University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
NEUROSCIENCES ICU ELECTIVE ROTATION
Philosophy:
The specialized nature of Neuro-Critical Care highlights the need to work closely with
Neurologists and Neurosurgeons. Therefore, the goal is not to assume sole responsibility
for patient care. Rather, the trainee must appreciate that optimal care requires multidisciplinary expertise provided by several specialties. Neuro Critical Care Medicine
training should therefore involve firstly consolidation of General Critical Care attitudes,
skills and knowledge, but also acquisition of knowledge pertaining to neuroanatomy;
physiology and pathology; and an appreciation of where the patient resembles others
with critical illness and where they differ. As such, the rotation objectives include book
knowledge, procedural skills, and an appreciation of future directions for clinical practice
and research inquiry. Exposure could also be offered, for those interested, in witnessing
operative and interventional patient care. The diagnosis and treatment of the potential
organ donor will also be stressed within this rotation.
Graduated responsibility will be used. The Trainee is expected to progress from
observing the NeuroIntensivist at work, to assuming the role of NeuroIntensivist; all whilst
under supervision of the rotating NeuroIntensivist.
Evaluation will be determined through completion of a standardized form by the
NeuroIntensivists that worked with the trainee. This should be supplemented by input
from Neurosurgeons, and the Unit Managers.
The resources available in achieving the rotation goals are listed immediately below. In
addition, an oral exit exam will also be offered to trainees and will be based upon the
objectives listed below.
Resources/Reading list to enable reaching rotation goals: (all texts and electronic
resources available in NeuroIntensivists office):
1.
2.
3.
4.
5.
NeuroAnatomy Text: Neurosurgical Intensive Care. Andrews B.T editor.
McGraw-Hill 1993
www.uptodate.com
Access to Ejournals available from www.ualberta.ca
CD of selected articles available from P Brindley/A Shustak.
Medical Management to Optimized Donor Organ Potential and Strategies to
Increase the Canadian Organ Donor Pool by Dr D.J Kutsogiannis (Associate
Director, NeuroSciences ICU)
Trainee should
1.
Attend Critical Care academic activities whilst on the rotation:




2.
3.
4.
5.
6.
Tuesday afternoon Grand Rounds
Journal clubs
Wednesday afternoon academic half-day
Friday morning NeuroSciences Grand Rounds and pertinent academic
sessions provided for Neurosurgical residents
Be included in all Critical Care Line telephone calls
Take second call for Neuro Critical Care during weekdays
Present patients daily to the ICU Attending Neurosurgeons/Neurologists
Be involved in all Family Conferences
Oral exit examination
University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
Rotation Objectives:
Medical Expert
Basic Science:

Describe the factors believed to affect cerebral perfusion and intracranial
hypertension.

Demonstrate knowledge of basic neuro anatomy associated with stroke, spinal
injury, traumatic brain injury and cerebral herniation.

Further demonstrate knowledge of neuroanatomy such that the trainee can
describe CT abnormalities; also distinguish types of intracranial bleeds and
understand the anatomical basis of operative procedures.

Description various grading systems for subarachnoid hemorrhage; and theories
as to the likelihood and timing of vasospasm.

Describe the pharmacologic basis behind typical strategies used in seizures and
status epilepticus.

Describe the physiological effects of evolving brain death. Perform a brain death
assessment.
Clinical knowledge:

Describe, and where possible implement, the therapeutic strategies believed to
optimize cerebral perfusion and minimize intracranial hypertension. Includes:
o
o
o
o
o
o
o
Sedation
Extra ventricular drainage
Hyperventilation
Mannitol
Steroids
Cooling
Neuromuscular blockade

Describe, and where possible implement, the therapeutic strategies that control
status epilepticus.

Describe, and where possible implement, the strategies available and rationale
surrounding intubation of the brain injured and spine injured patient. Includes;
o
o
o
The rational for the use of neuromuscular blockers, opiates,
benzodiazepines, propofol, lidocaine, etomidate
Rapid sequence intubation and modified rapid sequence intubation
Bronchoscopic strategies. needle cricothyroidotomy, surgical airways,
tracheostomy

Describe how to insert, monitor, and adjust an extraventricular drain.

Describe the principles of detection of vasospasm (clinical, ultrasound,
angiographic), as well as the use of triple H therapy.

Describe the rationale and evidence for pharmacological optimization of the
potential organ donor patient: Includes;
o
o
o
o
Vasopressin and diabetes insipidus
Steroids
Thyroid hormone
Esmolol
University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
o

Glucose homeostasis
Consolidate procedural skills related to central venous lines; arterial lines;
intubation, bronchoscopy; tracheostomy; and manipulation of mechanical
ventilators and vasoactive agents.
Communicator/health advocate

Be assessed by the Intensivist;
o
o
o
o
o
o
As to ability to communicate with Neurosurgeons, Neurologists, other
specialists, Respiratory Therapists and Nurses.
In the setting of a family conference. Be able to use appropriate language,
empathy, and answer questions
in the setting of a family conference
Be able to effectively communicate with families who may be dysfunctional,
angry, confused, or litigious
Be included in all Critical Care Line discussions, and offer advice to other
healthcare workers regarding optimal transportation of unstable patients.
Prepare documents that are accurate, timely and legible.
Manager/Collaborator


Be involved in discussions with NeuroSurgeons, Neurologists, other Intensivists,
the unit manager and bed managers regarding how best to optimize patient care
and manage available beds.
Prioritize activities and show good time management
Professional
 Crisis resource management skills including ability to remain calm and direct a
team in a singular goal.
 Demonstrate integrity, honesty, compassion, punctuality and conscientiousness
 Posses insight into own strengths and weaknesses. Seeks advice, accepts
feedback.
Scholar





Outline potential areas of research within NeuroIntensive Care, as well as how
one might design a study.
Identify challenges faced within management of the Critically-ill Neurosciences
patient and possible quality improvement initiatives.
Demonstrate appraisal of the available medical literature
Demonstrates ability to find medical information using computer/Medline and
library resources
Demonstrate an ongoing learning strategy and indicate resources used during
rotation.
University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
IN TRAINING EVALUATION REPORT
Rarely
meets
Inconsisten
tly meets
Generally
meets
Sometimes
exceeds
Considerably
exceeds
EXPECTATIONS: (for rotation/level of training)
PRECEPTOR
Could not
evaluate
PROGRAM: Neurosciences ICU
HOSPITAL / SITE: UAH
Does not
apply
Name of Resident:
ROTATION: NSICU
REPORT COVERS PERIOD FROM:
0
2
3
4
A. MEDICAL EXPERT
a) basic science knowledge
b) clinical knowledge (see knowledge areas below)
c) history/physical exam – complete, accurate, organized
d) demonstrates good clinical judgment
g) recognition and management of emergency situations
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
B. COMMUNICATOR
a) communicates effectively with patients, families & health care
workers
b) communicates effectively with other health professionals
c) prepares documentation that is accurate, legible and timely
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
C. COLLABORATOR
a) recognizes rules of, and interacts effectively with health
professionals
b) consults and delegates effectively
1
University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
D. MANAGER
a) makes cost effective use of health care resources
b) sets realistic priorities and uses time effectively to optimize
performance
c) knows the principles of quality assurance and outcome measures
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
E. HEALTH ADVOCATE
a) intervenes on behalf of patients with respect to their care
b) recognizes & responds appropriately in regard to patient safety
c) identifies socio-economic determinants of health of patients and
communities
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
F. SCHOLAR
a) develops & implements an ongoing and effective personal learning
strategy
b) assesses & critically appraises health & medical information
c) uses information effectively in clinical decision-making
d) teaches effectively both in classroom and clinical environment
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
G. PROFESSIONAL
a) demonstrates integrity, honesty, compassion and respect for
diversity
b) fulfills medical, legal & professional obligations of the specialist
University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
c) demonstrates reliability and conscientiousness
d) Understands principles of bioethics and applies these in clinical
situations
e) is aware of personal limitations and seeks advice when necessary
f) assesses own performance & has insight in attaining professional
standards
Comments (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
KNOWLEDGE AREAS, PROCEDURES AND TECHNICAL SKILLS
The Resident must demonstrate knowledge and technical proficiency in
each of the following:
a.
b.
c.
d.
e.
f.
g.
h.
Routine orotracheal intubation
Specialized intubation techniques for head injury/spinal injury.
Care of the patient requiring mechanical ventilation
Care of the patient requiring prolonged ventilation and weaning
Care of the patient managed using an extraventricular drain
Care of the patient requiring CPP/ICP manipulation
Care of the patient requiring tracheostomy
Care of the patient requiring management of seizures/status
epilepticus
Care of the patient following stroke
Care of patient with subarachnoid hemorrhage
Care of patient with suspected/confirmed vasospasm
Brain death determination
Organ donor management
Resuscitation of the patient with trauma/ undefined shock
Care of the patient following high risk surgery
Arterial cannulation
Central venous cannulation
i.
j.
k.
l.
m.
n.
o.
p.
q.
r. CT head interpretation
s. Organization & supervision of the patient requiring transport
t. Organization and management of the patient requiring immediate radiologic
testing
University of Alberta
Division of Critical Care Medicine
Adult Critical Care Medicine Resident Training Program
Has this resident met the core objectives of this rotation?
Yes
No
Comments: (your comments especially relating to ratings 0, 1 and 4 are specifically requested).
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