Neurocritical Care for The Advanced Practice Clinician

Description

By utilizing a review of case-based studies and providing concise management recommendations from leaders in the field, this book provides essential knowledge for those practicing in a dynamic specialty. In the rapidly developing field of Neurocritical Care, Advanced Practice Clinicians have become an integral component of the multi-disciplinary team. This essential volume provides a frame of reference for advanced practice nurses, physician assistants, physicians, and students on a wide range of common Neuro ICU diagnoses and management strategies.

Table of Contents

1. Chapter 1: The Role of Advanced Practice Clinicians in the Neuroscience ICU
2. Chapter 2: Neuroanatomy
3. Skull, Fossae, and Meninges
4. Cerebrum
5. Diencephalon
6. Basal Ganglia
7. Brainstem
8. Cerebellum
9. Cerebral Vasculature
10. Ventricles
11. Cranial Nerves
12. Spinal Column and Spinal Cord
13. Spinal Tracts
14. Chapter 3: Neuroradiology
15. Introduction
16. Definitions
17. Basic Brain Imaging
18. Computerized Tomography (CT) Scan
19. Magnetic Resonance Imaging (MRI)
20. Vascular Imaging
21. CT Angiography (CTA)
22. MR Angiography (MRA)
23. CT/MRI Venogram Brain/Neck
24. Angiography
25. Perfusion Imaging
26. CT Perfusion
27. MR Perfusion
28. Contrast Considerations
29. Chapter 4: Aneurysmal Subarachnoid Hemorrhage
30. Introduction
31. Case Example
32. Initial Evaluation
33. Presentation
34. Diagnostics
35. Interventions and Management
36. Prevention of Rebleeding
37. Aneurysm Treatment
38. Hydrocephalus
39. Cerebral Vasospasm and Delayed Cerebral Ischemia
40. Cerebral Salt Wasting
41. Cardiopulmonary Complications
42. Perimesencephalic Subarachnoid Hemorrhage
43. Chapter 5: Intracerebral Hemorrhage
44. Introduction
45. Case Presentation
46. Initial Evaluation
47. Neuroimaging
48. Diagnosis
49. Prognosis
50. Management and Interventions
51. Airway
52. Blood Pressure Management
53. Correct Underlying Coagulopathies
54. Monitor for Hydrocephalus
55. Glucose Management
56. Temperature Modulation
57. Seizure Monitoring
58. Surgical Interventions
59. Acute Ischemic Stroke
60. Introduction
61. Case Presentations
62. Case 1
63. Case 2
64. Initial Evaluation
65. Management and Interventions
66. Stroke Systems of Care
67. Acute Stroke Code
68. National Institutes of Health Stroke Scale Score (NIHSS)
69. Neuroimaging
70. IV tPA
71. Post Thrombolytic Care
72. Chapter 7: Mechanical Thrombectomy for Acute Ischemic Stroke
73. Introduction
74. IV Thrombolysis and the Need for Better Treatments
75. Mechanical Thrombectomy
76. Case Example
77. Stroke Systems of Care
78. Initial Evaluation
79. Patient Selection for Mechanical Thrombectomy Using Imaging
80. Interventions and Management
81. Current Guidelines
82. Postprocedure Care of Patients
83. Chapter 8: Malignant Ischemic Stroke and Hemicraniectomy
84. Introduction
85. Case Presentation
86. Initial Evaluation
87. Diagnostic Imaging
88. Management and Interventions
89. Brain Edema and Raised Intracranial Pressure
90. Malignant MCA Stroke and Decompressive Craniectomy
91. Ethics
92. Chapter 9: Cerebral Venous Thrombosis
93. Introduction
94. Case Presentation
95. Initial Evaluation
96. History
97. Neurological Examination
98. Differential Diagnosis
99. Imaging
100. Other Diagnostic Testing
101. Management and Interventions
102. Prognosis
103. Chapter 10: Traumatic Brain Injury
104. Introduction
105. Case Presentation
106. Initial Evaluation
107. Interventions and Management
108. ICP Monitoring and Surgical Indications
109. Other Systems and Considerations
110. Chapter 11: Intracranial Pressure Management
111. Introduction
112. Case Presentation
113. Initial Evaluation
114. Management and Interventions
115. Head Elevation
116. Sedation and Analgesia
117. Temperature Control
118. Cerebrospinal Fluid Diversion
119. Osmotherapy
120. Hyperventilation
121. Pentobarbital
122. Decompressive Hemicraniectomy (DHC)
123. Additional Therapies
124. Paralysis
125. Steroids
126. Seizure Control
127. Chapter 12: Seizures and Status Epilepticus
128. Introduction
129. Case Study
130. Initial Evaluation
131. Airway
132. Abortive Therapy
133. History
134. Neurological Evaluation
135. Diagnostics
136. Interventions and Management
137. Continuous EEG Monitoring and Interpretation
138. Seizure Management [11, 20–22]
139. Systemic Complications of Status Epilepticus
140. Prognosis [24–29]
141. Chapter 13: Neurological Infections
142. Introduction
143. Case Presentation
144. Initial Evaluation
145. Presentation
146. Stabilization
147. Empirical Antimicrobial Therapy
148. Dexamethasone
149. Imaging
150. Lumbar Puncture
151. Opening Pressure
152. CSF Analysis
153. Differential Diagnosis
154. Disposition
155. Interventions and Management
156. Community-Acquired Bacterial Meningitis (CABM)
157. Epidemiology
158. Presentation
159. Treatment Monitoring
160. Seizures
161. Hydrocephalus
162. Dysnatremia
163. Others
164. Prognosis
165. Immunizations
166. Nosocomial Bacterial Meningitis
167. Acute Encephalitis
168. Neuroimaging
169. CSF Examination
170. CNS Space-Occupying Infective Lesions
171. Brain Abscess
172. Subdural Empyema
173. Postoperative Neurosurgical Infections
174. Ventriculostomy Infections
175. Chapter 14: Brain Tumors
176. Introduction
177. Case Presentations
178. Case 1
179. Case 2
180. Case 3
181. Initial Evaluation
182. Interventions and Management
183. Routine Postoperative Management
184. Management of Cerebral Edema
185. Management of Seizures
186. Management of Hydrocephalus
187. Prevention of Venous Thromboembolism
188. Hospice/Palliative Care
189. Chapter 15: Spinal Cord Injury
190. Introduction
191. Morbidity and Mortality
192. Mechanism of Injury
193. Primary and Secondary Injury
194. Case Presentation
195. Initial Evaluation
196. Imaging
197. Evaluation and Classification of SCI
198. Specific Clinical Syndromes [11]
199. Spinal Shock
200. Management and Interventions
201. Neurogenic Shock
202. Cardiovascular Evaluation and Management
203. Respiratory Evaluation and Management
204. Ventilator Management
205. Other Systems and Considerations
206. Urinary Tract
207. Gastrointestinal Tract
208. Venous Thromboembolism (VTE) Prevention
209. Skin
210. Pain
211. Autonomic Dysreflexia [29]
212. Prognosis
213. Chapter 16: Neuromuscular Disease
214. Introduction
215. Case Example
216. Initial Evaluation
217. Neuromuscular Respiratory Failure
218. Interventions and Management
219. Guillain-Barre Syndrome
220. Clinical Presentation
221. Diagnosis
222. Treatment
223. Myasthenia Gravis
224. Clinical Presentation
225. Diagnosis
226. Treatment
227. Critical Illness Neuromyopathy
228. Treatment/Prevention
229. Chapter 17: Hypoxic-Ischemic Injury After Cardiac Arrest
230. Introduction
231. Pathophysiology of Anoxic-Ischemic Injury: The Basic Principles
232. Case Presentation
233. Management and Interventions
234. Targeted Temperature Management and Its Practice
235. Neurologic Evaluation of the Comatose Patient After Cardiac Arrest
236. Ancillary Diagnostics
237. Imaging
238. Prognostication Summary
239. Chapter 18: Brain Death and Organ Donation
240. Introduction
241. Case Presentation
242. Principles of Brain Death
243. Brain Death Evaluation and Clinical Management
244. Coma
245. Brainstem Areflexia
246. Apnea
247. Ancillary Tests
248. Family Communication
249. Pediatric Considerations
250. Management of the Patient After Determination of Death
251. Organ Donation
252. Chapter 19: Goals of Care and Difficult Conversations
253. Introduction
254. Definition of Palliative Care
255. “Primary” Palliative Care
256. Prognostication
257. Shared Decision-Making
258. Patient Inability to Participate in Shared Decision-Making
259. Substituted Judgment
260. Practical Challenges with Surrogate Decision-Makers
261. Degree of Involvement in Shared Decision-Making
262. Surrogate Decision-Makers’ Impressions of Prognosis
263. Consistency of Communication
264. Family Meetings
265. Setup
266. Approach to Effective Communication
267. Emotional Support
268. Limitations of Life-Sustaining Therapy
269. Code Status
270. No Escalation of Care/Withdrawal of Select Therapies
271. Time-Limited Trials
272. Conflict Mediation
273. Comfort Care
274. Symptom Management
275. Care Transitions
276. Chapter 20: Multimodality Monitoring
277. Introduction
278. Case Presentation
279. Intracranial Pressure (ICP)
280. Cerebral Blood Flow
281. Jugular Venous Oxygen Saturation (SjvO2)
282. Continuous Electroencephalography
283. Near-Infrared Spectroscopy
284. Cerebral Microdialysis
285. Brain Parenchymal Oxygen Tension
286. Bioinformatics
287. Chapter 21: Airway and Ventilation Management
288. Introduction
289. Assessment of Airway and Breathing and Airway Adjuncts
290. Decision to Intubate
291. Intubation
292. Preoxygenation
293. Positioning
294. Equipment Preparation
295. Medications
296. Personnel
297. Direct Laryngoscopy (DL) Versus Videolaryngoscopy (VL)
298. Post-intubation Assessment and Care
299. Modes of Ventilation [6, 10]:
300. Volume Assist-Control Mode
301. Synchronized Intermittent Mechanical Ventilation
302. Pressure Control Ventilation
303. Pressure Support Ventilation
304. Positive End Expiratory Pressure and Fraction of Inspired Oxygen
305. Arterial Blood Gas and Ventilator Adjustments [10]
306. Specific Considerations in Neurocritical Care Patients and Mechanical Ventilation
307. Sedation/Pain Control with Mechanical Ventilation [9]
308. Hyperventilation and Elevated ICP [3]
309. Neurogenic Pulmonary Edema (NPE) [2]
310. Weaning Parameters
311. Rapid Shallow Breathing Index (RSBI) [8, 15]
312. Maximum Inspiratory Pressure or Negative Inspiratory Force (PImax or NIF) [10]:
313. Forced Vital Capacity (Forced VC) [10]
314. Other Criteria [1, 4, 5, 11]
315. Extubation [6]
316. Goals of Care and Extubating for End of Life
317. Chapter 22: Pharmacology
318. Pharmacokinetics in Neurocritical Care
319. Hyponatremia [9]
320. Cerebral Salt Wasting (CSW) vs SIADH
321. Hypernatremia
322. Hemodynamic Management
323. Analgesia and Sedation
324. Antiepileptic Drugs
325. Anticoagulants and Antiplatelets (Tables 22.8, 22.9, 22.10, and 22.11)
326. Hyperosmolar Therapy
327. Neuromuscular Blocking Agents
328. Myasthenia Crisis
329. Pregnancy Considerations in Neurocritical Care (Table 22.15)
330. Chapter 23: Common Complications in the Neuro ICU
331. Introduction
332. Hospital-Acquired Infections
333. Catheter-Associated Urinary Tract Infection (CAUTI)
334. Central Line-Associated Bloodstream Infection (CLABSI)
335. Ventilator-Associated Pneumonia
336. Ventriculostomy-Related Infection
337. Treatment of Fever and Shivering
338. Normothermia/Fever Control Protocol
339. Disorders of Sodium
340. Diabetes Insipidus (DI)
341. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
342. Cerebral Salt Wasting (CSW)
343. Special Case: Triphasic Sodium Response
344. Prevention and Treatment of Venous Thromboembolism
345. Glycemic Control in the Neurocritical Care Unit
346. Chapter 24: Helpful Links and Resources
347. Organizations
348. Guidelines
349. Subarachnoid Hemorrhage
350. Intracerebral Hemorrhage
351. Acute Ischemic Stroke
352. Cerebral Venous Thrombosis
353. Traumatic Brain Injury
354. Seizures and Status Epilepticus
355. Spinal Cord Injury
356. Neuromuscular Disease
357. Brain Death
358. Neuroradiology Tutorials

Editors Biography

Jessica L. White is a physician assistant in the Neuroscience ICU at Yale New Haven Hospital. She has served as part-time faculty at Yale University and Quinnipiac University physician assistant programs, teaching topics of neurology and neurocritical care. Her research interests include family satisfaction and the role of the physician assistant in the multi-disciplinary team. Her training was completed at Midwestern University with a Master of Medical Science from the Physician Assistant program.

Kevin N. Sheth graduated from Johns Hopkins University and the University of Pennsylvania School of Medicine. He was recruited to Yale as the founding chief of the Division of Neurocritical Care and Emergency Neurology and Chief of Clinical Research. His interests are in the advancement of therapies and care of patients with devastating acute neurological syndromes. He is a recognized clinical, a translational scientist, has directed multicenter studies testing potential therapies against brain swelling, stroke, and hemorrhage. He is the winner of the Robert Siekert Award from the American Heart Association, and his research has been funded by the NIH, American Academy of Neurology, American Heart Association(AHA). He has written over 100 publications in critical care neurology and stroke. His collaborative work is dedicated to the improved understanding of neurological disease in the critically ill.