NeuroICU Fellows

This section

Call for the fellowship is unique and based on providing fellows with educational opportunities more than coverage model of the unit as most other fellowships employ. While fellows are not required to "cover" the ICU for nights given the APP staffing we have adopted it remains very beneficical to work both nights and weekends throguhout the year given the opportunities for clinical care and decision making at these times.

• While fellows are rotating on service in the neuroICU they are expected to cover at least one weekend that month

• Fellows will complete several (Sunday-Thursday) night shift weeks that may be a part of neuroICU month throughout the year (minimum of 4)

Fellows need to keep their own procedure logs for all procedures done in the ICU during fellowship. These include arterial lines, central venous catheters, endotracheal intubations, thoracostomies, bronschoscopies, external ventricular drains (EVDs) and subdural evacuating port systems (SEPS). You can use a notebook, online as example below, or however you would like.

Kate O'Connell 2021-2022

JUL – Orientation + NeuroICU

AUG – NeuroICU (1 week nights)

SEP – Elective(Boards)

OCT – NeuroICU

NOV – Elective

DEC - NeuroICU

JAN - Elective

FEB - STICU

MAR - NeuroICU

APR - CVICU

MAY - Elective

JUN – NeuroICU

Although currently the fellowship is not approved by the ACGME, UCNS follows ACGME duty hour rules and therefore the contract supplied through the GME follows these duty hours

• 80 hours/week averaged over 4 weeks

• no more than 24 hours continuous clinical time per shift

• one day off in 7 averaged over 4 weeks

• at least 8 hours off between clinical shifts

Should you have concerns about your duty hours you need to discuss this with the program director

Moonlighting opportunities in addtion to your work schedule are only offered should you meet/exceed your year one competency in the fellowship, and are included in the duty hour totals

Shock/Pressors

• The ICU Book: Ch 11, 12, 53: Hemorrhage and Hypovolemia, Colloid & Crystalloid Resuscitation, Hemodynamic Drugs

• Circulatory Shock, Finfer SR et al, NEJM Oct 2013

• Current Use and Advances in Vasopressors and Inotropes Support in Shock, Manolopoulos et al, J Emerg Crit Care Med Apr 2020

Sepsis

• Surviving Sepsis Campaign 2021, Evans et al, Crit Care Med Nov 2021

• The NeuroICU Book: Ch 53: Sepsis and Septic Shock

• The ICU Book: Ch 14: Inflammatory Shock Syndromes

Sedation in Critical Care

• The ICU Book: Ch 51: Analgesia and Sedation in the ICU

• The Practice of Neurocritical Care: Ch 16: Sedation and Analgesia in Neurocritical Care (sent by email)

• The NeuroICU Book: Ch 20: Sedation

• Sedatives in Neurocritical Care: an update on pharmacological agents and mode of sedation, Opedenakker et al., Curr Opin Crit Care 2019

• The Pathophysiology of Propofol Infusion Syndrome: A Simple Name for a Complex Syndrome, Vasile B et al., J Int Care Med, 2003

Procedures & Hemodynamic Monitoring in Critical Care

• The ICU Book: Section 1, Ch 1-3: Vascular Access, Ch 7-8, Arterial Pressure Monitoring, The Pulmonary Artery Catheter

• Intravascular Complications of Central Venous Catheterization by Insertion Site, Parienti J-J et al., NEJM, Sept 2015

• Transpulmonary Thermodilution: Advantages and Limits, Monnet et al., Critical Care, 2017

• Echocardiography as a Guide for Fluid Management, Boyd JH et al., Critical Care, Sept 2016

Fever & Temp Management in Neurocritical Care

• The NeuroICU Book: Ch 21: Fever and Temperature Modulation

• The ICU Book: Ch 43: Fever in the ICU

• Neurogenic Fever: Review of Pathophysiology, Evaluation and Management, Meier K et al., J Int Care Med, 2017

• Prevention of Shivering During Therapeutic Temperature Modulation: The Columbia Anti-shivering Protocol, Choi HA et al., Neurocrit Care, Jan 2011

Acute Respiratory Distress Syndrome

• The ICU Book: Ch 23: Acute Respiratory Distress Syndrome

• The NeuroICU Book: Ch 43: Acute Respiratory Distress Syndrome

• Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome, ARDSnet, May 2000

• Acute Respiratory Distress Syndrome: the Berlin Definition, ARDS Definition Task Force, JAMA Jun 2012

Nutrition in Critical Care

• The Neuro ICU Book: Ch 57: Nutrition and Metabolic Support

• The ICU Book: Ch 47-49: Nutritional Requirements, Enteral Tube Feeding, Parenteral Nutrition

• Nutrition in the Acute Phase of Critical Illness, Casear MP et al, NEJM Mar 2014

• ASPEN Guidelines, McClace SA et al, JPEN Feb 2016 The

Acute Heart Failure

• The ICU Book: Ch 47: Acute Heart Failure in the ICU

• The NeuroICU Book: Ch 37-38: Acute Decompensated Heart Failure and Cardiogenic Shock and Intraaortic Balloon Pump

Acute Kidney Injury

• The NeuroICU Book: Ch 47: Acute Kidney Injury

• The ICU Book: Ch 34: Acute Kidney Injury

• Acute Kidney Injury, Ronco C et al., The Lancet, Nov 2019

• Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury, STARRT-AKI, NEJM, Jul 2020