Most Important Teaching Points (Take-Home Points) for New Team Members | Unique Characteristics of the Neuro-ICU Environment (Not Ideal Tasks for New Team Members) | Generic Aspects of the Neuro-ICU Environment That Are Similar to Those in Other Medical Areas (Appropriate Initial Tasks for New Team Members) |
---|---|---|
Key components of neuromonitoring (vital signs, neurologic vital signs: pupils, Glasgow Coma Scale, intracranial pressure, NIHSS score, and so forth) | Resuscitation of unstable patient on initial presentation or with complications (eg, procedures surrounding airway management, status epilepticus treatment, intracranial pressure/herniation treatment, shock management, and so forth) | Monitoring vital parameters, level of consciousness, and respiratory parameters of nonintubated patients |
Recognizing potential life-threatening complications | Monitoring patients on invasive or noninvasive positive pressure ventilation | Management of enteral feeds and IV fluids |
Location of key equipment (code cart, difficult airway cart) and medications | Care and use of arterial and central lines, administration of vasopressors | Basic medication administration (may include managing alteplase/tenecteplase infusions, depending on background) |
Team members and rolesChain of help, contact information (pager/phone)Examples: ICU buddy team member (RN, RT, pharmacist, and so forth), charge nurse, NCC/stroke fellow, NCC/stroke attending physician on call | Use and interpretation of multimodal neuromonitoring:Intracranial pressure monitors (external ventricular drain)Cerebral oxygenation monitors: continuous brain tissue oxygenation, near-infrared spectroscopy, jugular venous catheterCerebral blood flow monitorsCerebral microdialysisContinuous electroencephalography | Placement and care of nasogastric/orogastric tube, IV line, Foley catheter, and so forth |
Key elements of AIS/ICH/SAH management (see also Table 4), basic and advanced life support | Brain death assessments and management | Bathing, turning, mobilizing patients |
Organ donation: donation after circulatory death or donation after neurologic death | Charting/documentation of patient course | |
Palliation, depending on circumstances; for patients with COVID-19, institutions may have unique policies for automatic do-not-resuscitate orders or care limitations that incorporate neurologic prognosis formation |
Note:—RN indicates registered nurse; RT, respiratory therapist; NCC, neurocritical care; AIS, acute ischemic stroke; ICH, intracerebral hemorrhage.
↵a For specific Neuro-ICU take-home points for the management of patients with acute ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage, see On-line Table.