Mayo Clinic Critical and Neurocritical Care Board Review

2019 ◽  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Nursing Staff ◽  
Mayo Clinic ◽  
Neurocritical Care ◽  
Multidisciplinary Care ◽  
Respiratory Care ◽  
Board Examination ◽  
Specialized Care ◽  
Board Review

Physicians have cared for acutely ill patients throughout history; after the devastating poliomyelitis epidemics of the 1950s, a new specialty emerged. Initially, respiratory care units were created for these severely affected patients, but soon they were transformed into intensive care units (ICUs). Trauma units and transplant units soon followed. Specialized care for patients with acute neurologic and neurosurgical disease occurred in parallel with these developments, but many of the early neuroscience ICUs were redesigned wards for neurosurgical or neurologic patients. Specialized physicians and nursing staff delivered multidisciplinary care, recognizing that no one group could function well alone. It was inevitable that critical care for the sickest patient was the only option to give them a fighting chance to survive. Currently, neurocritical care board examination combines neurocritical care with general intensive care, and questions are equally divided between the two. It is therefore appropriate to combine both areas of expertise in one single volume. The chapters correspond with the key disorders suggested by UCNS to assist in preparation for the examination. As expected, this book is not only detailed in basic pathophysiology but also presents major disorders and syndromes and their management. Because it has unprecedented full coverage of acute neurology, this book is equally useful as a preparation for the critical care medicine board examination.

A quick primer for setting up and maintaining surgical intensive care in an austere environment: Practical tips from volunteers in a mass disaster

2012 ◽  
Vol 7 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Randeep S. Jawa, MD ◽  
Jagtar S. Heir, DO ◽  
David Cancelada, MD ◽  
David H. Young, MD ◽  
David W. Mercer, MD
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Limited Resource ◽  
Respiratory Care ◽  
Mass Disaster ◽  
Support Personnel ◽  
Surgical Intensive Care ◽  
Field Hospital ◽  
Austere Environment ◽  
Relief Efforts

The provision of critical care in any environment is resource intensive. However, the provision of critical care in an austere environment/mass disaster zone is particularly challenging.While providers are well trained for care in a modern intensive care unit, they may be underprepared for resource-poor environments where there are limited or unfamiliar equipment and fewer support personnel. Based primarily on our experiences at a field hospital in Haiti, we created a short guide to critical care in a mass disaster in an austere environment. This guide will be useful to the team of physicians, nurses, respiratory care, logistics, and other support personnel who volunteer in future critical care relief efforts in limited resource settings.

Mayo Clinic Neurology Board Review

2021 ◽  
Keyword(s):  
Mayo Clinic ◽  
High Yield ◽  
Clinical Aspects ◽  
Clinical Neurology ◽  
Certification Examination ◽  
Board Examination ◽  
Current Therapies ◽  
Essential Knowledge ◽  
Board Review ◽  
First Time

Neurology is an exciting and rapidly expanding area of medicine. This new edition of Mayo Clinic Neurology Board Review is designed to assist both physicians-in-training who are preparing for the initial American Board of Psychiatry and Neurology (ABPN) certification examination and neurologists who are preparing for recertification. Trainees and other physicians in related specialties such as psychiatry, neurosurgery, or physiatry may also find this book useful in preparation for their own certification examinations. While erring on the side of thoroughness, Mayo Clinic Neurology Board Review, Second Edition, is not intended to replace an in-depth textbook or serve as a guide to the most current therapies. Instead, this book provides a core of essential knowledge of both basic and clinical aspects of neurology. The emphasis is on clinical knowledge related to diagnostic and therapeutic approaches to patient management. In addition, this text has an expansive array of illustrations, pathology, and radiologic images. There are different needs for those who are taking the initial board examination and for those who are recertifying. The first section covers basic sciences and psychiatry, and the remaining portion covers clinical neurology. It is intended that people taking the board examination for the first time would benefit from reviewing all chapters, whereas those recertifying may wish to mainly focus on the clinical section. Throughout the book, high-yield facts and questions have been included for your review.

scholarly journals Critical care medicine in the French Territories in the Americas: Current situation and prospects

2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Hatem Kallel ◽  
Dabor Resiere ◽  
Stéphanie Houcke ◽  
Didier Hommel ◽  
Jean Marc Pujo ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Road Traffic ◽  
Multidisciplinary Care ◽  
Scientific Cooperation ◽  
Specific Knowledge ◽  
Critical Care Management ◽  
Bed Capacity ◽  
Training Research ◽  
Seriously Ill Patients

Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about population size and intensive care unit (ICU) bed capacity in the FTA and literature on FTA ICU specificities. Persons living in or visiting the FTA are exposed to specific risks, mainly severe road traffic injuries, envenoming, stab or ballistic wounds, and emergent tropical infectious diseases. These diseases may require specific knowledge and critical care management. However, there are not enough ICU beds in the FTA. Indeed, there are 7.2 ICU beds/100 000 population in Guadeloupe, 7.2 in Martinique, and 4.5 in French Guiana. In addition, seriously ill patients in remote areas regularly have to be transferred, most often by helicopter, resulting in a delay in admission to intensive care. The COVID-19 crisis has shown that the health care system in the FTA is unready to face such an epidemic and that intensive care bed capacity must be increased. In conclusion, the critical care sector in the FTA requires upgrading of infrastructure, human resources, and equipment as well as enhancement of multidisciplinary care. Also needed are promotion of training, research, and regional and international medical and scientific cooperation.

scholarly journals Feasibility of Nurse-Led Multidimensional Outcome Assessments in the Neuroscience Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. e1-e8
Author(s):  
Erika Schlichter ◽  
Omar Lopez ◽  
Raymond Scott ◽  
Laura Ngwenya ◽  
Natalie Kreitzer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Neurocritical Care ◽  
Loss To Follow Up ◽  
Outcome Assessments ◽  
Neuroscience Intensive Care Unit

Background The outcome focus for survivors of critical care has shifted from mortality to patient-centered outcomes. Multidimensional outcome assessments performed in critically ill patients typically exclude those with primary neurological injuries. Objective To determine the feasibility of measurements of physical function, cognition, and quality of life in patients requiring neurocritical care. Methods This evaluation of a quality improvement initiative involved all patients admitted to the neuroscience intensive care unit at the University of Cincinnati Medical Center. Interventions Telephone assessments of physical function (Glasgow Outcome Scale-Extended and modified Rankin Scale scores), cognition (modified Telephone Interview for Cognitive Status), and quality of life (5-level EQ-5D) were conducted between 3 and 6 months after admission. Results During the 2-week pilot phase, the authors contacted and completed data entry for all patients admitted to the neuroscience intensive care unit over a 2-week period in approximately 11 hours. During the 18-month implementation phase, the authors followed 1324 patients at a mean (SD) time of 4.4 (0.8) months after admission. Mortality at follow-up was 38.9%; 74.8% of these patients underwent withdrawal of care. The overall loss to follow-up rate was 23.6%. Among all patients contacted, 94% were available by the second attempt to interview them by telephone. Conclusions Obtaining multidimensional outcome assessments by telephone across a diverse population of neurocritically ill patients was feasible and efficient. The sample was similar to those in other cohort studies in the neurocritical care population, and the loss to follow-up rate was comparable with that of the general critical care population.

scholarly journals Nursing Surge Capacity Strategies for Management of Critically Ill Adults with COVID-19

2020 ◽  
Vol 10 (1) ◽  
pp. 23-32
Author(s):  
Abbas Al Mutair ◽  
Anas Amr ◽  
Zainab Ambani ◽  
Khulud Al Salman ◽  
Deborah Schwebius
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Nursing Staff ◽  
Best Practice ◽  
Expert Panel ◽  
Evidence Based ◽  
Surge Capacity ◽  
Starting Point

Background: There is a vital need to develop strategies to improve nursing surge capacity for caring of patients with coronavirus (COVID-19) in critical care settings. COVID-19 has spread rapidly, affecting thousands of patients and hundreds of territories. Hospitals, through anticipation and planning, can serve patients and staff by developing strategies to cope with the complications that a surge of COVID-19 places on the provision of adequate intensive care unit (ICU) nursing staff—both in numbers and in training. Aims: The aim is to provide an evidence-based starting point from which to build expanding staffing models dealing with these additional demands. Design/Method: In order to address and develop nursing surge capacity strategies, a five-member expert panel was formed. Multiple questions directed towards nursing surge capacity strategies were posed by the assembled expert panel. Literature review was conducted through accessing various databases including MEDLINE, CINAHL, Cochrane Central, and EMBASE. All studies were appraised by at least two reviewers independently using the Joanna Briggs Institute JBI Critical Appraisal Tools. Results: The expert panel has issued strategies and recommendation statements. These proposals, supported by evidence-based resources in regard to nursing staff augmentation strategies, have had prior success when implemented during the COVID-19 pandemic. Conclusion: The proposed guidelines are intended to provide a basis for the provision of best practice nursing care during times of diminished intensive care unit (ICU) nursing staff capacity and resources due to a surge in critically ill patients. The recommendations and strategies issued are intended to specifically support critical care nurses incorporating COVID-19 patients. As new knowledge evidence becomes available, updates can be issued and strategies, guidelines and/or policies revised. Relevance to Clinical Practice: Through discussion and condensing research, healthcare professionals can create a starting point from which to synergistically develop strategies to combat crises that a pandemic like COVID-19 produces.

scholarly journals Evaluation of prevention of ventilator-associated infections in four Australian intensive care units

2020 ◽  
Vol 21 (4) ◽  
pp. 147-154
Author(s):  
Natasha Ciampoli ◽  
Stephane Bouchoucha ◽  
Judy Currey ◽  
Ana Hutchinson
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Care Delivery ◽  
Critical Care Nurses ◽  
Respiratory Care ◽  
Chart Audit ◽  
Endotracheal Suctioning ◽  
Standard Precautions ◽  
Mouth Care

Background: Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users. Objectives: To explore critical care nurses’ knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia. Methods: A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice; (2) observation of respiratory care delivery; and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation; and (2) frequency of endotracheal suctioning and mouth care. Results: Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse/patient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed ‘as required’ or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings. Conclusion: Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care.

scholarly journals The Neurointensive Care Nursery and Evolving Roles for Nursing

2016 ◽  
Vol 35 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Susan Peloquin ◽  
Annette Carley ◽  
Sonia L. Bonifacio ◽  
Hannah C. Glass
Keyword(s):  
At Risk ◽  
Critical Care ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Neurocritical Care ◽  
Team Approach ◽  
Pediatric Practice ◽  
Neurologic Status ◽  
Intensive Care Nursery

AbstractNeonatal neurocritical care is an emerging subspecialty that combines the expertise of critical care medicine and neurology with that of nursing and other providers in an interprofessional team approach to care.1,2 Neurocritical care of the neonate has roots in adult and pediatric practice. It has been demonstrated that adults with acute neurologic conditions who are treated in a specialized neurocritical care unit have reduced morbidity and mortality, as well as decreased length of stay, lower costs, and reduced need for neurosurgical procedures. In pediatrics, neurocritical care has focused on various primary and secondary neurologic conditions complicating critical care that also contribute to mortality, morbidity, and duration of hospitalization. However, the concept of neurocritical care as a subspecialty in pediatric practice is still evolving, and evidence demonstrating improved outcomes is lacking.3–5 In the neonatal intensive care nursery, neurocritical care is also evolving as a subspecialty concept to address both supportive and preventive care and optimize neurologic outcomes for an at-risk neonatal patient population. To enhance effectiveness of this care approach, nurses must be prepared to appropriately recognize acute changes in neurologic status, implement protocols that specifically address neurologic conditions, and carefully monitor neurologic status to help prevent secondary injury. The complexity of this team approach to brain-focused care has led to the development of a specialized role: the neurocritical care nurse (neonatal intensive care nursery [NICN] nurse). This article will review key concepts related to neonatal neurocritical care and the essential role of nursing. It will also explore the emerging role of the NICN nurse in supporting early recognition and management of at-risk infants in this neonatal subspecialty practice.

scholarly journals Preparing Neurology Residents and Advanced Practice Providers for the COVID-19 ICU—A Neurocritical Care Led Intervention

2021 ◽  
pp. 194187442110162
Author(s):  
Judy H. Ch’ang ◽  
Jenna Ford ◽  
Laura Cifrese ◽  
Elliott Woodward ◽  
Jennifer Mears ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Knowledge Base ◽  
Care Management ◽  
Neurocritical Care ◽  
Advanced Practice ◽  
Lecture Series ◽  
Critical Care Management ◽  
Care Training ◽  
Video Based Learning

Background and Purpose: With the surge of critically ill COVID-19 patients, neurology and neurosurgery residents and advanced practice providers (APPs) were deployed to intensive care units (ICU). These providers lacked relevant critical care training. We investigated whether a focused video-based learning curriculum could effectively teach high priority intensive care topics in this unprecedented setting to these neurology providers. Methods: Neurocritical care clinicians led a multidisciplinary team in developing a 2.5-hour lecture series covering the critical care management of COVID-19 patients. We examined whether provider confidence, stress, and knowledge base improved after viewing the lectures. Results: A total of 88 residents and APPs participated across 2 academic institutions. 64 participants (73%) had not spent time as an ICU provider. After viewing the lecture series, the proportion of providers who felt moderately, quite, or extremely confident increased from 11% to 72% (60% difference, 95% CI 49-72%) and the proportion of providers who felt nervous/stressed, very nervous/stressed, or extremely nervous/stressed decreased from 78% to 48% (38% difference, 95% CI 26-49%). Scores on knowledge base questions increased an average of 2.5 out of 12 points (SD 2.1; p < 0.001). Conclusion: A targeted, asynchronous curriculum on critical care COVID-19 management led to significantly increased confidence, decreased stress, and improved knowledge among resident trainees and APPs. This curriculum could serve as an effective didactic resource for neurology providers preparing for the COVID-19 ICU.

Framework for Biosignal Interpretation in Intensive Care and Anesthesia

1997 ◽  
Vol 36 (04/05) ◽  
pp. 340-344 ◽  
Author(s):  
I. Korhonen ◽  
M. van Gils ◽  
A. Kari ◽  
N. Saranummi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Data Management ◽  
Clinical Evaluation ◽  
Patient Monitoring ◽  
Research Community ◽  
Clinical Routine ◽  
The Poor ◽  
Outcomes Of Care

Abstract:Improved monitoring improves outcomes of care. As critical care is “critical”, everything that can be done to detect and prevent complications as early as possible benefits the patients. In spite of major efforts by the research community to develop and apply sophisticated biosignal interpretation methods (BSI), the uptake of the results by industry has been poor. Consequently, the BSI methods used in clinical routine are fairly simple. This paper postulates that the main reason for the poor uptake is the insufficient bridging between the actors (i.e., clinicians, industry and research). This makes it difficult for the BSI developers to understand what can be implemented into commercial systems and what will be accepted by clinicians as routine tools. A framework is suggested that enables improved interaction and cooperation between the actors. This framework is based on the emerging commercial patient monitoring and data management platforms which can be shared and utilized by all concerned, from research to development and finally to clinical evaluation.

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