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Responsibilities:

1) First-contact for Neurology Patients in the Neuro-ICU

2) Neuro-prognostication on any EC3 or other ICU patients; all neuro consults for intubated patients in ED

3) New for 2018-onward: Stroke pager coverage (M-F, 8am-5pm) for BOTH inpatient and ER stroke activations. On your weekend on, you are NOT responsible for stroke coverage.

  • If multiple strokes are activated, or an ICU patient is acutely ill, you may ask for help. First line = consult team (junior, then senior). Second line = inpatient team (junior, then senior).
  • If night float is taking care of an early morning stroke activation, you may (though are not obligated) help take over out of courtesy to allow them to leave in a timely fashion. Again, if you have an acutely ill ICU patient, that takes priority.

4) If a patient is admitted from the ED or from another team, the CONSULT TEAM writes initial H&P and orders while filling you in on the story; if they are an OSH transfer or transferred from NICU neurosurgery service to NICU neurology service, then YOU write initial H&P and orders.  

5) You usually carry 1-3 patients at a time, though can sometimes have more if things are really busy. If you have zero patients, they may ask you to follow a Neurosurgery patient (though you don't write notes or orders on them... the neurosurgery intern does...you just present them on rounds and follow along). 


Schedule

Weekdays:

  • 7:30-8am: Arrive and take sign out from the night float resident in the 4A conference room. Pick up a stroke pager. Head to 4D
  • 8am - 9:30am: Pre-round on your neuro-ICU patients. Be ready to present (or have your medical student present) to the team.
  • 9:30am: ICU rounds with Intensivist Attending on both Neurology and Neurosurgery patients.
  • 8am - 5pm: Admit any neurology patients to the Neuro-ICU. As above, any ER patients are triaged by consult team while OSH transfers are triaged by NICU resident. If consult team is extremely busy and you are not, they are welcome to ask you to help on an ER patient if it is clear that this patient should go to the Neuro-ICU under the care of Neurology. After 5pm, all ER and OSH NICU admissions should be handled by the dayfloat resident.
  • 5:30pm: New for 2018-onward: The daytime Neurology NICU resident signs out to both the night midlevel as well as the on-call Neurology resident. The signout to the midlevel should be the "real" signout (using the "Neurosurgery" context so it prints all together for them), the signout to the on-call resident can be quite brief. The midlevel will cover the NICU resident's pager. The on-call Neurology resident continues to have responsibility for all Neurology inpatients, they are just no longer first contact on the ICU Neurology patients.
    • Aaron Smith, pager 20086
    • Jana Barkman, pager 21622
    • Diane Gorham, pager 21802


Weekends:

  • 7:30-8am: Arrive and take sign out from the night float resident in the 4A conference room. Pick up a stroke pager. Head to 4D
  • 8am: Typically weekends there are not clearly designated ICU rounds. Start pre-rounding on your patients. At some point you should discuss your patients with the Neuro ICU attending on call to determine the plan for the day. 
  • Noon: You are allowed to sign out. ***Discuss with the NICU attending on whom to sign out to:
    • Option 1: Sign out to the mid-level provider on for that day. 
    • Option 2: Sign out to the ward junior or dayfloat covering if there is not a mid-level assigned to work that weekend day.


Days Off:

  • These should be arranged in conjunction with the NICU fellow on-call (either Larry Morgan or Shahid Ahmad ("Shaz")). 
  • Typically, you get 1 weekend off during your 14 day shift.





GCS

  • Ranges 3-15
  • Eye opening:
    • 4 - spontaneous
    • 3 - response to verbal command
    • 2 - response to pain
    • 1 - none
  • Verbal response:
    • 5 - oriented
    • 4 - confused
    • 3 - inappropriate words
    • 2 - incomprehensible sounds
    • 1 - none
  • Motor response:
    • 6 - obeys commands
    • 5 - localizing to pain
    • 4 - withdrawing to pain
    • 3 - flexion (decorticate)
    • 2 - extensor (decerebrate)
    • 1 - none


Post-cardiac arrest neuroprognostication guidelines

Closed NICU Procedure

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