Neurological Intensive Care Unit
SITE
Columbia
DURATION
4 weeks
MEETING PLACE
Neurological ICU Milstein 8 Garden South at 6:30AM
CALL SCHEDULE
Login: neuro
● Generally the EM resident will take approximately one 24-hour call and will work as the night float resident for approximately 1 week during this month.
ED SICK CALL RESPONSIBILITY
None
DAILY SCHEDULE
Sign-out from NF resident 6:30 AM
Pre-rounds 7:00AM
Attending Rounds 7:30AM-10:30AM*
Work Rounds (Fellow +/- residents) 4:30PM-6:00PM
Sign-out to NF resident 6:30PM
● Night float (NF) resident leaves after presenting all overnight admissions at the beginning of attending rounds.
● EM resident will participate in attending rounds, work rounds and didactics.
EM WEDNESDAY
CONFERENCE
Encouraged but not expected
EM ROTATOR PAGER
Personal Pager
CONTACT
Jan Classen, MD
Director, Neurological Intensive Care Unit
Director, Neurology Critical Care Fellowship
(212) 305-7232
Email: jac7002@nyp.org
Neurology Chief Resident:
Jessica Schulte jds2244@cumc.columbia.edu
*Attending Rounds duration varies from day to day.
Description of Rotation:
The EM resident will be an integral part of the NICU 1 team. The team is comprised of one neurology PGY 2/3 resident, one EM PGY2 resident, one neurosurgery intern or peds neuro PGY2 resident, one neurology critical care fellow and one attending. Please note that there will also be NICU 2 (neurosurgical post-op) patients in the NICU; the NICU 1 team is not responsible for the care of these patients. A neurosurgical resident is assigned to care for these NICU 2 patients. The neuro, neurosurg/peds neuro, and EM residents covering the NICU for the month will rotate as night float for approximately 1 week at a time. On Sundays, one of the scheduled residents will take 24-hour call.
The EM resident will develop the ability to evaluate, stabilize and treat the critically ill neurological and neurosurgical patient. Techniques particular to critical care neurology will be learned including intracranial pressure monitoring, ventilator management and fluid and electrolyte management. The resident will learn the ethical and legal principles applicable to the care of the critically ill neurological and neurosurgical patient including end of life discussions.
Educational Objectives:
- Develop the ability to evaluate, stabilize and treat the critically ill neurologic and neurosurgical patient based on sound judgment, available evidence, and patient preference. (PC, MK, PBL)
- Develop an understanding of the unique issues and concerns in the care of the critically ill neurologic and neurosurgical patient (MK, PC)
- Become familiar with the physiology of the critically ill neurologic and neurosurgical patient (MK, PC)
- Learn how to utilize medical technology including hemodynamic and intracranial monitoring in the care of the critically ill neurologic and neurosurgical patient (MK, PC)
- Learn about ventilator management and, in particular, issues and aspects of ventilator management critical to the treatment of patients with neurologic and neurosurgical illnesses (MK, PC)
- Learn how to manage the whole patient in order to maximize/optimize the patient’s neurologic status. This includes the management of blood pressure, electrolytes and glucose in the critically ill neurologic and neurosurgical patient (MK, PC)
- Perform critical care procedures such as placement of central lines and arterial lines, Swan-Ganz catheterization and ventriculostomy drains under direct supervision (PC)
- Describe dosage, indications and contraindications for the commonly used pharmacologic agents (MK)
- Demonstrate an understanding of the appropriate use of consultants in the critically ill neurologic and neurosurgical patient (MK, PC, SBP)
- Learn to identify brain death including the performance of an apnea test and cold calorics (MK, PC)
- Demonstrate an understanding of the ethical and legal principles applicable to the care of the critically ill neurologic and neurosurgical patient including end of life discussions (PC, ICS, SBP)
- Demonstrate effective use of informational resources, scientific studies and technology to enhance patient care and pursue self improvement and self education (PBL, SBP)
- Demonstrate good interpersonal skills among patients, families and professional colleagues (PC, ICS, P)
- Always demonstrate respect, compassion, integrity and honesty (P)
- Always advocate for quality patient care (P)
KEY: PC – Patient Care; MK – Medical Knowledge; PBL – Practice-Based Learning; ICS – Interpersonal & Communication Skills; P – Professionalism; SBP – System-Based Practice. Please refer to Section VI of this manual for a full description of ACGME’s Core and General Competencies.
Evaluations:
The residents will receive a core competency-based evaluation by the supervising attending following his/her 4-week rotation in the Neurologic ICU. The review will be forwarded to the Program Director and will become part of the formal semi-annual resident evaluation process. Immediate problems or areas of concern will be discussed as necessary on a case-by-case basis. The resident will evaluate the rotation via the web-based system. This evaluation will become part of the annual review of the program that will be reviewed by the Program Director.
Survival Tips:
Readings:
On Call Neurology, Second Edition. Randolph Marshall, MD & Stephan Mayer, MD, Saunders.
Emergency Medicine Concepts and Clinical Practice, Rosen 5th Edition, Mosby.
Emergency Medicine: A Comprehensive Study Guide, Tintinalli 5th Edition, McGraw Hill.