Correction of Excessive Hydrogen Ion (Acidosis)

Hypovolemia

Venous Access

DRUG THERAPY

Sympathomimetic Drugs and Vasopressors

Antiarrhythmic Agents

Lidocaine

Other Agents

CLINICAL SETTINGS

Special Situations

Termination of ACLS and Post-ACLS Care

UTILITY OF ULTRASONOGRAPHY FOR CARDIOPULMONARY RESUSCITATION

CONCLUSIONS

REFERENCES

11 Critical Care Echocardiography

BASIC CRITICAL CARE ECHOCARDIOGRAPHY

Equipment Requirements

Technical Challenges

Training in Basic Critical Care Echocardiography

The Basic Critical Echocardiography Examination

Clinical Applications of Goal-Directed Echocardiography

Limitations of Basic Critical Care Echocardiography

ADVANCED CRITICAL CARE ECHOCARDIOGRAPHY

Training Requirements

Transesophageal Echocardiography

Limitations of Advanced Critical Care Echocardiography

REFERENCES

12 Resuscitation From Shock Following Hemorrhage

PHYSIOLOGIC RESPONSES TO HEMORRHAGE

Coagulopathy

Hemodynamics

Metabolic

Immunologic

SHOCK RECOGNITION

Utility of Ultrasonography for Diagnosis of Hemorrhagic Shock

HEMORRHAGE CONTROL

HISTORY OF HEMORRHAGIC SHOCK RESUSCITATION

INITIAL RESUSCITATION

ONGOING RESUSCITATION

Endpoints of Resuscitation

Coagulation Endpoints

Monitoring

Fluids and Component Therapy

Vasopressor and Inotropic Support

Additional Therapies

SUMMARY

REFERENCES

13 Mechanical Complications of Myocardial Infarction

CONSEQUENCES OF ISCHEMIA

DIAGNOSIS, TREATMENT, AND OUTCOME OF SHOCK DUE TO LEFT VENTRICULAR PUMP FAILURE

RIGHT VENTRICULAR INFARCTION

MYOCARDIAL RUPTURE

Papillary Muscle Rupture

Ventricular Septal Rupture

Free Wall Rupture

LEFT VENTRICULAR REMODELING

UTILITY OF ULTRASONOGRAPHY FOR DIAGNOSIS OF MECHANICAL COMPLICATIONS OF MYOCARDIAL INFARCTION

Papillary Muscle Rupture

Ventricular Wall Rupture

Free Wall Rupture

REFERENCES

14 Pericardiocentesis

INTRODUCTION

INDICATIONS FOR PERICARDIOCENTESIS

ANATOMY

PROCEDURE

SHORT-TERM AND LONG-TERM MANAGEMENT

Utility of Ultrasonography for Management of Pericardial Effusion

SUMMARY

REFERENCES

15 Temporary Cardiac Pacing

INTRODUCTION

INDICATIONS FOR TEMPORARY CARDIAC PACING

Bradyarrhythmias

Tachyarrhythmias

DIAGNOSIS OF RAPID RHYTHMS

ACUTE MYOCARDIAL INFARCTION

EQUIPMENT AVAILABLE FOR TEMPORARY PACING

Transvenous Pacing Catheters

Utility of Ultrasonography for Transvenous Pacemaker Insertion

Esophageal Electrode

Transcutaneous External Pacemakers

Epicardial Pacing

Pulse Generators for Temporary Pacing

CHOICE OF PACING MODE

PROCEDURE TO ESTABLISH TEMPORARY PACING

COMPLICATIONS OF TEMPORARY PACING

REFERENCES

16 Pulmonary Artery Catheters

INTRODUCTION

PHYSIOLOGIC RATIONALE FOR USE OF PULMONARY ARTERY CATHETER

CONTROVERSIES REGARDING USE OF PULMONARY ARTERY CATHETER

INDICATIONS FOR USE OF PULMONARY ARTERY CATHETER

CATHETER FEATURES AND CONSTRUCTION

Pressure Transducers

INSERTION TECHNIQUES

General Considerations

Typical Catheter Insertion Procedure

Special Considerations

Utility of Ultrasonography for Pulmonary Artery Catheter Insertion

PHYSIOLOGIC DATA

Pressures

Cardiac Output

Derived Parameters

CLINICAL APPLICATIONS OF THE PULMONARY ARTERY CATHETER

Normal Resting Hemodynamic Profile

COMPLICATIONS

Complications Associated with Central Venous Access

Balloon Rupture

Knotting

Pulmonary Infarction

Pulmonary Artery Perforation

Thromboembolic Complications

Rhythm Disturbances

Intracardiac Damage

Infections

Other Complications

GUIDELINES FOR SAFE USE OF PULMONARY ARTERY CATHETERS

SUMMARY

REFERENCES

17 Management of Implantable Pacemakers, Defibrillators, and Cardiac Resynchronization Devices and Cardiac Devices in the ICU

INTRODUCTION

GENERAL DEVICE MANAGEMENT

Normal Device Function and Special Considerations

Pacemaker Malfunction

DEVICE-SPECIFIC CONSIDERATIONS

Implantable Cardioverter Defibrillators

Cardiac Resynchronization Therapy (Biventricular Pacing)

SUMMARY

REFERENCES

SECTION 5 Vascular and Hematological Procedures

18 Arterial Line Placement and Care

INTRODUCTION

INDICATIONS FOR ARTERIAL CANNULATION

EQUIPMENT, MONITORING, TECHNIQUES, AND SOURCES OF ERROR

TECHNIQUE OF ARTERIAL CANNULATION

Site Selection

Radial Artery Cannulation

Evaluation of Collateral Circulation of the Hand

Percutaneous Insertion

Dorsalis Pedis Artery Cannulation

Brachial Artery Cannulation

Femoral Artery Cannulation

Axillary Artery Cannulation

Utility of Ultrasonography for Arterial Catheterization

COMPLICATIONS OF ARTERIAL CANNULATION

Thrombosis

Cerebral Embolization

Diagnostic Blood Loss

Other Mechanical and Technical Complications

Infections

RECOMMENDATIONS

REFERENCES

19 Central Venous Catheters

INTRODUCTION

INDICATIONS AND SITE SELECTION

GENERAL CONSIDERATIONS

Informed Consent

Patient Comfort and Safety

Mobile Catheter Cart

Catheter Tip Location

Vascular Erosions

Complications

ROUTES OF CENTRAL VENOUS CANNULATION

Antecubital Approach

Internal Jugular Approach

External Jugular Vein Approach

Femoral Vein Approach

Subclavian Vein Approach

REFERENCES

20 Venous Thromboembolism and Associated Prothrombotic Disorders in the Intensive Care Unit

INCIDENCE

RISK FACTORS

Inherited Hypercoagulable Disorders

Acquired Hypercoagulable Disorders

Diagnostic Approach to Hypercoagulable Conditions

PATHOPHYSIOLOGY

PREVENTION

DIAGNOSIS

Symptoms and Signs

Clinical Prediction Models

D-Dimer

Diagnosis of Acute Deep Venous Thrombosis

Diagnosis of Acute Pulmonary Embolism

An Integrated Approach to Venous Thromboembolism Diagnosis

Risk Stratification

TREATMENT

Anticoagulation

Thrombolytic Therapy

Inferior Vena Cava Interruption

Pulmonary Embolectomy

Adjunctive Care for Massive Pulmonary Embolism

SPECIAL THERAPEUTIC CONSIDERATIONS

Central Venous Catheter–Associated Thrombosis

Pregnancy-Associated VTE

SEQUELAE OF VENOUS THROMBOEMBOLISM

Duration of Anticoagulation

Complications of Anticoagulation

Utility of Ultrasonography for Evaluation of Venous Thromboembolism

ACKNOWLEDGMENT

REFERENCES

21 Therapeutic Apheresis: Technical Considerations and Indications in Critical Care

TECHNICAL RATIONALE AND INSTRUMENTS

PHYSIOLOGIC PRINCIPLES

VASCULAR ACCESS FOR THERAPEUTIC APHERESIS

ANTICOAGULATION AND FLUID REPLACEMENT

VASCULAR ACCESS

LIMITATIONS AND POTENTIAL ADVERSE EVENTS

INDICATIONS IN CRITICAL CARE

Therapeutic Plasma Exchange

Red Blood Cell Exchange

Leukapheresis

Plateletpheresis

APHERESIS CONSULTATION

REFERENCES

SECTION 6 Gastrointestinal and Abdominal Procedures

22 Endoscopic Placement of Feeding Tubes

INDICATIONS FOR ENTERAL FEEDING

ACCESS TO THE GASTROINTESTINAL TRACT

TECHNIQUES

Nasoenteric Route

Percutaneous Route

Fluoroscopic Technique

Complications

SURGICAL PROCEDURES

Gastrostomy

Needle-Catheter Jejunostomy

Transgastric Jejunostomy

DELIVERING THE TUBE-FEEDING FORMULA

MEDICATIONS

COMPLICATIONS

Nasopulmonary Intubation

Aspiration

Gastrointestinal Intolerance

Metabolic Complications

Bacterial Contamination

Occluded Feeding Tubes

Utility of Ultrasonography for Feeding Tube Insertion

REFERENCES

23 Gastrointestinal Endoscopy

PATIENT SELECTION

Evaluation of the Upper Gastrointestinal Tract

Evaluation of the Pancreaticobiliary Tract

Evaluation of the Mid-gastrointestinal Tract (Jejunum and Ileum)

Evaluation of the Lower Gastrointestinal Tract

PREPROCEDURAL CARE

INTRAPROCEDURAL CARE

Upper Gastrointestinal Endoscopy

PANCREATICOBILIARY ENDOSCOPY

Lower Gastrointestinal Endoscopy

POSTPROCEDURAL CARE

FUTURE DIRECTIONS

REFERENCES

24 Gastroesophageal Balloon Tamponade for Acute Variceal Hemorrhage

HISTORICAL DEVELOPMENT

ROLE OF BALLOON TAMPONADE FOR THE MANAGEMENT OF BLEEDING ESOPHAGEAL VARICES

INDICATIONS AND CONTRAINDICATIONS

TECHNICAL AND PRACTICAL CONSIDERATIONS

Airway Control

Hypovolemia, Shock, and Coagulopathy

Clots and Gastric Decompression

Infection, Ulceration, and Encephalopathy

Balloons, Ports, and Preparation

Insertion and Placement of the Tube

Ultrasonography for Tube Insertion

Fixation and Traction Techniques

Maintenance, Monitoring, and Care

Removal of the Tube

COMPLICATIONS

REFERENCES

25 Paracentesis and Diagnostic Peritoneal Lavage

ABDOMINAL PARACENTESIS

Indications

Techniques

Needle Technique

Catheter Technique

Complications

DIAGNOSTIC PERITONEAL LAVAGE

Indications

Techniques

Interpretation of Results

Complications

REFERENCES

26 Ultrasound-Guided Procedures in the ICU

ULTRASOUND GUIDANCE FOR PERCUTANEOUS TRACHEOSTOMY

Technique for Use of Ultrasound for Percutaneous Dilatational Tracheostomy

Real-Time Ultrasound Guidance—Evidence and Technique

SUPERFICIAL LYMPH NODE BIOPSY

CHEST WALL AND PLEURAL-BASED MASS BIOPSY

Technical Considerations

CONSIDERATION OF PERCUTANEOUS DRAINAGE OF LUNG ABSCESSES

EVOLVING USES OF ULTRASOUND FOR CRITICALLY ILL PATIENTS

Real-Time Guidance of Thoracentesis and Chest Tube Placement

Transthoracic Ultrasound-Guided Transbronchial Lung Biopsy in the ICU

CONCLUSIONS

REFERENCES

SECTION 7 Genitourinary Procedures

27 Renal Replacement Therapy in the ICU

INTRODUCTION

PRINCIPLES OF SOLUTE CLEARANCE AND FLUID REMOVAL BY DIALYTIC TECHNIQUES

OVERVIEW OF DIALYSIS MODALITIES

Intermittent Hemodialysis

Peritoneal Dialysis

Continuous Renal Replacement Therapies

Continuous Arteriovenous Hemofiltration, Hemodialysis, and Hemodiafiltration

Continuous Venovenous Hemofiltration, Hemodialysis, and Hemodiafiltration

Slow Continuous Ultrafiltration

TECHNICAL CONSIDERATIONS FOR RENAL REPLACEMENT THERAPY

Anticoagulation

Blood and Dialysate Flow Rates

Dialyzer Membrane

Dialysate Composition

Dialysis Access

Arteriovenous Fistula and Graft

Peritoneal Dialysis Catheters

HEMODIALYSIS CATHETERS AND INSERTION TECHNIQUES

Temporary Hemodialysis Catheter Placement

INDICATIONS FOR AND TIMING OF INITIATION OF RENAL REPLACEMENT THERAPY

Early Versus Late Initiation of RRT

Dialysis Dose

MODALITY SELECTION

IHD Versus CRRT

Recommendations

Discontinuation of Therapy

COMPLICATIONS OF RRT

Infection

Electrolyte and Acid-Base Disorders

Access Thrombosis

Hypotension

REFERENCES

28 Ultrasonography for the Evaluation of the Urinary System

EQUIPMENT

SCANNING TECHNIQUE FOR THE KIDNEY

ULTRASONOGRAPHIC ANATOMY OF THE KIDNEY

SCANNING TECHNIQUES FOR IMAGING THE BLADDER

CLINICAL APPLICATION OF ULTRASONOGRAPHY OF THE URINARY SYSTEM

LIMITATIONS OF ULTRASONOGRAPHY FOR EVALUATION OF AKI

REFERENCES

SECTION 8 Peripheral Procedures

29 Aspiration of the Knee and Synovial Fluid Analysis

INTRODUCTION

INDICATIONS

CONTRAINDICATIONS

COMPLICATIONS

TECHNIQUE

UTILITY OF ULTRASONOGRAPHY FOR KNEE JOINT ASPIRATION

Identification of Knee Joint Effusion

Guidance of Knee Aspiration

SYNOVIAL FLUID ANALYSIS

GROSS EXAMINATION

Color

Clarity

Viscosity

CELL COUNT AND DIFFERENTIAL

CRYSTALS

GRAM STAIN AND CULTURE

REFERENCES

SECTION 9 Patient Comfort During Procedures

30 Anesthesia for Bedside Procedures

INTRODUCTION

COMMON PAIN MANAGEMENT PROBLEMS IN ICU PATIENTS

Dosing of Agents

Selection of Agents

CHARACTERISTICS OF SPECIFIC AGENTS USED FOR BEDSIDE PROCEDURES

Hypnotics

Opioids

NEUROMUSCULAR BLOCKING AGENTS

PRACTICAL CONSIDERATIONS FOR TIVA

REFERENCES

31 Therapeutic Paralysis

PHARMACOLOGY OF NEUROMUSCULAR BLOCKING AGENTS

THE NICOTINIC ACETYLCHOLINE RECEPTOR

DEPOLARIZING NEUROMUSCULAR BLOCKERS

NONDEPOLARIZING NMBAS

Atracurium

Cisatracurium

Rocuronium

Vecuronium

Pancuronium

Doxacurium

Pipecuronium

THERAPEUTIC PARALYSIS

DRUG INTERACTIONS

MONITORING OF NMBAS

ADVERSE EFFECTS OF DEPOLARIZING AND NONDEPOLARIZING NMBAS IN CRITICALLY ILL PATIENTS

INTENSIVE CARE UNIT–ACQUIRED WEAKNESS

Critical Illness Polyneuropathy

Critical Illness Myopathy

SUMMARY AND RECOMMENDATIONS

REFERENCES

Index

 

An aparitie	12 Nov. 2020
Autor	Craig M. Lilly MD, Paul H. Mayo, Seth J. Koenig, Richard S. Irwin MD
Dimensiuni	17.53 x 1.52 x 25.15 cm
Editura	LWW
Format	Paperback
ISBN	9781975144951
Limba	Engleza
Nr pag	480