Neuro ICU
The Neurosciences Intensive Care Unit (NEURO ICU) mission is to provide state of the art life-saving and intensive supportive care to critically ill neurosurgical and neurological patients. The patient population includes patients admitted to the Neurosurgery or Neurology services. This will include but is not limited to pre- or post-operative neurosurgery patients; patients with large hemispheric infarct (LHI), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and patients with other acute neurological impairment, as well as any patient who is deemed critically ill and requires emergent intensive care unit care.
The goal of the NEURO ICU rotation is to allow fellows, residents and medical students an opportunity to learn and apply critical care medicine principles in the above patient population. Unique aspects of this rotation are as follows:
To learn management principles in intracranial hypertension, SAH/ICH/LHI status epilepticus and neuro prognostication.
To be exposed to neurological diseases that require intensive care treatment such as primary malignant tumors, acute neuromuscular diseases and seizure disorders
To learn how to identify and treat infections in neurologically ill patients;
To learn to manage common critical care problems such as, but not limited to, acute coronary syndrome, shock, sepsis, arrhythmias, ARDS, and AKI.
To learn to care for patients with other organ support devices such as ventilator management and CRRT.
To learn how to work in a unit with a multidisciplinary provider model including critical care Nurse Practitioners (NP), residents from neurology, neurosurgery, and ENT, and critical care fellows from Anesthesiology, Neurology, Emergency Medicine and Internal Medicine.
The NCCU is divided into two units with 12 beds on the West side and 10 beds on the East side. Residents typically rotate on the West side and are assigned between 6-7 beds. The Residents are responsible for taking care of any patients in those rooms as well as any admissions or transfers to and from those rooms.
The NeuroICU is considered a closed unit meaning all orders are placed by the ICU team. However, many patients are co-managed with either stroke neurology or neurosurgery and are admitted under a neurosurgery or stroke neurology attending. General neurology patients are admitted under a neuro ICU attending and not typically followed by the general neurology (CNS) service until ready for transfer out of the ICU.
It is expected that you complete this checklist of activities during your time on the NCCU. Please discuss this with either the fellow or attending on service.
Helpful info
Please reach out to the outgoing resident on the Friday prior to your rotation in order to get sign out and find out which section of the ICU you will be taking over on Monday.
Please be ready to receive sign-out at 6:30am from the nighttime provider. Arrive earlier on the first day in order to get oriented to your new patients and be prepared for rounds by 8 AM.
Many residents utilize the “MD sign-out w/o notes” page on Epic for pre-rounding and presenting on rounds.
Use the computer-on-wheels to display imaging and place orders when not presenting on rounds.
The Neuro ICU has the following TigerConnect Roles that can be used to facilitate communication:
UMMC Neurocritical Care Triage Attending
UMMC Neurocritical Care Fellow
For any emergent concern, please call the Attending via the direct line at 8-4552 (24 hours/ 7 days), rather than texting via TigerConnect.
RESIDENT RESPONSIBILITIES
The NEURO ICU resident(s) is responsible for obtaining the history and physical examination, reviewing all laboratories, imaging findings and placing orders for every patient they admit to the Unit. The resident, under the supervision of the NCC attending, is the primary practitioner responsible for the care of a certain number (usually not more than 6) patients during the daytime. They are responsible for all 12 patients in the Unit during their Friday overnight. The resident is responsible for pre-rounding each morning and presenting the patients assigned to him/her during rounds in a structured format (see below). It is the expectation that the resident will formulate a patient care plan for each patient and follow that patient. The resident is also responsible for keeping the attending informed as to admissions, transfers and patient status. Residents will present their patients at morning rounds and maintain daily sign out notes on their patients that will serve as the basis for transfer summaries for when patients leave the ICU. It is expected that the resident will be ready for attending rounds at 0800, participate in Attending sign-out rounds at 1630, and give report to the night team at 1830 on the unit. Once a week (Friday), the resident will be on a 24 hour shift, from Friday 0630 - Saturday 0700. An NP will be covering the other side of the NCCU and will be available for support and assistance. Daily provider notes written under “Notes→incomplete” will serve as the basis for transfer and discharge summaries when patients leave the ICU.
PGY-1 OR 2 ROTATION
Prior to beginning the rotation, residents should contact Dr. Badjatia’s admin, Lorine Andersen (landersen@som.umaryland.edu), to schedule an introductory meeting. The PGY-1 or 2 [“Junior”] resident rotates on the NeuroCritical Care Unit (NCCU) at University of Maryland Medical Center in one 2-week block as a PGY-1 or one 4-week block as a PGY-2. The NCCU is a 22-bed start-of-the-art combined neurology/neurological surgery intensive care unit that receives patients with severe and acute neurological emergencies who require advanced monitoring, mechanical ventilation, cardiovascular support, invasive procedures, and neurosurgical interventions. The junior resident participates as a member of the NCCU team, and has the role of evaluating and admitting patients, gathering clinical information from patients, families, and other medical sources, accumulating laboratory data, presenting a synthesis of the case to the attending neurointensivist, contributing to management decisions, performing procedures, providing follow-up assessments and evaluation, maintaining ongoing electronic record of each patient’s clinical course, and preparing summaries for patients discharged from the NCCU.
Goals/Objectives: At the end of the rotation, residents will be expected achieve the following competencies and milestones.
Patient Care
To obtain medical and neurological histories from patients, or family members of patients, on admission to the NCCU with acute neurological disorders requiring intensive care unit monitoring and management.
To learn the neurological examination of the comatose patient.
To become familiar with the determination of brain death using clinical and laboratory-based techniques.
To become familiar with the assessment and management of severe, acute neurological disease, including coma and encephalopathy, status epilepticus, severe acute ischemic or hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis, acute neuromuscular weakness and respiratory compromise due to myasthenia gravis or acute demyelinating neuropathies, head trauma, spinal cord compression, brain tumors, and increased intracranial pressure, under direct supervision of faculty and neurocritical care fellows.
To become familiar with the principles of monitoring and management of the critically ill neurological patient, including management of acute ischemic stroke with thrombolytics, the management of vasospasm after subarachnoid hemorrhage, the monitoring and management of intracranial pressure, blood pressure control, ventilation, anticonvulsant use and induced coma in status epilepticus, hypothermia and treatment of fever in the neurocritical care unit, and the management of metabolic, infectious, and other medical complications of acute neurological illness.
To learn the indications and potential adverse consequences of neurosurgical and invasive neuroradiological interventions in patients with acute neurological emergencies and critical neurological illness.
To develop skill in recognizing the radiographic appearance of acute ischemic stroke, hemorrhagic stroke [including intracerebral hemorrhage and subarachnoid hemorrhage], and the cerebral herniation syndromes.
To learn the indications and potential limitations of continuous EEG recording in patients in the NCCU.
To contribute to the diagnostic and management plan of the patients in the NCCU, incorporating clinical, physiologic and image-based data.
Medical Knowledge
To learn about the pathophysiology of severe, acute neurological diseases, including coma and encephalopathy, status epilepticus, severe acute ischemic or hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis, acute neuromuscular weakness and respiratory compromise due to myasthenia gravis, myopathy or acute demyelinating neuropathies, head trauma, spinal cord compression, brain tumors, and increased intracranial pressure.
To become familiar with the physiology of cerebral hemodynamic monitoring and its application to the patients with comas and severe stroke.
To become familiar with the pathophysiology of increased intracranial pressure and cerebral edema.
To become familiar with the pathophysiology and management of fluid and electrolytes abnormalities, including SIADH and diabetes insipidus.
Interpersonal Skills & Communication
To interact and communicate effectively and compassionately with neurocritical care patients and their family members in a professional, ethical and culturally-sensitive manner.
To develop and improve the interpersonal and communication skills, both written and oral, necessary to (i) transmit an accurate neurological history and exam to other members of the neurocritical care unit (ii) present cases on rounds, (iii) to provide competent counseling to patients and families, and (iv) to communicate through written discharge summaries the diagnostic and management plan for patients transferred out of the NCCU to the ward services.
To maintain up-to-date electronic documentation of history, neurological examination, physiological monitoring and laboratory data, and NCCU course of patients with neurocritical illness.
Professionalism
To demonstrate the professional habits of punctuality, responsibility, honesty, integrity, compassion, and cultural sensitivity in caring for neurocritical care patients and their families.
To demonstrate an approach to the ethical concepts of neurocritical care, including informed consent, advance directives, medical futility, palliative care, and end-of-life care, including issues relating to brain death and the persistent vegetative state.
To be compliant with ethical and legal standards, work hours guidelines and the requirements of patient confidentiality.
System-Based Practice
To demonstrate the ability to function as a member of the multidisciplinary NCCU team.
To develop awareness of NCCU monitoring and management protocols, practice guidelines and other resources that contribute to the care of neurocritical care patients.
To become familiar with transfer planning for patients who are discharged from the NCCU to the Ward Service, Stroke Service, step-down/monitoring units, and the neurosurgery service, including recommendations for in-patient medical management and neurological rehabilitation.
Practice-Based Learning & Improvement
To begin to use the medical literature, including electronic databases, in the diagnosis and management of patients with neurocritical care illness.
To become familiar with hospital information systems in the evaluation and treatment of patients in the neurocritical care unit.
To become familiar with the management protocols in the NCCU, and their outcomes.
To become familiar with the clinical trials, protocols, and other medical evidence that has shaped the current standard of monitoring and management for patients with critical neurological illness.
To participate in morbidity and mortality rounds.
PGY-3 ROTATION
The PGY-3 [“Senior”] resident rotates on the Neurocritical Care Unit at University of Maryland Medical Center in one 4 week block. The senior junior resident role builds upon the neurocritical care knowledge base and skill set developed during the PGY-2 to contribute at a more advanced level to the evaluation and management of patients admitted to the NCCU. While working under the supervision of the faculty neurointensivist and neurocritical fellows, the PGY-3 neurology resident brings a larger clinical experience, more independence in the decision-making, and a greater appreciation of evidence-based medicine and medical ethics in the care of neurocritical patients, while serving as a proximate role model and educator of the PGY-2 residents and the medical students on the NCCU service.
Goals/Objectives: At the end of the rotation, residents will be expected achieve the following competencies and milestones:
Patient Care
To become familiar with the assessment and management of severe, acute neurological disease, including coma and encephalopathy, status epilepticus, severe acute ischemic or hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis, acute neuromuscular weakness and respiratory compromise due to myasthenia gravis or acute demyelinating neuropathies, head trauma, spinal cord compression, brain tumors, and increased intracranial pressure, under direct supervision of faculty and neurocritical care fellows.
To develop more skill and confidence in the determination of brain death using clinical and laboratory-based techniques.
To become familiar with the principles of monitoring and management of the critically ill neurological patient, including management of acute ischemic stroke with thrombolytics, the management of vasospasm after subarachnoid hemorrhage, the monitoring and management of intracranial pressure, blood pressure control, ventilation, anticonvulsant use and induced coma in status epilepticus, hypothermia and treatment of fever in the neurocritical care unit, and the management of metabolic, infectious, and other medical complications of acute neurological illness.
To refine skills in recognizing the radiographic appearance of acute ischemic stroke, hemorrhagic stroke [including intracerebral hemorrhage and subarachnoid hemorrhage], and the cerebral herniation syndromes.
To begin to interpret the results of continuous EEG recording in patients in the NCCU, including the electrographic appearance of seizures.
To contribute at an advanced resident level to the diagnostic and management plan of the patients in the NCCU, incorporating clinical, physiologic and image-based data.
Medical Knowledge
To increase knowledge regarding the pathophysiology of severe, acute neurological diseases, including coma and encephalopathy, status epilepticus, severe acute ischemic or hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis, acute neuromuscular weakness and respiratory compromise due to myasthenia gravis, myopathy or acute demyelinating neuropathies, head trauma, spinal cord compression, brain tumors, and increased intracranial pressure.
To become familiar with the physiology of cerebral hemodynamic monitoring and its application to the patients with comas and severe stroke.
To become familiar with the pathophysiology of increased intracranial pressure and cerebral edema.
To become familiar with the pathophysiology and management of fluid and electrolytes abnormalities, including SIADH and diabetes insipidus.
Interpersonal Skills & Communication
To improve communication skills and counseling for patients with neurological disease and their family members, interacting in a professional, ethical and culturally-sensitive manner.
Professionalism
To demonstrate the professional habits of punctuality, responsibility, honesty, integrity, compassion, and cultural sensitivity in caring for neurocritical care patients and their families.
To develop a sophisticated approach to the ethical concepts of neurocritical care, including informed consent, advance directives, medical futility, palliative care, and end-of-life care, including issues relating to brain death and the persistent vegetative state.
To be compliant with ethical and legal standards, work hours guidelines and the requirements of patient confidentiality.
Systems-Based Practice
To contribute at a managerial level to the multidisciplinary NCCU team, demonstrating awareness of the principles of triage and hospital resource management.
To become adept with NCCU monitoring and management protocols, practice guidelines and other resources that contribute to the care of neurocritical care patients.
To orchestrate transfer planning for patients who are discharged from the NCCU to the Ward Service, Stroke Service, step-down/monitoring units, and the neurosurgery service, including recommendation for in-patient medical management and neurological rehabilitation.
Practice-Based Learning & Improvement
To become familiar with the management protocols in the NCCU, and their outcomes.
To become familiar with the clinical trials, protocols, and other medical evidence that has shaped the current standard of monitoring and management for patients with critical neurological illness.
To participate in morbidity and mortality rounds.
DAILY ROUTINE OF THE NEURO ICU
Sign-out Rounds
The incoming day practitioner will obtain a sign-out or report from the outgoing night practitioner regarding the status of the current patients in the NEURO ICU. The active bed requests and the patients that could possibly transfer out of the NEURO ICU should be reviewed. These activities should be done in a timely fashion in order to be ready for 0800 Attending Rounds. All sign in/out activities will follow a structured format that adheres to the UMMC Graduate Medical Education guidelines.
Morning Rounds
At 0600 each morning the overnight practitioner (not daytime practitioner) will attend the morning work rounds with the surgical team. Bedside rounds with the NCC attending will begin at approximately 08:00 daily. Rounds will be attended by the NEURO ICU attending, fellow, NPs, residents, medical students, nurses and ancillary staff. It is understood that fellows, NPs, residents, and medical students will have seen and evaluated all of their assigned patients in the NEURO ICU prior to rounds. Nursing input is vital to patient care. It is the responsibility of the ICU team to notify the nurse at the time that the ICU team begins rounding on their patient. During rounds, one resident / NP presents with appropriate images and labs available for review, while another inputs orders. This maintains a constant, efficient work flow, allowing for more time for teaching and for most (ideally all) orders to be placed during rounds. Interruptions from rounds should be limited to emergencies only (i.e. non-emergent phone calls should be returned later).
Multidisciplinary Rounds
At 1100 each morning the charge nurses from the ICU, step down unit and floor, as well as case managers from neurology and neurosurgery will meet for 30 minutes to discuss pending transfers and begin discharge planning for patients from the intensive care unit. The purpose of this meeting is to improve patient throughput and maximize resources between patient care settings. It is the expectation the fellows and / or ICU triage attending will attend these daily am rounds. Residents may be asked to attend if the NCCU fellow is post call on Thursdays.
NIGHT CALL
This will occur once a week with the Neurology resident on Fridays. Night call begins 630 PM and ends by 0700 AM. The on call provider will “run the list” with Attending on call for the Neuro ICU between 9-11 PM. At 630 AM daytime will receive sign out from on call provider. Additionally, on call provider is expected to call the on call attending with any new admissions or significant events. As with new patients during daytime, the on call provider is expected to enter an admission note. For any events on existing patients, the on call provider is expected to update sign out note in Epic.
Procedures
Procedures will be performed by the residents or medical students under the supervision of the fellow/attending. Endotracheal intubations will be performed primarily by the critical care attending. Critical care fellows may perform intubation under appropriate supervision.
Notes/Orders
Medication Reconciliation shall be done on admission with history detailed from patient, family or pharmacy.
All restraint orders will be documented within 15 minutes of application and will be reassessed and re-ordered every 24 hours.
A running transfer summary is to be written on all patients daily by the responsible NP, fellow, resident or fourth-year medical student. All notes written by a resident and fellow should be co-signed by an Attending physician in a manner consistent with compliance guidelines. A medical student’s note is not considered the daily patient note; a higher level practitioner should write his/her own note.
All orders should be entered into the computer. Those orders discussed on rounds should be entered during rounds. Except for urgent orders, all orders by primary or consulting services must be reviewed by a NEURO ICU physician.
A template for the daily progress note is accessible by typing: .NCCUTRANSFER
Transfer, Discharge and Interim Summaries
ICU discharge summaries will be written by the ICU provider primarily responsible (NP/resident/Fellow) for the patients who expire or are discharged from the NEURO ICU to an outlying facility. Discharge. A “death note” and death certificate also need to be completed for patients who expire.
Neurology:
Transfer summaries are written for all neurology patients moving to another floor in-house phone call.
Discharge summaries and the depart process will be done by the ICU providers for all neurology patients regardless of length of stay.
Neurosurgery:
Transfer summaries are written for neurosurgery patients with a length of stay > 72 hours and will be entered into Epic. <72 hours Neurosurgery will write discharge summary or transfer summary.
Discharge plans and medications are entered by the Neurosurgery team only as they will follow the patient after discharge from the hospital. The discharge order is placed by the ICU team. A discharge summary should be written if the patient is here >72 hours.
Attending Sign-Out Rounds
Sign-out rounds with the Attending will be performed beginning at 1630 daily. The NP, resident, fellow and attending will participate in these brief 30 minute rounds that are focused on ensuring AM goals are being met and developing specific overnight goals of care.
COMMUNICATION
Communication among the NEURO ICU staff and primary service / consulting services is absolutely essential to the smooth function of the NEURO ICU. The quality of patient care depends on the lines of communication being open and used frequently.
Patients in the NEURO ICU are cared for by the NEURO ICU team in collaboration with each patient’s primary and consulting services. Recommendations for care as well as the patient’s changing status should be made known to the primary service as soon as possible. Consulting service recommendations must be approved by the critical care attending.
Anticipated discharge of a patient from the NEURO ICU must be communicated in a timely fashion. Emergent admissions or discharges will be handled as judiciously as possible. Communication prevents confusion and misunderstandings and is a hallmark of quality patient care.
Any conflicts in the management of patients between the primary service and the critical care team that cannot be resolved in a timely fashion should be brought to the attention of the Medical Director immediately (24/7/365).
Neurosurgery
Text or call pager 9290 for all neurosurgical issues)
Notify for the following issues:
Elevations in ICP
Change in neurologic exam for neurosurgery patient population
Need for emergent CT scan
SAH IV Heparin protocol issues
EVD issues; clotted, leaking, level, non-occlusive dressing, CSF draws etc.
Neurosurgery in return is responsible for discussing with the NCCU team the following:
Need for further imaging
Changes in EVD settings
OR dates and times
Providing OR hand-off report to providers in the patient room “Hard Stop”
Upon transfer out of NCCU to IMC or floor, complete a transfer summary if >72 hours and page/contact Neurosurgery to notify them of the transfer and to communicate any critical information.
Port: Dr’s Simard, Aarabi, Neurosurgery NP Contact # 8-7121
Starboard: Dr’s. Woodworth, Eisenberg, Sansur / NP # 8-7122
Communicating with Stroke Neurology
Text or page 0395
Notify for the following issues:
Change in neurologic exam
Need for emergent CT or MRI scan
Stroke Neurology rounds every mid morning on their patients and will communicate the following with the NCCU team:
Need for further imaging
Changes in antithrombotic/anticoagulation management
Upon transfer out of NCCU to IMC or floor, complete a transfer summary and page/contact Neurology resident to notify them of the transfer and to communicate any critical information.
Attendings: Cole, Cronin, Kittner, Mehnidratta, Phipps, Wozniak, Chaturvedi
Communication with General Neurology (CNS service)
The Neurocritical Care service will remain the primary team responsible for all non – stroke neurology patients.
Once a decision has been made to transfer out of NCCU to IMC or floor (ie downgrade patient), there must be a full, formal sign out to the designated CNS team member and the transfer summary must be completed. Given there may be a delay of up to several days that may occur between time of down grade and time of obtaining a bed, at the time the patient receives a bed in the IMC/floor, page/contact Neurology resident to notify them of the transfer and to communicate any new critical information. The NCC service will continue to take primary responsibility for all patients during the time that the patient is downgraded but still in the ICU.
GUIDELINES FOR NEURO-ICU PRESENTATIONS
Because ICU patients can be complicated, presentations on morning rounds are most effective when they are structured and well-organized. The role of the presenting resident is to convey a coherent picture of what has been "going on" with the patient to the rest of the team. This serves as a take off point for examination of the patient, review of imaging studies, and discussion. The end-point of each discussion is to formulate a plan for the day. We expect the resident/NP (not Fellow or Attending) to initiate the discussion of a plan by systems. A systems format for organizing morning presentations follows:
PROBLEM LIST: Present a summary of patient and pertinent issues. eg “ 46 yo SAH HH4F3 PBD 5 POD 3 who has aspiration PNA day 5 of atb and thrombocytopenia due to HIT.” For new admissions this is replaced by a complete CC, HPI, PMH, Meds, All, SH, FH, ROS).
EVENTS OF PRECEDING 24 HOURS: (This should include spontaneous breathing trial performance, interventions, diagnostic test results, deterioration, etc). TO BE PRESENTED BY RN
VITAL SIGNS: HR, BP, RR, Temp, ICP, CPP, PBO2, Microdialysis, I+O's including EVD output.
DRIPS AND INFUSIONS: Fluids, vasoactive and sedative meds (by dose not cc/hr), feeds
LABS: ABG (with vent settings), BMP, CBC, AED levels, others. No need to read off all labs – provide pertinent highlights and interpretation
BEDSIDE EXAM: Resident/NP provides summary of exam findings noted during pre rounding. The entire team examines the patient together (this may occur here or at end of systems plan).
PLAN BY SYSTEMS (always in this order)
NEUROLOGICAL (what do you think is going on with the patient? How do you explain the findings? Are further diagnostic studies are needed? What are the therapeutic goals for the day? Do we need to adjust any on going therapies? Sedation / analgesia adequate? What needs to be communicated to Neurosurgery/Neurology?)
CARDIOVASCULAR (essential components: rate/rhythm, ischemia, pump, pressure: is cardiac performance optimized for achieving neuro goals? What is the goal BP (MAP)? hemodynamic values [CVP, CO, CI,SVI, SVRI], ECHO results], ECG & arrhythmias).
PULMONARY (current ventilator settings, performance during weaning over past 24 hrs, CXR, ABGs, secretions, vital capacity,extubate/trach?).
RENAL / FLUIDS, ELECTROYTES, UROLOGIC status (kidney failure, do meds need renal dosing adjustments, lytes repleted? Is the patient euvolemic? What are the total fluids the patient is receiving hourly? What are our sodium and/or fluid balance goals?)
HEMATOLOGIC (Hct & platelets, coags, are there transfusion triggers for hb, plt?)
INFECTIOUS DISEASE (Is there any signs of acute infection? Are cultures being followed up on? Are antibiotics appropriately dosed/duration? Are all lines/tubes necessary? Need for ongoing Foley catheter use must be clearly identified).
GASTROINTESTINAL/NUTRITION (Any signs of ileus, hepatic insuff, or GI bleeling, last BM, is the patient receiving adequate nutritional support?)
ENDOCRINE (is the serum glucose level well controlled, do we need to adjust; any signs of adrenal insufficiency, s/p pituitary tumor DI watch)
SOCIAL SITUATION/FAMILY STATUS: to be presented by RN.
FAST HUGS BID/CHECKLIST: to be presented by RN.
KEY READINGS
REQUIRED READINGS
Continuum
NCS Brain death Tool Kit:
Consensus Guidelines
American Heart Association (AHA)
Ischemic Stroke
SAH
Cerebral venous thrombosis
Cardiac Arrest
AAN Practice Parameters
Neurocritical Care Society (NCS)
NCS guidelines & consensus statements on the following can be found here:
Clinical Performance Measures in Neurocritical Care
Standards for Neurocritical Care Units
Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients
Implementation of Targeted Temperature Management
Reversal of Antithromobtics in Intracerebral hemorrhage
Prophylaxis of Venous Thrombosis in Neurocritical Care Patients
Management of Large Hemispheric Infarction
Evaluation and Management of Status Epilepticus
NCS Consensus Statements
Insertion and management of External Ventricular Drains
Multimodality Monitoring
Management of Patients Following Aneurysmal Subarachnoid Hemorrhage
ADDITIONAL READING
The Neuro ICU Book
Decision-making in Neurocritical Care
Neurocritical Care, Wijdicks & Rabinstein 2011
NCC ON CALL
We have purchased a subscription to NCC On Call for all residents to share.
Can access via: https://oncall.neurocriticalcare.org/
Username is: neurochiefs@som.umaryland.edu
Password is: Brains!21
Last Updated: July 21, 2022