Introduction
Pediatric neurologists’ participation in the delivery of critical care to patients with neurologic disease is a frequent expectation at many academic centers. An understanding of the fundamental principles guiding neurocritical care of pediatric patients is increasingly important, especially in light of the recent advancing knowledge in the field. This elective rotation allows for an immersive experience in the pediatric ICU with an emphasis on the delivery of evidence-based neurocritical care. Though PICU patients with neurologic disease are frequently encountered on the Pediatric Neurology Inpatient Consult service, this elective rotation will allow for a deeper dive into the interplay of management of neurologic disease and elements of critical care generally not scrutinized by consulting pediatric neurologists.
Schedule
The schedule for this week-long inpatient elective will be determined in accordance with Dr. Munjal in the weeks preceding the elective. Coordinating this elective when Dr. Munjal is the PICU service attending is preferred. Early coordination of this elective is therefore necessary.
Child Neurology residents are expected to be present for AM fellow sign out in order to familiarize themselves with patients with neurologic disease admitted to the PICU. PICU AM signout is at 07:00am, rounds begin at 08:30am and afternoon sign out occurs at 5:00pm. There are no call responsibilities during this rotation. Brain Care clinic occurs on Thursday afternoons at the Waisman Center. If able, residents should attend that clinic with the PICU staff. Additional neurocritical care learning resources will be available for review during the elective, specifically if the neurocritical care patient census is low.
Patient Care
Goals
Residents must demonstrate the ability to provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for treatment of neurological problems and the promotion of critically ill children with neurologic disease.
Objectives
Demonstrate proficiency in gathering a history and physical on patients with neurologic disorders in the PICU.
Apply relevant clinical pathways to the care delivery in patients in the PICU (e.g. Post TBI management, status epilepticus, pediatric stroke, brain death).
Recognize the importance of continuity of care and outpatient follow up for patients with brain injury and continuum of care between fetal consult and NICU stay in patients with predetermined neurologic disease and appropriate apply plans made for those patients.
Medical knowledge
Goals
Residents will know, critically evaluate and use current medical information and scientific evidence for patient care.
Objectives
Describe the pathologic basis of fundamental disorders of pediatric neurocritical care including (but not limited to) status epilepticus, traumatic brain injury, pediatric stroke/intracranial hemorrhage, CNS neoplasms and infection.
Summarize neuroprotective strategies for patients with brain injury and those at risk for secondary brain injury.
Gain familiarity with treatment approaches for the common diagnoses encountered in the PICU including seizures/status epilepticus, traumatic brain injury, elevated intracranial pressure, neuromuscular disease, etc.
Use continuous EEG and quantitative EEG to support decision making in the PICU.
Employ the use of multimodal monitoring in pediatric neurocritical care patients. Gain familiarity with both invasive (e.g. EVD, intraparenchymal monitor) and non-invasive (e.g. automated pupillometer, qEEG, cerebral NIRS, TCD) techniques for neuromonitoring.
Demonstrate an understanding of the physiological underpinnings of testing for death by neurological criteria and comfort with the indications and use of ancillary studies for death by neurological criteria.
Interpersonal Communication
Goals
Demonstrate excellent communication skills by partnering with the multidisciplinary neurocritical care team aiming to provide timely patient care with complete and prompt documentation.
Demonstrate active listening as well as empathetic and comprehensive counseling to families of patients in the PICU.
Objectives
Effectively communicate with patient’s families regarding relevant clinical information and deliver prognoses in a compassionate manor.
Interface with the multidisciplinary team by participating in daily rounds and family care conferences.
Maintain comprehensive, accurate and timely medical records.
Practice-Based Learning and Improvement
Goals
Identify opportunities for improvement in the delivery of quality of patient care
Objectives
Integrate feedback from supervising faculty and other teams into practice.
Reference to the literature about evidence-based practice pertinent to neurocritical care.
Professionalism
Goals
Residents will demonstrate ongoing self-education and habits of life-long learning.
Objectives
Residents will maintain the highest standards of professionalism, especially in interactions with patients and PICU faculty and staff. The resident will be responsible for tracking duty hours and reporting them to the supervisory attending.
Systems-Based Practice
Goals
Residents will recognize that they are part of a multidisciplinary team and the complexity required to coordinate care across multiple subspecialties.
Objectives
Demonstrate ability to deliver thoughtful, and quality base care by considering cost and allocation of resources in the PICU.
Recognize barriers to care for patients following discharge and leverage resources to improve likelihood of appropriate follow up.
Latest Revision: 7/1/2024, Adam Wallace, MD
