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The following are specific diseases, conditions, and clinical syndromes commonly managed by a neurointensivist:
A. Cerebrovascular Diseases
1. Infarction and ischemia
Massive hemispheric infarction
Basilar artery occlusion and stenosis
Carotid artery occlusion and stenosis
Occlusive vasculopathies (Moya-Moya, sickle cell)
Spinal cord infarction
2. Intracerebral hemorrhage
3. Subarachnoid hemorrhage - aneurysmal and other Vascular malformations
Developmental venous anomalies
4. Dural sinus thrombosis
5. Carotid-cavernous fistulae
6. Cervical and cerebral arterial dissections
1. Traumatic brain injury
"Diffuse axonal injury"
Contusions and lacerations
Penetrating craniocerebral injuries
Traumatic subarachnoid hemorrhage
2. Spinal cord injury
Traumatic injury (transection, contusion, concussion)
Vertebral fracture and ligamentous instability
C. Disorders, Diseases, Seizures, and Epilepsy
1 . Seizures and epilepsy
Status epilepticus (SE) Convulsive
Non-convulsive (partial-complex and "subtle" secondarily generalized SE) Myoclonic
2. Neuromuscular diseases
Rhabdomyolysis and toxic myopathies
Critical illness myopathy and neuropathy
Encephalitis (viral, bacterial, parasitic)
Meningitis (viral, bacterial, parasitic)
Brain and spinal epidural abscess
4. Toxic-metabolic disorders
Neuroleptic malignant syndrome/malignant hyperthermia
Drug overdose and withdrawal (e.g., barbiturates, narcotics, alcohol, cocaine, acetaminophen).
Temperature related injuries (hyperthermia, hypothermia)
5. Inflammatory and demyelinating diseases
Multiple sclerosis (Marburg variant, transverse myelitis)
Acute disseminated encephalomyelitis (ADEM)
Chemical or sterile meningitis (i.e. posterior fossa syndrome, NSAID induced)
Central pontine myelinolysis
6. Neuroendocrine disorders
Diabetes insipidus (including triple phase response)
Thyroid storm and coma
1 . Brain tumors and metastases
2. Spinal cord tumors and metastases
3. Carcinomatous meningitis
4. Paraneoplastic syndromes
1. Eclampsia, including HELLP Syndrome
2. Hypertensive encephalopathy
3. Hepatic encephalopathy
4. Uremic encephalopathy
5. Hypoxic-ischemic and anoxic encephalopathy
2. Herniation syndromes with monitoring & ICP
3. Elevated intracranial pressure and Intracranial hypotension/hypovolemia
4. Hydrocephalus detection & treatment
5. Cord compression
6. Death by neurologic criteria, end of life issues, and organ donation
7. Vegetative state
8. Dysautonomia (cardiovascular instability, central fever, hyperventilation)
9. Reversible posterior leukoencephalopathy
10. Psychiatric emergencies (psychosis)
G. Perioperative Neurosurgical Care
II. General Critical Care: Pathology, Pathophysiology, and Therapy
A. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy
1. Shock (hypotension) and its complications (vasodilatory and cardiogenic)
2. Myocardial infarction and unstable coronary syndromes
3. Neurogenic cardiac disturbances (ECG changes, stunned myocardium)
4. Cardiac rhythm and conduction disturbances; use of antiarrhythmic medications; indications for and types of
5. Pulmonary embolism
6. Pulmonary edema: cardiogenic versus noncardiogenic (including neurogenic)
7. Acute aortic and peripheral vascular disorders (dissection, pseudoaneurysm)
8. Recognition, evaluation and management of hypertensive emergencies and urgencies
9. Calculation of derived cardiovascular parameters, including systemic and pulmonary vascular resistance,
alveolararterial gradients, oxygen transport and consumption
B.Respiratory Physiology, Pathology, Pathophysiology and Therapy
1.Acute respiratory failure
Hypoxemic respiratory failure (including ARDS)
Hypercapnic respiratory failure
Neuromuscular respiratory failure
3. Bronchopulmonary infections
4. Upper airway obstruction
5. COPD and status asthmaticus, including bronchodilator therapy
6. Neurogenic breathing patterns (central hyperventilation, Cheyne-Stokes respirations)
7. Mechanical ventilation
Positive pressure ventilation (BIPAP)
PEEP, CPAP, inverse ratio ventilation, pressure support ventilation, pressure control, and non- invasive ventilation
Negative pressure ventilation
Barotrauma, airway pressures (including permissive hypercapnia)
Criteria for weaning and weaning techniques
8. Pleural Diseases
9. Pulmonary hemorrhage and massive hemoptysis
10. Chest X-ray interpretation
11. End tidal C02 monitoring
12. Sleep apnea
13. Control of breathing
C. Renal Physiology,Pathology, Pathophysiology and Therapy
1.Renal regulation of fluid and water balance and electrolytes
2.Renal failure: Prerenal, renal, and postrenal
3.Derangements secondary to alterations in osmolality and electrolytes
4. Acid-base disorders and their management
5.Principles of renal replacement therapy
6. Evaluation of oliguria and polyuria
7.Drug dosing in renal failure
8. Management of rhabdomyolysis
9. Neurogenic disorders of sodium and water regulation (cerebral salt wasting and SIADH).
D. Metabolic and Endocrine Effects of Critical Illness
1. Enteral and parenteral nutrition
Disorders of thyroid function (thyroid storm, myxedema coma, sick euthyroid syndrome)
Ketotic and hyperglycemic hyperosmolar coma Hypoglycemia
3. Disorders of calcium and magnesium balance
4. Systemic Inflammatory Response Syndrome (SIRS)
5. Fever, thermoregulation, and cooling techniques
E.Infectious Disease Physiology, Pathology, Pathophysiology and Therapy
2. Infection control for special care units
Development of antibiotic resistance
Isolation and reverse isolation
3. Tetanus and botulism
4. Hospital acquired and opportunistic infections in the critically ill
5. Acquired Immune Deficiency Syndrome (AIDS)
6. Evaluation of fever in the ICU patient
7. Central fever
8. Interpretation of antibiotic concentrations, sensitivities
F.Physiology, Pathology, Pathophysiology and therapy of Acute Hematologic Disorders
1 . Acute defects in hemostasis
Disseminated intravascular coagulation
Acute hemorrhage (GI hemorrhage, retroperitoneal hematoma)
Iatrogenic coagulopathies (warfarin and heparin induced)
2. Anticoagulation and fibrinolytic therapy
3. Principles of blood component therapy (blood, platelets, FFP)
4. Hemostatic therapy (vitamin K, aminocaproic acid, protamine, factor VIla)
5. Prophylaxis against thromboembolic disease
6. Prothrombotic states
G. Physiology, Pathology, Pathophysiology and Therapy of Acute Gastrointestinal (GI) and Genitourinary (GU)
1. Upper and lower gastrointestinal bleeding
2. Acute and fulminant hepatic failure (including drug dosing)
3. Ileus and toxic megacolon
4. Acute perforations of the gastrointestinal tract
5. Acute vascular disorders of the intestine, including mesenteric infarction
6. Acute intestinal obstruction, volvulus
8. Obstructive uropathy, acute urinary retention
9. Urinary tract bleeding
H. Immunology and Transplantation
1. Principles of transplantation (brain death, organ donation, procurement, maintenance of organ donors, implantation)
2. Immunosuppression, especially the neurotoxicity of these agents
I. General Trauma and Burns
1. Initial approach to the management of multisystem trauma
2. Skeletal trauma including the spine and pelvis
3. Chest and abdominal trauma - blunt and penetrating
4. Burns and electrical injury
2. Prognostic, disease severity and therapeutic intervention scores
3. Principles of electrocardiographic monitoring
4. Invasive hemodynamic monitoring
5. Noninvasive hemodynamic monitoring
6. Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space,
compliance, resistance, capnography)
7. Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient)
8. Use of computers in critical care units for multimodality monitoring
K. Administrative and Management Principles and Techniques
1. Organization and staffing of critical care units
2. Collaborative practice principles, including multidisciplinary rounds and management
3. Emergency medical systems in prehospital care
4. Performance improvement, principles and practices
5. Principles of triage and resource allocation, bed management
6. Medical economics: health care reimbursement, budget development
L. Ethical and Legal Aspects of Critical Care Medicine
1. Death and dying
2. Forgoing life-sustaining treatment and orders not to resuscitate
3. Rights of patients, the right to refuse treatment
4. Living wills, advance directives; durable power of attorney
5. Terminal extubation and palliative care
6. Rationing and cost containment
7. Emotional management of patients, families and caregivers
8. Futility of care and the family in denial
M. Principles of Research in Critical Care
1. Study design
3. Grant funding and protocol writing
4. Manuscript preparation
5. Presentation preparation and skills
6. Institutional Review Boards and HIPAA
Ill. Procedural Skills
A. General Neuro-Critical Care
1 . Central venous catheter placement; dialysis catheter placement
2. Pulmonary artery catheterization
3. Management of mechanical ventilation, including CPAP/BiPAP ventilation
4. Administration of vasoactive medications (hemodynamic augmentation and hypertension lysis)
5. Maintenance airway and ventilation in nonintubated, unconscious patients
6. Interpretation and performance of bedside pulmonary function tests
7. Direct laryngoscopy
8. Endotracheal intubation
9. Shunt and ventricular drain tap for CSF sampling
10. Performance and interpretation of transcranial Doppler
11. Administration of analgosedative medications, including conscious sedation and barbiturate anesthesia
12. Interpretation of continuous EEG monitoring
13. Interpretation and management of ICP and CPP data
14. Jugular venous bulb catheterization
15. Interpretation of Sjv02 and Pbt02 data
16. Management of external ventricular drains
I 7. Management of plasmapheresis and IVIG
18. Administration of intravenous and intraventricular thrombolysis
19. Interpretation of CT and MR standard neuroimaging and perfusion studies and biplane contrast neuraxial
20. Perioperative and postoperative clinical evaluation of neurosurgical and interventional neuroradiology patients
21. Performance of lumbar puncture and interpretation of cerebrospinal fluid results
22. Induction and maintenance of therapeutic coma and hypothermia
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STOCKHOLM, Jan. 12, 2021 /PRNewswire/ -- IRRAS AB, a commercial-stage clinical know-how business with a comprehensive portfolio of resourceful items for neurocritical care, today announced a collaboration contract with Karolinska tuition clinic, a global-classification medical facility, that comprises the initiation of an assessment of IRRAflow, the enterprise's lead commercial product.
Peter Alpkvist, Neurosurgeon and head of Neurosurgical Intensive Care Unit (NICU) at Karolinska university health center, comments, "we are excited to convey an imaginative, next-technology solution for the medication of intracranial bleeding to their neurocritical care patients."
"we're completely satisfied and excited to have this collaboration agreement completed and look ahead to having the realm's first irrigating ventricular drainage gadget obtainable to the clinical group at the neurosurgery department of Karolinska university medical institution," mentioned Coenraad Tamse, vice chairman of overseas sales at IRRAS.
"This partnership makes it possible for us to accelerate industrial launches within the Nordic region whereas working intently with a leading facility and scientific experts," added Edmond Malek, IRRAS' Nordic nation earnings Head.
About Karolinska institution sanatorium
Karolinska college medical institution is one of Scandinavia's premier fitness amenities and considered one of Europe's biggest teaching hospitals. Their capabilities encompass fitness care for disorders starting from essential public fitness diseases to rare clinical situations. in the Stockholm vicinity, they are a designated company of incredibly specialized medical services. Karolinska school health facility additionally serve many sufferers from different constituents of Sweden and from other nations all over the world. because the county council's teaching medical institution, Karolinska university clinic has a main responsibility for the scientific accessories of research and schooling. at the side of the area-revered Karolinska Institutet, they lead in scientific breakthroughs in Sweden. They consider that affected person care, analysis, and training need to all play equally amazing roles in its effort to extend and increase americans's lives. As an enormous educating health facility they and train tomorrow's clinical experts and healthcare experts.
IRRAS is a world medical care business concentrated on supplying resourceful scientific options to enhance the lives of severely ill sufferers. IRRAS designs, develops, and commercializes neurocritical care products that transform affected person effects and reduce the overall can charge of care by using addressing problems linked to present treatment methodologies. IRRAS markets and sells its finished, imaginitive IRRAflow and Hummingbird ICP Monitoring product traces to hospitals worldwide through its direct income corporation in the united states and select European countries as well as a global network of distribution companions.
IRRAS keeps its headquarters in Stockholm, Sweden, with company offices in Munich, Germany, and San Diego, California, united states of america.Β For greater suggestions, please discuss with www.irras.com.
IRRAS is listed on Nasdaq Stockholm (TICKER:IRRAS).
For extra counsel, please contact:
u . s .
Kleanthis G. Xanthopoulos, Ph.D.
+46 seventy three 951 95 email@example.com
The counsel become released for public disclosure, in the course of the agency of the contact person above, on January 12, 2021 at 08:00 (CET).
This guidance changed into brought to you by means of Cision http://news.cision.com
View common content:http://www.prnewswire.com/news-releases/irras-announces-collaboration-with-karolinska-college-clinic-301205965.html
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