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Neurocritical Care

Introduction and Goals

The field of neurointensive care is developing rapidly, and it’s important for all neurologists to have some familiarity with the contemporary diagnosis and management of critically ill patients with neurological and neurosurgical disease. This elective rotation complements the required neurosurgery experience, focusing on the ICU management of patients presenting with acute neurological illnesses such as traumatic brain injury, subarachnoid hemorrhage, malignant brain infarction, status epilepticus, and neuromuscular ventilatory failure.

Objectives and Evaluation Matrix

As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).

Schedule

The Neurocritical Care rotation is an inpatient elective involving primary management of patients admitted to the Neurocritical Care service as well as consultations on patients in the Neuro ICU and other clinical environments. The resident will work on a team consisting of a Neurocritical Care attending as well as other learners that may include some combination Neurology interns, Neurosurgery residents, medical students, and/or off-service fellows.

The specific daily schedule will depend on the service and the attending, and should be discussed in advance with the attending on service before the first day of the rotation. Residents will have their usual continuity clinics during this rotation, and will need to ensure appropriate handoff of any outstanding patient care obligations to the Neurocritical Care attending or to another team member during the continuity clinic afternoon.

Residents are also expected to attend Monday afternoon Neurosurgery case conferences at 3:00 and 4:00 pm when scheduled, as well as the Morbidity & Mortality conference at 7:00 am on Wednesday. Residents are encouraged to stay for Neurosurgery Grand Rounds that follow.

Work Hours

The estimated average number of work hours per week is 50. There are no call responsibilities required during these rotations.

It is the responsibility of each resident to communicate with the supervisory attending regarding work hours. In the event that any of the ACGME work hours regulations are in jeopardy of being violated, the supervisory attending physician must be notified immediately. It will be that attending’s responsibility to rectify the situation immediately by appropriate means.

Suggested References

Wijdicks, E. F. M., & Wijdicks, E. F. M. (2010). The practice of emergency and critical care neurology. New York: Oxford University Press.
 
Latest revision: 07-03-2019