Table 3:

Take-home points for new staff and unique-versus-generic aspects of stroke care in the Neuro-ICUa

Most Important Teaching Points (Take-Home Points) for New Team MembersUnique 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 complicationsMonitoring patients on invasive or noninvasive positive pressure ventilationManagement of enteral feeds and IV fluids
Location of key equipment (code cart, difficult airway cart) and medicationsCare and use of arterial and central lines, administration of vasopressorsBasic 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 callUse 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 electroencephalographyPlacement 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 supportBrain death assessments and managementBathing, turning, mobilizing patients
Organ donation: donation after circulatory death or donation after neurologic deathCharting/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.