Description & Objectives

Intended Audience

This course is intended for any clinician caring for acutely ill neurological and neurosurgical patients. It will be particularly beneficial to adult hospitalists, nocturnists, pulmonologists, emergency medicine physicians and advanced practice clinicians.

Needs Statement

Hospitalist medicine is a rapidly growing discipline. Hospital-based specialists have emerged in a number of disciplines, including neuroscience. However, there remain a limited number of specialty providers available for 24-hour hospital coverage of neurological and neurosurgical patients. Night and weekend care of these patients is often provided by internists or hospitalists. Hence, there is a need to train internists and hospitalists in the recognition and management of commonly-encountered issues in acute-care neurology and neurosurgery. Specialized clinical neuroscience training allows hospitalists to triage calls and evaluate and manage these patients, ensuring around-the-clock in-house physician coverage. It also augments the ability of hospitalists to co-manage neurological and neurosurgical patients.

Course Objectives

At the conclusion of this symposium, the participant will provide better patient care through an increased ability to:

• Discuss the growth of evidence for neurocritical care, define the main treatment endpoints in Neuro-ICU and outline brain monitoring for brain injured patients
• Outline the various models for Telehealth in the ICU setting and describe advantages and disadvantages of various TeleICU support models
• Describe the importance of ICU throughput and outline the factors that affect ICU throughput
• Review medical management of SAH and outline rationale for the treatment of vasospasm
• Describe surgical approaches to treatment of SAH, including aneurysms and arteriovenous malformations
• Describe the advantages and disadvantages of heparin infusion, discuss blood pressure optimization and review ventriculostomy management in patients undergoing endovascular treatment of SAH
• Review postoperative management of patients undergoing craniotomy and major spine surgery and discuss common complications and their management after craniotomy and major spine surgery
• Review the diagnosis, differential diagnosis and early and late medical management of intracerebral hemorrhage (ICH)
• Avoid common pit-falls in neuroimaging, review perfusion imaging and discuss the limitations of conventional anatomic imaging
• Describe medical complications of neurological and neurosurgical patients; review a checklist for the care of patients in the NCCU; and outline respiratory, diabetic and antihypertensive management
• Identify acute neuromuscular disease, review the basics of treatment and outline the role of the ICU in managing patients with neuromuscular disease
• Review basic protocols and approaches to managing status epilepticus; workup and treat difficult status epilepticus; and discuss ECT, IVIG, Plasmaphoresis, Steroids and other therapies for status management
• Outline treatment options for management of the MCA syndrome and review the criteria for hemi-craniectomy in MCA syndrome
• Outline the decision-making processes especially in the setting of prognostic uncertainty, review the use of time-limited trials and discuss general principles of medical ethics
• Describe the concept of palliative care and specifically how it relates to neurology and neurosurgery patients
• Identify common areas of patient miscommunication; apply effective strategies to prevent miscommunication with patients, families and others on the health-care team; and outline the health-care provider’s role in claims management defense