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Table 3: Take-home points for new staff and unique-versus-generic aspects of stroke care in the Neuro-ICUa
Most Important Teaching Points (Take-Home Points) for New Team Members Unique Characteristics of the Neuro-ICU Environment (Not Ideal Tasks for New Team Members) Generic Aspects of the Neuro-ICU Environment That Are Similar to Those in Other Medical Areas (Appropriate Initial Tasks for New Team Members) Key components of neuromonitoring (vital signs, neurologic vital signs: pupils, Glasgow Coma Scale, intracranial pressure, NIHSS score, and so forth) Resuscitation of unstable patient on initial presentation or with complications (eg, procedures surrounding airway management, status epilepticus treatment, intracranial pressure/herniation treatment, shock management, and so forth) Monitoring vital parameters, level of consciousness, and respiratory parameters of nonintubated patients Recognizing potential life-threatening complications Monitoring patients on invasive or noninvasive positive pressure ventilation Management of enteral feeds and IV fluids Location of key equipment (code cart, difficult airway cart) and medications Care and use of arterial and central lines, administration of vasopressors Basic medication administration (may include managing alteplase/tenecteplase infusions, depending on background) Team members and rolesChain of help, contact information (pager/phone)Examples: ICU buddy team member (RN, RT, pharmacist, and so forth), charge nurse, NCC/stroke fellow, NCC/stroke attending physician on call Use and interpretation of multimodal neuromonitoring:Intracranial pressure monitors (external ventricular drain)Cerebral oxygenation monitors: continuous brain tissue oxygenation, near-infrared spectroscopy, jugular venous catheterCerebral blood flow monitorsCerebral microdialysisContinuous electroencephalography Placement and care of nasogastric/orogastric tube, IV line, Foley catheter, and so forth Key elements of AIS/ICH/SAH management (see also Table 4), basic and advanced life support Brain death assessments and management Bathing, turning, mobilizing patients Organ donation: donation after circulatory death or donation after neurologic death Charting/documentation of patient course Palliation, depending on circumstances; for patients with COVID-19, institutions may have unique policies for automatic do-not-resuscitate orders or care limitations that incorporate neurologic prognosis formation
Note:—RN indicates registered nurse; RT, respiratory therapist; NCC, neurocritical care; AIS, acute ischemic stroke; ICH, intracerebral hemorrhage.
↵a For specific Neuro-ICU take-home points for the management of patients with acute ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage, see On-line Table.