The Allan H. Ropper Neuro-ICU Service handles all ICU level inpatient neurology care in the hospital. The Neuro-ICU is a 22 bed unit located on 9C and 9D. There will be neurosurgical patients in the Neuro-ICU as well (covered by a separate team). The Neurology ICU team cares for patients in critical condition due to a neurologic problem or those with neurologic problems that require ICU level monitoring. It is an excellent opportunity to learn about the ICU management of neurologic and medical issues. Many of the patients are intubated and have multiple system problems. It is also an excellent opportunity to learn about the ethical issues and attend family meetings. You will gain experience taking a history, performing a neurologic examination, including a coma exam, localizing the lesion, and formulating the differential diagnosis, and diagnostic and therapeutic plan.
The team consists of an attending, a fellow in stroke or neuro-critical care, PGY 3 resident, a PGY 2 resident, and 1-2 students. Due to the structure of the service, the students may have limited interaction with the attending and will be rounding primarily with the fellow.
The residents and student admit any new patients or transferred patients on a daily basis. Although the student is on call q4, there is the possibility the student will admit patients on a more frequent basis.
As a student on the service, you should have 1-2 patients that you are following. You should accumulate all the important data and history and perform an examination of the patient. You should write out a detailed H&P and present them to your resident. The resident will also see the patient themselves and review and edit your recommendations as needed. Your note cannot substitute for the resident note.
You should produce a daily written note on all your patients. However, this note does not substitute for the resident’s note.
You should continue to follow up test results and accumulate on-going data on all your patients. The condition of patients in the ICU can change quickly and you should attempt to keep abreast of new developments.
Rounds with the fellow will occur daily. You should be prepared to present patients that you saw on rounds and to give updates on follow ups as well. You should be prepared to examine the patient in front of the other team members.
Common problems in the ICU:
Stroke (thromboembolic and hemorrhagic)
Neuro-muscular disorders with impaired respiratory function (e.g., MG, AIDP)
Systemic issues such as sepsis, difficult to control blood pressure, impaired respiratory function requiring ventilator support, renal failure