SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Describe the anatomy of the brain and spinal cord, identifying major external and internal structures, coverings, and fluid-filled spaces
2. Describe the anatomy of the brainstem, demonstrating knowledge of specific functions
3. Identify and describe the function of the cranial nerves
4. Illustrate cerebral arterial and venous vascular anatomy supply

INCLUDED TOPICS:

• Module 1: Neuroanatomy and Lesion Localization
• Module 2: Brainstem Anatomy and Localization

OPTIONAL RESOURCES:

• Neurosurgical Atlas
• Neuroanatomy

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Demonstrate knowledge of brain anatomy by accurately correlating the clinical presentation with the specific region of injury
2. Performs a detailed neurologic exam on an awake and oriented patient
3. Performs a detailed neurologic exam on patients with varying levels of consciousness, including the comatose patient
4. Perform rapid assessment and focused exam in neurologic emergency situations

INCLUDED TOPICS:

• Module 3: Anatomy and Pathology of the Brainstem, Basal Ganglia, and Thalamus
• The Pocket Guide to Neurocritical Care – Chapter 1: Coma Exam Components
• N-Case: NCS Advanced Nursing Neurological Assessment

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Summarize common etiologies of metabolic encephalopathy
2. Manage on patient with acute metabolic encephalopathy, with a focus on laboratory investigation and interpretation

INCLUDED TOPICS:

• ON CALL topic on Metabolic Encephalopathies and Delirium

OPTIONAL RESOURCES:

• Pocket Guide to Neurocritical Care - Chapter 18: Acid-Base and Electrolyte Disturbances
• Pocket Guide to Neurocritical Care-Chapter 5: Multidisciplinary Care in the NCCU
• 2020 NCS Position Statement on the Nomenclature of Delirium and Acute Encephalopathy
• PONS Presentation: Substance Withdrawal in Neurocritical Care

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Manage two patients presenting with AIS syndromes, providing rapid evaluation and determination of eligibility for acute stroke interventions, including pharmacologic treatments and endovascular approaches
2. Manage two patients presenting with AIS, providing a detailed neurological exam with a focus on localization of stroke symptoms and common clinical presentations of large vessel occlusions
3. Manage one patient presenting with AIS who received IV alteplase and developed hemorrhagic transformation within 24hrs, with a focus on appropriate reversal of IV alteplase
4. Manage one patient presenting with AIS who develops malignant cerebral edema, with a focus on medical management with hypertonic/hyperosmolar therapies and decompressive hemicraniectomy

INCLUDED TOPICS:

• ENLS Acute Ischemic Stroke: Protocol
• ENLS Acute Ischemic Stroke: Manuscript
• ON CALL topic on Acute Ischemic Stroke
• Pocket Guide to Neurocritical Care - Chapter 10: Ischemic Stroke

OPTIONAL RESOURCES:

• NCS Guideline: Evidence-based Guidelines for the Management of Large Hemispheric Infarction
• PONS Presentation: Alteplase for Acute Ischemic Stroke: Updates & Issues
• PONS Presentation: Indications and Considerations for the Use of Antiplatelet Agents in Neurocritical Care
• PONS Presentation:  Alteplase for Acute Ischemic Stroke
• NCS Guideline: Evidence-based Guidelines for the Management of Large Hemispheric Infarction

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Evaluate neuroimaging on one patient presenting with ICH, calculating ICH score and determining bleed stability
2. Manage one patient presenting with ICH and hypertension, with a focus on acute blood pressure management
3. Manage one patient presenting with coagulopathy related ICH, applying appropriate pharmacological reversal agents

INCLUDED TOPICS:

• Emergency Neurological Life Support (ENLS) Intracerebral Hemorrhage Protocol
• ENLS Intracerebral Hemorrhage Manuscript
• Neurocritical Care ON CALL topic on Intracerebral Hemorrhage
• The Pocket Guide to Neurocritical Care - Chapter 8: Intracerebral Hemorrhage

OPTIONAL RESOURCES:

• PONS Presentation: Acute Blood Pressure Control Following ICH
• PONS Presentation: Beyond the Horizon: Exploring the Next Frontier in Anticoagulation Reversal
• PONS Presentation: LDL in Intracerebral Hemorrhage: How Low Can You Go?
• 2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage
• NCS Guideline: Guideline for Reversal of Antithrombotic in Intracranial Hemorrhage

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Manage one patient presenting with SAH and hypertension, with a focus on pre-aneurysm securement
2. Demonstrate determination of the Hunt and Hess Scale and modified Fisher Scale scores
3. Manage one patient presenting with SAH, after aneurysm securement who develop delayed cerebral ischemia with a focus on the medical management of symptomatic vasospasm

INCLUDED TOPICS:

• Emergency Neurological Life Support (ENLS) Subarachnoid Hemorrhage Protocol
• ENLS Subarachnoid Hemorrhage Manuscript
• Neurocritical Care ON CALL topic on Subarachnoid Hemorrhage
• The Pocket Guide to Neurocritical Care – Chapter 9: Subarachnoid Hemorrhage

OPTIONAL RESOURCES:

• PONS Presentation: Reversible Cerebral Vasoconstrictive Syndrome (RCVS)
• PONS Presentation: Non-Opioid Options for Treating Subarachnoid Hemorrhage (SAH) Induced Headache
• 2023 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Interpret CSF profiles for bacterial meningitis, viral meningitis, herpes encephalitis, and subarachnoid hemorrhage
2. Prescribe antibiotics for suspected meningitis based on patient characteristics

INCLUDED TOPICS:

• ENLS Meningitis and Encephalitis: Protocol
• ENLS Meningitis and Encephalitis: Manuscript
• ON CALL topic on Neuroinfectious Diseases
• Pocket Guide to Neurocritical Care - Chapter 12: Meningitis and Encephalitis

OPTIONAL RESOURCES:

• PONS Presentation: Managing Autoimmune Encephalitis

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Identify first and second line AEDs for utilization in the critical care environment, including dosing, and adverse effects
2. Manage one patient in status epilepticus including appropriate selection and up titration of anti-epileptic drugs
3. Discuss role of continuous electroencephalographic (cEEG) monitoring in a patient presenting with status epilepticus

INCLUDED TOPICS:

• ENLS Status Epilepticus: Protocol
• ENLS Status Epilepticus: Manuscript
• ON CALL topic on Seizures and Epilepsy
• Pocket Guide to Neurocritical Care - Chapter 10: Status Epilepticus

OPTIONAL RESOURCES:

• PONS Presentation: Management of Status Epilepticus
• PONS Presentation: Management of Super Refractory Status Epilepticus

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

1. Interpret measurements of cerebral perfusion, intracranial pressure, and brain oxygen monitoring
2. Recognize both clinical and hemodynamic changes seen in two patients at risk for herniation
3. Illustrate appropriate treatment algorithm utilized for cerebral herniation

INCLUDED TOPICS:

• ENLS Intracranial Hypertension and Herniation: Protocol
• ENLS Intracranial Hypertension and Herniation: Manuscript
• Pocket Guide to Neurocritical Care – Chapter 6: Elevated ICP & Hydrocephalus
• Presentation: Neuro-oncology in the Neuro ICU: Background, Epidemiology and Grading

OPTIONAL RESOURCES:

• PONS Presentation: Osmotic Therapy for Elevated Intracranial Pressure
• NCS Guideline: Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

SUGGESTED COMPETENCIES:

To show competency in this topic area, learners should be able to demonstrate the following to their hospital preceptor or program director:

Differentiate different types of neuroimaging modalities, selecting appropriate image technique for diagnosis and assessment of neurological injury.

A. Computed Tomography (CT)
B. Computed Tomography Angiography (CTA)
C. Computed Tomography Venography (CTV)
D. Computed Tomography Perfusion (CTP)
E. Cerebral Angiogram
F. Magnetic Resonance Imaging (MRI)
G. Magnetic Resonance Angiography (MRA)
H. Transcranial Doppler (TCD)

INCLUDED TOPICS:

• Module 4: Neuroradiology and Neuroanatomy for Advance Practice Providers
• N-Case: NCS Basic Neuroimaging for Stroke: What All Nurses Need to Know

OPTIONAL RESOURCES:

• Radiopaedia
• POCUS Webinar: Pathology Review Cranial & TCD Cases