Leading Insights

Diversity, Equity, Inclusion, Belonging and Nurses: Embracing the Mission of the HEARD Center

Written By: Jordan Yakoby, EdD, DNP, ACNP-BC, FNYAM, FCCM, FNCS

Recently, some groups have challenged various initiatives related to diversity, equity, inclusion, and belonging (DEI), with so called...

Leading Insights

A Neurocritical Care Perspective on the Effects of Wildfires

Written By: Peter Papadakos, MD, FCCM, FAARC, FCCP

The massive wildfires that impacted the Los Angeles area destroyed over 10,000 structures and affected hundreds of thousands of individuals.

Leading Insights, Ethics

The Ethics of Unionization for America’s Healthcare Workers: How and Why We Got to This Moment

Written By: Richard Choi, DO, FNCS; Jamie Nicole LaBuzetta, MD, MSc, MPhil; Mitch Hargis, MD

The quality of care that American healthcare workers provide has many new practical and theoretical challenges. These include persistent...

Leading Insights

Global Health Helps Achieve the Unimaginable

Written By: Lucia Rivera Lara, MD; Jose Kuzli, MD

“Alone we can do so little, together we can do so much” – Helen Keller The power of a team that Helen Keller so famously...

Leading Insights, POCUS

Role of Point-of-Care Ultrasound in Evaluation for Pneumothorax

Written By: Stuart Brill , DO; Georgina Ang, MD; Jon Rosenberg

A 70-year-old man presented to the hospital with a right frontal intracerebral hemorrhage (ICH score 3) with intraventricular hemorrhage, mass...

Leading Insights, Ethics

Errors of Omission or Commission: Examining the Decision to Withhold Intensive Therapies

Written By: Matthew N. Jaffa, MD; Alexandra S. Reynolds, MD

We have all likely encountered the case of a patient stricken by severe acute neurologic injury (SANI) for which the neurosurgical team’s...

Leading Insights

A Looming Crisis in Neurocritical Care Due to Hospital Closings

Written By: Peter Papadakos, MD, FCCM, FAARC, FCCP

Over the last few years, many hospitals and clinics have been forced to close due to staffing, low reimbursement rates, and increasing operational...

Leading Insights, Pharmacy

Making a Case for Ketamine in Pediatric Status Epilepticus

Written By: Nicolas Chiriboga, MD; Renad Abu-Sawwa, PharmD, BCPPS

Status epilepticus (SE) is one of the most common neurological emergencies in children, with 23 cases per 100,000 children and a mortality of up...

Leading Insights

The Role of Nurses in Managing Severe Hyponatremia and Preventing Central Pontine Myelinolysis

Written By: Jordan Yakoby, EdD, DNP, ACNP-BC, FNYAM, FCCM, FNCS

The role of nurses in monitoring patients’ clinical condition and laboratory results is critical in preventing complications from overly...

Leading Insights

The Curing Coma Campaign’s 5th Anniversary Town Hall

Written By: Shradda Mainali, MD; Daiwai Olson, PhD, RN; Claude Hemphill, MD, MAS; Len Polizzotto; Jose Suarez, MD; Keri Kim

The Curing Coma Campaign (CCC) celebrated its 5th anniversary during the 2024 Neurocritical Care Society (NCS) Annual Meeting with a comprehensive...

Leading Insights

The Magnetic Power of the Future: The Iseult CEA 11.7 T MRI

Written By: Shane Musick, MD; Nilufer Yalcin, MD

The Iseult CEA 11.7 Tesla (T) MRI machine marks a significant leap forward in magnetic resonance imaging, offering unmatched magnetic field...

Leading Insights, Ethics

Who Invited Legal Into the Peer Review Conference?

Written By: Krista Lim-Hing, MD; Alexandra Reynolds, MD; Daryl McHugh, MD; Julia Durrant, MD; Matthew N. Jaffa, DO

When asking physicians to reflect on their years of medical training, it is rare to find one without a formative memory connected to a morbidity...

Leading Insights

Tricks of the Trade: A Stepwise Approach to Managing Post-TBI Agitation

Written By: Christine Picinich, MS, AGACNP-BC, CCRN

Patients with traumatic brain injury (TBI) commonly develop agitation during their recovery.

Leading Insights

Beyond Survival: Mapping Recovery Paths After Cardiac Arrest in the POST-ICECAP Study

Written By: Sachin Agarwal, MD, MPH; Natalie Fisher, MS; Liz O’Donohue, MPH; Danielle A. Rojas, MS; Romergryko G. Geocadin, MD; Clifton W. Callaway, MD, PhD

Out-of-hospital cardiac arrest (OHCA) represents a critical medical emergency with high immediate mortality rates, but survival rates have...

Leading Insights

Examining Perceptions of Racism: Ebonye Green’s Insights and Preview of Her NCS 22nd Annual Meeting Presentation

Written By: Ebonye Green, MNSc, APRN, FNCS, UAMS

In this insightful Q&A, NCS editorial staff dives into a conversation with Ebonye Green, DNP, APRN, FNCS, who will be presenting...

Leading Insights

Resilience and Revolution: John Moon's Journey and His NCS 22nd Annual Meeting Keynote Session

Written By: John Moon, (retired) Freedom House Emergency Medical Technician, Assistant Chief of Pittsburgh Emergency Medical Service; Rachel Schollmeier, NCS Currents Editorial Staff

In a candid interview, Rachel Schollmeier, NCS Currents Editorial Staff member, sits down with John Moon, (retired) Freedom House Emergency...

Leading Insights, Business of Neurocritical Care

The Business of Neurocritical Care: Understanding Physician Benefits

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM, FAAN

In general, when most neurointensivists look into selecting a job, we focus on the job requirements (schedule, call, support from APPs and...

Leading Insights, Ethics

Behavioral Safety & Patient Alerts in the EMR: Helpful or Harmful?

Written By: Vishal N. Patel, MD; Julia Durrant, MD; Krista Lim-Hing, MD; Matthew N. Jaffa, DO

A 48-year-old African American man with a previous history of poly-substance abuse, traumatic brain injury, epilepsy, and behavioral issues with...

Leading Insights

Brain-Computer Interfaces in Neurocritical Care: The Layer 7 Cortical Interface

Written By: Benjamin Rapoport, MD, PhD, Chief Science Officer and Co-founder of Precision Neuroscience; Jackie Dister, Clinical Research Lead at Precision Neuroscience

Dr. Ben Rapoport, Chief Science Officer and co-founder of Precision Neuroscience, and Jackie Dister, Clinical Research Lead at Precision...

Leading Insights

Unlocking Autonomy with Brain-Computer and Brain-Machine Interfaces: Current Insights and Future Frontiers

Written By: Shalane Morales-Nunez, MD; Nilufer Yalcin, MD

Brain-Computer Interfaces (BCIs) and Brain-Machine Interfaces (BMIs) are revolutionizing neuroscience and tech.

Leading Insights, Pharmacy

Cefepime’s Double-Edged Sword: Neurotoxicity in Critically Ill Patients

Written By: Michelle Payne, PharmD, BCCCP

As a fourth-generation anti-Pseudomonal cephalosporin, cefepime is one of the first-line antimicrobials used to treat various hospital-associated...

Leading Insights, POCUS

Transcranial Color Doppler in the Neuro-ICU

Written By: Brittany M. Kasturiarachi, DO

Transcranial Color Doppler (TCCD) ultrasound is a versatile imaging modality with multiple potential uses in the acute setting.

Leading Insights

Postgraduate Residencies and Fellowships in Neurocritical Care for Advanced Practice Providers

Written By: Jordan Yakoby, EdDc, DNP, MBA, ACNP-BC, CCRN, CNE, FCCM

With the growing aging population, healthcare leaders are increasingly concerned that the demand for services will soon exceed supply, especially...

Leading Insights, POCUS

Autosomal Dominant Polycystic Kidney Disease in Aneurysmal Subarachnoid Hemorrhage

Written By: Brandon Lau, PA-C; Veronica Woods, PA-C; Laura Scholtz, MD

A 49-year-old man was in his usual state of health when he experienced sudden onset worst headache of life followed by right arm and leg weakness....

Leading Insights, Ethics

Patient Care in an Era of Drug Shortages

Written By: Peter Papadakos, MD, FCCM, FAARC, FCCP

One of the latest issues affecting our daily care of patients in the Neuro ICU is an ever-growing list of critical medications and intravenous...

Leading Insights

“Time Is Brain” for ICH Too!

Written By: Sasha Yakhkind, MD; Qi Li, MD PhD; Joshua Goldstein, MD PhD; Stephan Mayer, MD

Imagine you are a stroke clinician on call alone at night. Your pager goes off. Somehow, the jarring ringtone never fails to startle you....

Leading Insights

Innovation for Health Disparities Research in Hemorrhagic Stroke

Written By: Nirupama Yechoor, MD, MSc ; Rachel Forman, MD; Christine Fox, MD, MAS

As clinicians working with patients who have sustained an acute brain injury, we are naturally focused on caring for the injury itself.

Leading Insights

Neurocritical Care and the Need to Advocate for Safe E-Scooter Use

Written By: Peter Papadakos, MD, FCCM, FAARC, FCCP

We who care for patients in the Neuro ICU each day are sometimes the first to observe how certain recreational practices may lead to an increase...

Leading Insights, Ethics

Consent for Brain Death Determination: The Ends Justify the Means - or It Does Not

Written By: Clotilde Balucani, MD; Julia Durrant, MD; Richard K. Choi, DO

A 78-year-old woman has been admitted to the Neurocritical Care Unit. She arrived following a cardiac arrest in the setting of a Hunt and Hess 5...

Leading Insights, Business of Neurocritical Care

The Business of Neurocritical Care: Understanding Risk Adjustment Factor (RAF) Scores and Their Impact on Reimbursement

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM, FAAN

In an earlier article in this series, I discussed the importance of provider documentation in the H&P, especially the documentation of...

Leading Insights

Essentials of Advanced Practice Provider Orientation to the Neuro ICU

Written By: Jordan Yakoby, EdD, DNP, ACNP-BC, CCRN, CNE, FCCM, FNYAM

The transition into the advanced practice role has been historically difficult (Dillon et al., 2016; Pleshkan and Hussey, 2020).

Leading Insights

ChatGPT: Your AI Colleague – Embrace or Tolerate, It's Here to Stay

Written By: Keaton S. Smetana, PharmD, MBA, FNCS, FCCM

Our recent annual meeting beckoned us to envision "beyond the horizon," a call that echoed in discussions on technological advancements,...

Leading Insights, POCUS

Role of Point-of-Care Ultrasound in Lumbar Puncture

Written By: Earllondra Brooks, MD; Izn Shahab, MD; Gary Hunter, MD; Erika Sigman, MD

Despite major advances in neuroimaging, lumbar puncture (LP) remains a necessary diagnostic and therapeutic procedure for a variety of neurologic...

Leading Insights, Ethics

Medical Futility: An Ongoing and Evolving Challenge

Written By: Vishal N. Patel, MD; Krista Lim-Hing, MD; Richard K. Choi, DO; Matthew N. Jaffa, DO

A 78-year-old woman has been admitted to the Neurocritical Care Unit. She arrived following a cardiac arrest in the setting of a Hunt and Hess 5...

Leading Insights

Where Did My Beds Go?

Written By: Peter Papadakos, MD, FCCM, FAARC, FCCP

As all of us know, it has been increasingly difficult for us to place our neurocritical care patients in post-acute facilities after discharge...

Leading Insights

Nurse Staffing: A Public Health Crisis in the Making

Written By: Jordan Yakoby, EdDc, DNP, MBA, ACNP-BC, CCRN, CNE, FCCM

The phenomenon of burnout has been well documented pre-pandemic, in many cases due to understaffing. This was exacerbated by the severe strain of...

Leading Insights, POCUS

Point of Care Ultrasound Education in Neurocritical Care: A Call to Action

Written By: Thanujaa Subramaniam, MD; Toufic Chaaban, MD; Judy Ch’ang, MD; Aarti Sarwal, MD; Atul Kalanuria, MD, FACP, MHCI

Post-intensive care clinics following admission to the intensive care unit (ICU) have gained significant traction in recent years across the...

Leading Insights

NeuroRecovery: Understanding the Landscape of Post-NeuroICU Clinics

Written By: Matthew Jaffa, DO; Julia Carlson, MD

Post-intensive care clinics following admission to the intensive care unit (ICU) have gained significant traction in recent years across the...

Leading Insights

Violence in the Healthcare Setting: A New Pandemic

Written By: Peter Papadakos, MD, FCCM, FAARC, FCCP

Safety in healthcare settings has always been a top priority in our daily workspace, be it against infection, occupational injury, or attacks...

Leading Insights, POCUS

Early Diagnosis of Tricuspid Valve Infective Endocarditis by Point of Care Ultrasonography

Written By: Anne Borja, PA-C

A 40-year-old female with unknown past medical history was brought in from a shelter, after she was found altered with right sided weakness. On...

Leading Insights

Advancing Health Equity in Acute Neurological Diseases and Neurocritical Care: The Path Forward

Written By: Hera Kamdar, MD; Minjee Kim, MD; Jennifer Kim, MD, PhD; Shraddha Mainali, MD; ROSC Currents Subcommittee

The pursuit and understanding of health equity is an integral guiding principle for quality and comprehensive healthcare. Health equity refers to...

Leading Insights, International

The Artificial Intelligence-Enhanced Management of Severe Traumatic Brain Injury (AIMS-TBI) Project: Bringing Data Science to the TBI Patient Bedside

Written By: Robert McNamara, FCICM; Andrew Udy, FCICM, PhD; Shiv Meka

As part of the Artificial Intelligence-Enhanced Management of Severe Traumatic Brain Injury (AIMS-TBI) project, up to ten trauma ICUs in Australia...

Leading Insights, Ethics

The Ethical Conundrums of Normothermic Regional Perfusion

Written By: Richard Choi, DO; Misti Tuppeny, MSN, APRN-CNS, CCRN, CNRN, CCNS; Alexandra Reynolds, MD

Heart transplantation has proven to be lifesaving for thousands of patients with advanced heart failure since its inception in 1967. Despite our...

Leading Insights, Business of Neurocritical Care

Business of Neurocritical Care: Billing Updates for 2023

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM

Just as 2022 restructured the rules associated with outpatient billing and documentation, January 1, 2023, begins with substantial changes that...

Leading Insights

The Tower of Babel: Translating the ICU-EEG Nomenclature in Spanish

Written By: Clio Rubinos, MD, MS; Andres Fernandez, MD, MSEd; Maria Jose Bruzzone, MD

In the last few decades, continuous electroencephalography (cEEG) has become increasingly adopted as part of the standard management of critically...

Leading Insights, Pharmacy

Cangrelor Use in Neurointerventional Radiology: Tackling the Unknowns

Written By: Catherine Donaldson, PharmD, PGY2 ; Veronica Bonderski, PharmD, BCCCP

The use of antiplatelet agents, such as P2Y12 inhibitors, is standard care in the management of numerous neurological pathologies and...

Leading Insights

La Torre de Babel: El Proceso de Traduccion de la Nomenclatura de EEG en la UCI

Written By: Clio Rubinos, MD, MS; Andres Fernandez, MD, MSEd; Maria Jose Bruzzone, MD

In the last few decades, continuous electroencephalography (cEEG) has become increasingly adopted as part of the standard management of critically...

Leading Insights

What Should Our Daughters Expect? A Neurointensivist’s and Mother’s Perspective

Written By: Sarah Nelson, MD, MPH

I am a neurointensivist who has cared for several gunshot wound victims and am also a new mother of a daughter. I feel these roles provide me with...

Leading Insights, Pharmacy

Communication After Isolation: The Challenge of Re-Engaging Family Members in Neurocritical Care

Written By: Elaina Etter, PharmD

Communication is a cornerstone of patient care. We are taught that patient-centered care requires trust, which can only be fostered if both...

Leading Insights

Neurocritical Care Outreach: Developing Programs to Help Underserved Communities

Written By: Peter Papadakos, MD

There is overwhelming public health data on the increased incidence of many common diseases in underserved communities, as well as a lack of...

Leading Insights

Estimating Left Ventricular Function With Bedside Echocardiography in a Stroke Patient

Written By: Bryan Boling, DNP, AGACNP; David Bacon, MD

A 67-year-old man presented to the Emergency Department with left-sided weakness and slurred speech. A CT head showed no acute abnormalities,...

Leading Insights, Pharmacy

Don’t Be Afraid of the Dark: Neurocritical Care Pharmacy at Night

Written By: Brittny Medenwald, PharmD, BCCCP; Jessie Lipstreuer, PharmD

Healthcare workers face unique challenges during evening and overnight hours: an abundance of unplanned intensive care unit (ICU) admissions,...

Leading Insights, Pharmacy

Transitioning Alteplase to Tenecteplase for Acute Ischemic Stroke

Written By: Brian Gilbert, PharmD, MBA, BCPS, BCCCP; Danielle Murray, PharmD; Peter Tran, PharmD; Kathryn Qualls, PharmD, BCPS, BCCCP

The transition from alteplase (ALT) to tenecteplase (TNK) in the management of acute ischemic stroke (AIS) has been an exciting and...

Leading Insights, Resident/Fellow

Pearls For Career Success: If I Only Knew What I Know Now

Written By: Paola Martinez, MD; Diana Alsbrook, MD; Stefanie Cappucci, MD; Shweta Goswami, MD; Eunice Lee, MD; Naomi Niznick, MD

The NCS Trainee Section has launched the second year of the Professional and Career Development Workshops Series. This interactive webinar series...

Leading Insights, Pharmacy

Bringing Neurocritical Care to Rural Virginia: Considerations When Transitioning to Tenecteplase for Acute Ischemic Stroke

Written By: Ashley Asbell, PharmD

In August 2022, I started a new job as a pharmacist at a small, rural community hospital not too far from where I trained. I completed two years...

Leading Insights

Saving the Brain (And Other Organs) After the Heart Stops

Written By: Sarah Livesay, DNP, APRN; Mary Kay Bader, RN, MSN; Karen Hirsch, MD; Romer Geocadin, MD

All who watched Monday Night Football this week were shocked and dismayed to witness Damar Hamlin collapse after experiencing a cardiac arrest,...

Leading Insights, Pharmacy

Please Pass the Salt: Rapid Access to Hypertonic Saline and Considerations During Shortage

Written By: Lindsey Coppiano, PharmD, BCCCP; Jessica Ringler, PharmD, BCCCP

Hypertonic solutions are high risk yet life-saving medications which can make the difference between a good or poor outcome during a neurologic...

Leading Insights, Ethics

The Nursing Code of Ethics and Patient Advocacy

Written By: Michelle Schober, MD, MS; Audrey Paulson, DNP, FNP-BC, CCRN, CNRN, SCRN

Ethical principles common to the various health care professions include the concepts of justice, nonmaleficence, beneficence, and autonomy. The...

Leading Insights, Pharmacy, Resident/Fellow

Invited Clinical Pharmacist (ICP) Program

Written By: Scott DeBoer, MD, PhD; Salia Farrokh, PharmD; Melissa Dang, PharmD

The ICP program was designed and implemented in 2017 to provide NCS members a venue to initiate or expand clinical pharmacy services in the neuro...

Leading Insights, POCUS

Incidental Finding of Hepatic Portal Venous Gas (HPVG) by Point of Care Ultrasonography

Written By: Mina Lee, PA-C

An 86-year-old male presented to our institution after a mechanical fall resulting in a large acute right-sided subdural hematoma with 1.5 cm...

Leading Insights

Will Isotonitazene Be Our New Overdose Crisis Drug?

Written By: Peter Papadakos, MD, FCCM, FCCP, FAARC, FNIV

The DEA Washington Division is warning local residents of a dangerous new drug emerging in the DC area that is as deadly as fentanyl. We as...

Leading Insights, Resident/Fellow

Mentorship That Matters: How to Foster a Successful Mentor-Mentee Team

Written By: Erin Wieruszewski, PharmD, R.Ph.; Hera Kamdar, MD, MBBS; Shraddha Mainali, MD; Jennifer Kim, MD

The NCS Trainee Section launched the Research Mentorship Program in 2017 with the primary objective of providing support and guidance for...

Leading Insights, International

Cuidados Neurointensivos en América Latina: Un Futuro Prometedor

Written By: Clio Rubinos, MD; Lia Franco Castro, MD; Jorge Mejia-Mantilla, MD

La primera unidad de cuidados intensivos (UCI) fue creada en 1953 por el anestesiólogo danés Bjørn Aage Ibsen (1915-2007). Enfrentando una de las...

Leading Insights, International

Neurointensive Care in Latin America: A Bright Future Ahead

Written By: Clio Rubinos, MD; Lia Franco Castro, MD; Jorge Mejia-Mantilla, MD

The first intensive care unit (ICU), as it is currently known, was created by the Danish anesthesiologist Bjørn Aage Ibsen (1915-2007). Facing one...

Leading Insights, Ethics

Ethical Hazards of Variability in Brain Death: A Call for Standardizing Education

Written By: Matthew Jaffa, DO; Matthew Kirschen, MD, PhD; Krista Lim-Hing, MD; Michelle Schober, MD; Mitchell Hargis, MD; Jamie Labuzetta, MD, MSc, MPhil

The art of medicine requires practice honed through careful study of masters. Before we are tasked with snaking a 7Fr catheter into the subclavian...

Leading Insights, Business of Neurocritical Care

Business of Neurocritical Care Quality-based Compensation: The Future of Physician Incentive Programs?

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS

Physician compensation in academic and hospital-based employment models has historically involved a base salary and some sort of incentive...

Leading Insights, POCUS

Signs of Right Ventricular Strain on Point-Of-Care-Ultrasound (POCUS) in the setting of Pulmonary Embolism

Written By: Eric Dornoff, MD; Kelly Rath, DNP; Vasisht Srinivasan, MD

Case Details A 38-year-old woman, previously healthy, was admitted to the neuroscience intensive care unit following a thoracic fusion. On...

Leading Insights, International

Neurocritical Care Services in National Brain Center Hospital, Jakarta

Written By: Ita Muharram Sari, MD

National Brain Center Prof. Dr. Mahar Mardjono Hospital (NBC) is the main referral hospital specializing in brain and nervous systems under the...

Leading Insights, Pharmacy

Pediatric Neurology/Neurocritical Care Clinical Pharmacy Specialist: A Consult Service Aiding in Transitions of Care of Patients with Epilepsy

Written By: Renad Abu-Sawwa, PharmD, BCPPS

“When you adjust for hypoalbuminemia, his phenytoin level was therapeutic at 17.5 mcg/mL following his fosphenytoin load. In addition to...

Leading Insights, Pharmacy

Neuropharmacology Training for the Neurologist in the Neurocritical Care Unit: Multidisciplinary Situated Learning

Written By: Steven Lazar, MD; Jon Cokley, PharmD, BCPPS

Best practices in neurocritical care emphasize a multidisciplinary approach (Moheet et al., 2018). While various medical training pathways have...

Leading Insights, International, Resident/Fellow

International Medical Graduates in Neurocritical Care in the US: Can They Fit In and Succeed?

Written By: Masoom Desai, MD; Alexis Steinberg, MD; Fajun Wang, MD; Hana Nobleza, MD; Deepa Malaiyandi, MD

The journey of foreign physicians in the field of neurocritical care (NCC) can be full of exciting opportunities but also unsettling...

Leading Insights, POCUS

Use of Cardiac POCUS in Diagnosis of HFrEF in a Patient with Ischemic Stroke

Written By: Donald Langan, MD, PharmD; Alexandra Schroeder, PA-C

Ischemic strokes in younger adults, those 18 to 50 years old, account for approximately 10% to 15% of all ischemic strokes. Risk factors for...

Leading Insights

Where Have All the Healthcare Staff Gone?

Written By: Peter Papadakos, MD, FCCM, FCCP, FAARC, FNIV

It is seven in the morning and you are starting your day in the ICU. The sign-out you received was that you have several complex new admissions...

Leading Insights, International

Continuous EEG Monitoring in Intensive Care Units in Resource-Limited Settings: A Necessary Skill for Intensivists

Written By: Clio Rubinos, MD, MSCR; Maria Jose Bruzzone, MD, MSCR

Introduction The use of continuous electroencephalogram (cEEG) monitoring in the intensive care unit (ICU) has increased significantly in the...

Leading Insights, International

Monitoreo continuo de EEG en las unidades de cuidados intensivos en regiones de recursos limitados: una habilidad necesaria para los intensivistas

Written By: Clio Rubinos, MD, MSCR; Maria Jose Bruzzone, MD, MSCR

Introducción El uso del monitoreo continuo electroencefalográfico (cEEG) en la unidad de cuidados intensivos (UCI) ha aumentado...

Leading Insights, Business of Neurocritical Care

The Business of Neurocritical: Understanding Split-Share Billing with APPs

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB

This series will be a running feature highlighting billing, coding, practice management, and other business aspects of neurocritical...

Leading Insights, International

Development of Neurocritical Care Services in the Sultanate of Oman

Written By: Abdullah Al Jadidi; Adil Al-Kharusi; Keshavan Venkatesh; Sharma Pradeep Kumar; Ruqaiya Al Harthi

Neuroscience services in Oman were first established in Khoula Hospital in 1974. Khoula hospital was the first surgical hospital in the Sultanate...

Leading Insights, Pharmacy

Cleaning Up the Clutter: Polypharmacy Consults in Neurocritical Care Patients: A Pediatrics Experience

Written By: Marry Vuong, PharmD, BCPPS

Introduction Rates of chronic conditions in pediatric patients are steadily increasing and the medications used to treat these conditions are...

Leading Insights

Proceedings Summary: Second Curing Coma® Campaign NIH Symposium

Written By: Shraddha Mainali, MD; Jose Suarez, MD, FNCS, FANA; Len Polizzotto, PhD; Claude Hemphill, MD, MAS, FNCS; DaiWai Olson, PhD, RN, FNCS; Keri Kim, PharmD, MS, CTS

Following the 1st NIH symposium held in September 2020, the National Institute of Neurological Disorders and Stroke (NINDS) collaborated with the...

Leading Insights

Clinician Burnout: A Case for Parallels with ICU Delirium

Written By: Renad Abu-Sawwa, PharmD, BCPPS

Burnout. Delirium. Both terms have infiltrated their way into medical literature in recent years, especially in the realms of psychiatry and...

Leading Insights, Ethics

Anticipatory Ethics: The Time is Now

Written By: Krista Lim-Hing, MD; Michelle Schober, MD

Circulation of clinical guidelines and release of novel therapeutics, diagnostic technologies and other practice-changing scientific advances all...

Leading Insights, Resident/Fellow

Researcher Spotlight: Corey Fehnel

Written By: Corey Fehnel, MD, MPH, FNCS; Brandon Merical, MD

In our inaugural Currents Researcher Spotlight, Beth Israel Deaconess Medical Center (BIDMC) neurology chief resident Brandon Merical profiles...

Leading Insights

Addressing Patient Non-Compliance in the Neuro ICU

Written By: Peter Papadakos, MD, FCCM, FCCP, FAARC, FNIV

The global pandemic has had a major impact on ICU utilization. We have all experienced major shortfalls in being able to admit critically...

Leading Insights, International

Neuro-interventional Care in Nepal

Written By: Subash Phuyal, MD, DM; Gentle Shrestha, MD, FACC, EDIC, FCCP, FNCS

Nepal is a small country located in south Asia, with diverse geography ranging from Himalayan regions in the north to plain terrains in the south....

Leading Insights, Ethics

Consent for Thrombolysis: More Ethics than Science

Written By: Matthew Jaffa, DO; Evie Marcolini, MD

Nearly every clinical decision presents us with the opportunity to lean into the historical ethos attributed to Hippocrates to “first, do no...

Leading Insights, Pharmacy

Dosing of Prothrombin Complex Concentrate in Factor Xa Inhibitor-Associated Intracranial Hemorrhage

Written By: Brian Gilbert, PharmD, MBA, BCCCP, BCPS; Brooke Barlow, PharmD; J. Spencer Dingman, PharmD, BCCCP

Optimal reversal strategies for factor Xa (FXa) inhibitor-associated intracranial hemorrhage (ICH) have garnered much attention in recent years....

Leading Insights, Pharmacy, International

Clinical Pharmacy Services in Neurocritical Care Units: The Experience from the MENA Region

Written By: Dana Bakdach; Farah Kablaoui; Nouran Salem; Rita Jebrin; Maha Elhamid

Background In the Middle East and North Africa (MENA), the scope of clinical pharmacy practice is relatively new and emerging. Several...

Leading Insights

Embracing Creativity and Community: Two Neurocritical Care Nurses Grow During the Pandemic

Written By: Shivani Ghoshal, MD

As the wave of Omicron crashed onto hospitals this winter, memories from 2020 came flooding back, along with concomitant emotional fatigue. This...

Leading Insights, POCUS

Point of Care Ultrasonography in the Evaluation and Management of Hypertension and Chest Pain in a Patient with Acute Ischemic Stroke

Written By: Mikel Shea Ehntholt

A 73-year old woman presented to our institution with a three-week duration of headache and dizziness. She had a past known history of an...

Leading Insights

Patient Education on Sleep Apnea and Stroke

Written By: Peter Papadakos, MD, FCCM, FCCP, FAARC, FNIV

Those of us working in neurocritical care are the frontline individuals caring for ICU patients with acute stroke. This allows us a special...

Leading Insights, Pharmacy

A World of Difference: A Pharmacist’s Perspective on Racial and Ethnic Diversity in Neurocritical Care

Written By: Sarah Jung, PharmD, MS, BCCCP

The rise of the COVID-19 pandemic in 2020 was also accompanied by the peak of the Black Lives Matter movement. According to the U.S. Census...

Leading Insights, POCUS

Role of Point of Care Ultrasound (POCUS) in Percutaneous Tracheostomy

Written By: Mahammed Khansuheb, MD; Amay Parikh, MD

Percutaneous tracheostomy (PcT) is a technique first described by Shelden in 1957. Over 100,000 adults in the United States receive...

Leading Insights, Business of Neurocritical Care, Resident/Fellow

Business of Neurocritical Care: Choosing a First Job After Fellowship: Review of Practice Models From a New Grad Perspective

Written By: Aleksandra Yakhkind, MD MS; Hana Nobleza, M.D., MSCI; Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS

This series will be a running feature highlighting billing, coding, practice management, and other business aspects of neurocritical...

Leading Insights

Harnessing the Potential Benefits of Therapeutic Hypothermia in Patients with Acute Brain Injury

Written By: Yingying Su; Guoping Ren; Linlin Fan; Huijin Huang

The functional recovery of nerve cells after brain injury is extremely complex and difficult. Finding effective ways to save as many nerve cells...

Leading Insights

Undoing Disability Bias by Rethinking Quality of Life

Written By: Erika Sigman, MD; Jennifer Sarrett, PhD; Elizabeth Sivertsen, MBE, CCRN, HEC-C; Gillian Hue, PhD; Tommy Thomas, MD, PhD

A 72-year-old man with Parkinson’s disease was admitted to the intensive care unit (ICU) after a fall. He suffered a high cervical spinal...

Leading Insights, International

Neurocritical Care Status in Nigeria

Written By: Halima Salisu-Kabara, CCRN, BNSC, MPA, PhD, FWACN; Shuaibu Dambatta, MBBS, FRCS; Dalhat Salahu, FWACS; Abdullahi Ibrahim, RN, CCRN, PGDPHEP, BNSc; Folakemi Olufunbi Olufemi-Iseyemi, CCRN, BNSc

Introduction Nigeria is a country on the coast of West Africa, bordered by Benin, Cameroon, Chad, and Niger, it shares...

Leading Insights, Business of Neurocritical Care

The Business of Neurocritical Care: How Your Documentation Impacts Your Hospital

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB

When providers are asked to admit patients to the NeuroICU, their initial efforts are focused on stabilization of the patient and placement of...

Leading Insights

Critical Conversations About Brain Death

Written By: Linda Dhennin, RN, CNS, APRN

Critical care involves an endless series of crucial conversations; among the most difficult is the brain death confirmation/declaration...

Leading Insights

Initiating a Neurocritical Care Practice: Challenges, Solutions, and Opportunities

Written By: Toufic A. Chaaban, MD

Toufic A. Chaaban, MD Neurocritical care units are becoming the standard of care in referral centers for acute brain injury...

Leading Insights, POCUS

POCUS Case: Persistent Eustachian Valves - An Uncommon Nidus For Infective Endocarditis

Written By: Logan Pyle; Vasisht Srinivasan; Kelly Rath; Jordan Bonomo

A 30-year-old man with a past medical history of polysubstance drug abuse, chronic Candida bacteremia and endocarditis status post mitral valve...

Leading Insights

ICU Staff Burnout and Wellness: What Price Has the Pandemic Inflicted?

Written By: Peter Papadakos, MD, FCCM, FCCP, FAARC, FNIV

The worldwide pandemic has developed many stressors on those in the Neuro ICU, such as taking care of critically ill non-Neuro Patients outside of...

Leading Insights, POCUS

Utility of Bedside Cardiac POCUS in Identification and Management of a Patient With Subarachnoid Hemorrhage and Takotsubo Cardiomyopathy

Written By: Jennifer Mears, PA; Judy Ch’ang, MD

The incidence of subarachnoid hemorrhage (SAH) patients who develop Takotsubo cardiomyopathy (TCM) is approximately 4-15%.1 Vasospasm is...

Leading Insights

To Sleep or Not to Sleep: The Unasked Question of Hourly Neuro Checks

Written By: Diane McLaughlin, DNP; Kimberly McPhearson, DO

The goal of serial neuro checks is to detect impending neurological deterioration early enough to facilitate timely intervention. However, there...

Leading Insights, International

Ten Years of Standardized Training of Brain Death Determination in China

Written By: Yingying Su

In 2012, the brain injury evaluation quality control center of the National Health Commission of the people's Republic of China (BQCC / PRC /...

Leading Insights, Pharmacy

What is the Optimal Duration of Nimodipine for Aneurysmal Subarachnoid Hemorrhage?

Written By: Jocelyn Owusu-Guha, PharmD, BCCCP; Pamela Buschur, PharmD, BCPS

Nimodipine, a lipophilic calcium channel antagonist, has been established as a standard of care in the management of aneurysmal subarachnoid...

Leading Insights

Pediatric Research within the Neurocritical Care Society - Interview with Dr. Michelle Schober, MD, MS

Written By: Caitlin Brown, PharmD; Michelle Schober, MD; Shraddha Mainali, MD; Cassia Righy, MD; Minjee Kim, MD; Tom Lawson, CNP

Can you tell me a little about yourself and how you got involved in the Neurocritical Care Society? I am a...

Leading Insights

Hybrid 2nd Neurocritical Care Regional Meeting in the Middle East and Africa

Written By: Yasser B. Abulhasan, MBChB, FRCPC, FNCS

It was a great pleasure organizing the 2nd Neurocritical Care Regional Meeting in the Middle East and Africa in conjunction with the 17th edition...

Leading Insights

The Business of Neurocritical Care: Practice Models and Models of Documentation

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB

When assembling and organizing a Neuro ICU team, one must begin with the end in mind. It is important to note that each organization defines...

Leading Insights

Advanced Practice Providers – A Historical Review

Written By: Misti Tuppeny; Kelly A. Rath

Healthcare through the 20th and 21st centuries has seen significant change and growth, and through this evolution, the role of the advanced...

Leading Insights

Interprofessional Partnerships and Intersections in Neurocritical Care: A Focus on the Neurointensivist and Neurocritical Care Pharmacist

Written By: Salia Farrokh; Lucia Rivera Lara; Jon Cokley; Hana Nobleza

Specialized neurocritical care teams have been found to improve outcomes such as mortality, length of stay, and discharge dispositions for...

Leading Insights

Adapt, Grow, and Evolve - The Age of Neurocritical Care in the Philippines

Written By: Jose Miguel Medrano, MD, FPNA; Joanne Robles, MD, FPNA; Isabelita Rogado, RN, MAAN; Geraldine Siena Mariano, MD, FPNA, FPCP, FNCS, FPSCCM

COVID-19 has put a spotlight on the importance of excellent, holistic, multidisciplinary critical care; despite this pandemic, there remains a...

Leading Insights

INCC Virtual Book Club: August 2021

Written By: Gabrielle Horstman, MD/PhD

This month we would like to highlight one of the new programs launched this year by the Inclusion in Neurocritical Care (INCC)...

Leading Insights

Building an APP Student Rotation

Written By: Richard Leston, APP Supervisor; Alexis Catania, PA; Krista O’Leary, PA-S

South Shore University Hospital was preparing to open its brand-new Neuro ICU in March of 2020, eager to become a major...

Leading Insights

Pride in Neurocritical Care: Sexual and Gender Minorities and Neurocritical Care Health Professionals

Written By: Zachary Threlkeld, MD; Ahmad Riad Ramadan, MD; Sara Hefton, MD; Starane Shepherd, MD; H.E. Hinson, MD

As part of broader diversity, equity, and inclusion efforts within NCS, the Sexual and Gender Minority (SGM) subcommittee of the Inclusion in...

Leading Insights, POCUS

POCUS Case: Evaluation of Hypoxia in a Patient with Traumatic Brain Injury

Written By: Jon Rosenberg, MD; Laura Chen, DO; Judy Ch’ang, MD

A 34-year-old man presented with a high-grade traumatic brain injury (TBI) after being struck by a motor vehicle. In the emergency department he...

Leading Insights, POCUS

Expanding POCUS in Neurocritical Care through Educational Initiatives

Written By: Bryan Boling, DNP; Jennifer Mears, PA; Aarti Sarwal, MD; Judy Ch’ang, MD

Point-of-care-ultrasound (POCUS) is an indispensable tool used in the diagnosis, screening, procedural guidance, and management of critically ill...

Leading Insights

Trainee and Fellowship Sections Collaborate to Upgrade Fellowship Resources on the NCS Website

Written By: Shweta Goswami, MD; Sasha Yakhkind, MD

Every year, neurology residents combine the wisdom of their mentors, their experience, their passion, and their personalities to guide them in the...

Leading Insights

Challenges of Neurocritical Care in Latin America Beyond the Pandemic

Written By: Luis Rafael Moscote-Salazar, MD; Iván David Lozada-Martínez, MS

Neurological and neurosurgical diseases are a major cause of morbidity and mortality worldwide, and Latin America is no exception [1-3]. The...

Leading Insights

Desafíos de la atención neurocrítica en América Latina más allá de la pandemia

Written By: Luis Rafael Moscote-Salazar, MD; Iván David Lozada-Martínez, MS

Las enfermedades neurológicas y neuroquirúrgicas son una de las principales causas de morbilidad y mortalidad en todo el mundo, y América Latina...

Leading Insights

Welcome to the NEW Currents NCS Arts Corner!

Written By: Shivani Ghoshal, MD

Currents is excited to launch a new Arts Corner to recognize visual, performing, and creative artworks pertaining to neurocritical care, as well...

Leading Insights

Advances in Neuro-ICU Coma Evaluation in China

Written By: Yingying Su, MD

In 1998, when the neuro ICU of Xuanwu Hospital of Capital Medical University was established, we initiated a research project with the Beijing...

Leading Insights

A Journey of Racial Awakening: Contemplations on the Ethics of Racial Justice and Race-Conscious Actions Within and Outside of Medicine

Written By: Richard Choi, DO

The recent wave of increased social and racial injustice awareness as well as the significant increase in anti-Asian hate crimes1 have had me...

Leading Insights, Business of Neurocritical Care

The Business of Neurocritical Care: Getting Started

Written By: Ryan Hakimi, DO, MS, NVS, RPNI, CPB

This series will be a running feature highlighting billing, coding, practice management, and other business aspects of neurocritical...

Leading Insights

Emergency Department Boarding of Neurocritical Care Patients

Written By: J. Spencer Dingman, PharmD, BCCCP; Brian W. Gilbert, PharmD, BCCCP, BCPS; Sean Di Paola, PA-C, MPAS; Christopher D. Cassidy, MD

Time-to-intervention has become well-recognized as an important quality measure in numerous areas of medicine, including acute coronary syndromes,...

Leading Insights

Neurocritical Care in the Last Frontier – a Pharmacist’s Perspective

Written By: Dyan Fleming, PharmD, BCPS, BCCCPS

Treating neurocritical care patients in Alaska, land of the midnight sun, comes with unique geographical, environmental, and seasonal challenges....

Leading Insights

Burden of Neurological Disorders in Adult Intensive Care Unit in Bahrain: Five Years’ Experience

The Kingdom of Bahrain, home of the ancient Dilmun civilization, is a Middle Eastern island situated in the Arabian Gulf. Bahrain is made up of an...

Leading Insights

What Did We Do? Was it Unwise to Ban Family from the ICU?

Written By: Peter J Papadakos, MD, FCCM, FCCP, FAARC, FNIV

During the worldwide COVID-19 pandemic, critical care practitioners throughout the United States and the world were instructed by health agencies,...

Leading Insights

Diffuse Correlation Spectroscopy: Same Particle, Different Wave

Written By: Kia Ghiassi; Jesyree Veitia; Francisco Gomez

Adequate cerebral blood flow (CBF) is a key component in ensuring optimal oxygen delivery to brain parenchyma, considered a biomarker of tisular...

Leading Insights

What is Open Access (OA) Publishing and Why Should I Care?

Written By: Michael Diringer, MD

The financial infrastructure for scientific publishing is being completely transformed by a desire to ensure that scientific knowledge is freely...

Leading Insights

The Great Political Divide in Medicine

Written By: Jamie Nicole LaBuzetta, MD, MSc, MPhil

In the early 1990s, most physicians were Republicans. Three decades later, the demographic composition of the medical workforce has...

Leading Insights

COVID-19 and Racial Justice

Written By: Starane Shepherd, MD

Over the last year of this pandemic, I have taken care of a large number of patients with COVID-19 infections in our neurocritical care unit. At...

Leading Insights

Verticalization for Refractory Intracranial Hypertension: A Case Series

Written By: Tommy T. Thomas, MD, PhD; Ebonye Green , MNSc, ACNPC-AC, CNRN, SCRN; APRN; Deepa Malaiyandi, MD; Hana Nobleza, MD

Some of us watched the videos. A doctor’s cry for help from the very medical establishment to which she belongs. A CEO expresses contrition...

Leading Insights

Therapeutic Monitoring of Unfractionated Heparin: Any Role for Anti-Xa Assays Monitoring in the Neurocritical Care Patients?

Written By: Reem Alsultan, Pharm.D, BCPS

Intravenous unfractionated heparin (UFH) is widely used in the clinical setting including neurocritical care patients.1,2 Pharmacokinetic...

Leading Insights

Emotional Support of Neurocritical Care Patients During the COVID-19 Pandemic

Written By: Stephen A. Trevick, MD

The emotional impact of the COVID-19 pandemic will be felt throughout society for months and years to come. This impact will come in many...

Leading Insights

Turning a Neuro ICU Into a COVID-19 ICU: Cleveland Clinic Abu Dhabi’s Experience

Written By: Lucie Pelunkova, MSc; Nouran Salem, PharmD, BCCCP, MBA; Seby John, MD; Fadi Hamed, MD; Jamil R. Dibu, MD

Severe Acute Respiratory Syndrome Coronavirus-2 is a novel coronavirus first detected in Wuhan, China in December 20191, causing a pandemic of...

Leading Insights

Recap of the 11th Chinese Conference of Neurocritical Care

Written By: Yingying Su, MD, PhD

By Yingying Su, MD, PhD The 11th National Conference of Neurocritical Care Committee of the Chinese Society of Neurology (NCC/CSN) was held on...

Leading Insights

Milrinone for the Treatment of Delay Cerebrovascular Ischemia in Aneurysmal Subarachnoid Hemorrhage – Is Aggressive Therapy the Answer?

Written By: Thomas D. Bernier, PharmD; Michael Schontz, PharmD, BCPS, BCCCP

Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes, and due to a multitude of complications, patients are at exceptional...

Leading Insights

On the Frontline of COVID-19 in Qatar: Navigating Through Crisis, Embracing Change and Leading Innovation

In Qatar, the first case of COVID-19 was confirmed on Feb. 27, 2020. While the global death toll continues to climb, Qatar stands out with a low...

Leading Insights

Adjunctive Agents for Agitation Management in Neurocritical Care Patients

Written By: Brian R. Schuler, PharmD; Kaylee K. Marino, PharmD, BCCCP, BCPS; Michael Reznik, MD

As pharmacists and clinicians working in the neurosciences intensive care unit (ICU), we understand the importance of agitation and delirium...

Leading Insights

Clinical Neurotoxicology: A Focus on Drug-induced Seizures

Written By: Anthony Jaworski, PharmD, BCCCP

A reported 6% of new onset seizures and 9% of status epilepticus cases are attributed to drug neurotoxicity.1,2 Over the years, there has...

Leading Insights

Establishing Regional Critical Care Chapters to Encourage Interdisciplinary Collaboration

Written By: Padmaraj Duvvuri, MD; Lauren Koffman, DO, MS

Over the past two years, there has been an ongoing effort to establish a Midwest Chapter within the Society of Critical Care Medicine (SCCM). I...

Leading Insights

Surviving COVID-19 as an Intensivist in a Developing Country

Written By: Telmo E. Fernandez-Cadena; Manuel Jibaja; Nelson Maldonado, MD; Miguel Andrade, MD

On Feb. 29, 2020, the first case of SARS-CoV-2 in Ecuador was announced in Guayaquil. What we saw as a distant problem in Wuhan and New York...

Leading Insights

Volunteering in a COVID-19 ICU: My NYC Experience

Written By: Pravin George, DO

More than three months ago, New York City experienced the largest reported metropolitan surge of COVID-19 patients in the entire country, possibly...

Leading Insights

Advice and Suggestions to Questions about Career in Neurocritical Care (ASQC): Navigating Conversations About Race and Discrimination

Written By: Christa O’Hana S. Nobleza, MD, MSCI; Aleksandra Yakhkind, MD MS

Our most recent question is very relevant to the state of our country today. We want to remind everyone that NCS has a commitment to diversity and...

Leading Insights

Wellness and Self-Care During COVID-19

Written By: Swarna Rajagopalan, MD, MS

Intensivists and healthcare professionals work tirelessly around the clock as the COVID-19 pandemic ravages throughout the world. This article...

Leading Insights

Mechanical Ventilation Strategy for Acute Respiratory Distress (ARDS)

Written By: Peter J. Papadakos, MD, FCCM, FAARC, FCCP; Thomas J. Kallstrom, MBA, RRT, FAARC,

The COVID-19 worldwide pandemic has brought to light the importance of proper mechanical ventilation strategy in that the majority of patients...

Leading Insights

Reflections From a Deployed NYC COVID-ICU Nurse Practitioner

Written By: Mary Presciutti, NP, CCRN, CNRN

Weeks before deployment, my fellow advanced care providers (APP) and I were told that our New York City hospital was in the process of rearranging...

Leading Insights

The Continuum of Consent

Written By: Jamie Nicole LaBuzetta, MD, MSc, Mphi

In a prior Currents article, I discussed that in order to obtain informed consent or refusal for medical care, a clinician must ensure...

Leading Insights

It’s OK for Patients to Refuse Medical Care

Written By: Jamie Nicole LaBuzetta, MD, MSc, Mphi

Informed consent is the complex basis of shared decision-making in the medical realm. It involves sharing information with a patient or surrogate...

Leading Insights

Neurointensivists! Let's Step into the Frontline of Coronavirus Battle Field

Written By: Jeong-Ho Hong, MD, PhD

Recently, I was working as a neurointensivist at one of the hub-hospitals treating COVID-19 patients, Daegu Dongsan Hospital (branch...

Leading Insights

Taking a Closer Look into Neurocritical Care Mechanical Ventilation During the COVID19 Pandemic and the Use of Anesthesia Machines in the Neuro ICU

Written By: Shaun Golden, MSN, RN; Sarah Beth Thomas, MSN, RN, CCRN, CNRN, SCRN

Since the beginning of the COVID-19 global pandemic, ventilators have been at the forefront of public discourse. Discussions on social...

Leading Insights

AnaConDa: Anesthetic Gases in the NICU Are No Laughing Matter!

Written By: Francisco Gomez, MD; Alyssa B. Polotti, PharmD, BCCCP; Fawaz Al-Mufti, MD

Sedation is an integral part of critical care patient management. This intervention improves patient comfort, decreases pain and anxiety,...

Leading Insights

Cooling Techniques and Devices for Targeted Temperature Management in Post-Cardiac Arrest Patients

Written By: Francisco Gomez, MD; Kiruba Dharaneeswaran, MD; Fawaz Al-Mufti, MD

Out-of-hospital cardiac arrest (OHCA) has an incidence of about 110.8 per 100,000 in all ages, while in-hospital cardiac arrest (IHCA) has an...

Leading Insights

Intra-Arterial Selective Cooling in Acute Systemic Stroke

Written By: Francisco Gomez, MD; Ivo Bach, MD; Fawaz Al-Mufti, MC

Thrombectomy and thrombolysis have proven effective in the treatment of stroke; however, strides remain to be made to promote tisular reperfusion...

Leading Insights

COVID-19 and the Changing Landscape of Neurocritical Care

Written By: Alexis Steinberg, MD; Matthew R. Leach, MD; Angela Hays Shapshak, MD; Lori Shutter, MD

The Covid-19 pandemic has dramatically changed the practice of critical care, and neurocritical care has not been immune to these changes. ...

Leading Insights

COVID-19: Difficulties and Countermeasures in the Prevention and Control of Neuro ICU Infection and Medical Quality Control in China

Written By: Yingying Su, MD, PhD

From February to March 2020, the epidemic of COVID-19 peaked in China. The situations for neuro ICU were as follows: In addition to some medical...

Leading Insights

Personal Protective Equipment (PPE) and COVID-19

Written By: Francisco Gomez, MD; Fawaz Al-Mufti, MD; Veeresh Shivamurthy, MD; Prateka Koul, MD

The ongoing pandemic of Coronavirus Disease 2019 (COVID-19) is unprecedented in scale, with devastating effects seen in the economic and social...

Leading Insights

The Role of Neurocritical Care Ethics in the COVID-19 Pandemic

Written By: Stephen Trevick, MD

I am writing from Chicago on March 20. I feel this is important to share as the COVID-19 pandemic is developing so rapidly that some concerns that...

Leading Insights

A Personal Opinion from Spain: Experience and Insight on COVID-19 Adjuvant Therapy

Written By: Alberto Hernandez, MD, PhD, DESA; Peter J. Papadakos, MD, FCCM, FAARC

These days, there are multiple papers emerging daily about COVID-19 management, protocols, guidelines, etc. Many research protocols are in play,...

Leading Insights

Finding Certainty in Uncertain Times

Written By: Lauren Koffman, DO, MS

Months ago, I had plans for a weekend trip with a friend, and despite my multiple reassurances, she cancelled. She had family and friends in China...

Leading Insights

COVID-19 and the Rise of International Medical Cooperation via the Digital Highway

Written By: Peter J. Papadakos, MD, FCCM, FAARC

As an individual who studies the effect of technology on the practice of medicine, one of the most amazing aspects of this terrible pandemic is...

Leading Insights

Walking on Thin Ice on Blood Thinners

Written By: Peter J. Papadakos, MD, FCCM, FAARC

As neurocritical care providers, we are confronted with an increased number of individuals who are on blood thinners who are involved in falls...

Leading Insights

Training Pathways for Neurocritical Care Advance Practice Providers

Written By: Erika Bassett, PA-C; Alexis Steinberg, MD

Throughout the years, we have seen APPs come and go in our neurological ICUs (NICU). Some enter neurocritical care, learn the nuances of...

Leading Insights

Opinion: Challenges with OPOs

Written By: Wade Smith, MD, PhD, FNCC

I have practiced neurocritical care since 1994. As a fellow in 1993, I engaged in the first case of donation after cardiac death (DCD) in...

Leading Insights

Educating Trainees on Communication and Consultation Etiquette

Written By: Kristi Tucker, MD

Trainees are taught how to communicate with patients and how to behave professionally during patient interactions, but sadly there is much less...

Leading Insights

A New Era for Pharmacy in Neurocritical Care: The Neurology-Trained Clinical Pharmacist

Written By: Brittny Medenwald, PharmD

At 19 years old, my best friend was involved a motorcycle crash. Her severe TBI caused her to stay in the neurocritical care (NCC) unit for 13...

Leading Insights

Inhalational Anesthetics in Patients with Refractory Status Epilepticus

Written By: Matilda Dervisevic; Chetan Sateesh Nayak; Francisco Gomez

Refractory status epilepticus (RSE) is a condition in which there is continuing seizure activity despite the administration of two first-line...

Leading Insights

Report from the First German – Austrian – Swiss Conference of Aspects of Circulatory Arrest in Berlin

Written By: Jens Nee; Erich Schmutzhard; Raimund Helbok

Medical Department, Divison of Nephrology and Intensive Care Medicine - Circulatory Arrest Center, Charité University Medicine Berlin,...

Leading Insights

Neurocritical Care Education in the Dominican Republic

Written By: Lauren Koffman, DO; Starane Shepherd, MD

Through a partnership with the Rush University Global Health Department, a local nonprofit organization, Community Empowerment and the Feltrex...

Leading Insights

NEWS: Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomized, placebo-controlled trial.

Written By: Wazim Mohamed, MD; CRASH-3 trial collaborators

Read the article.* *You will need to log in to US National Library of Medicine National Institutes of Health to read this...

Leading Insights

An Interview with Dr. Cherylee Chang

Written By: Jody Manners

Dr. Cherylee Chang was born on Kauai, Hawaii and raised in Los Angeles from an early age. She graduated from Stanford University and completed...

Leading Insights

A Stroke Awareness Campaign in Kuwait

Written By: Amr A. Akl, BMSc; Brouj Miskin, BMSc; Azzah A. Alrashidi, BMSc; Hamad J. AlKhader, BMSc

Stroke is one of the most common healthcare-related diseases in modern day medicine. It is ranked as the second most common cause of death and...

Leading Insights

Neurocritical Units Partner with First Responders

Written By: P.J. Papadakos, MD, FCCM, FAARC

It should be the goal of every neurocritical care unit to provide community health education in conditions such as stroke and traumatic brain...

Leading Insights

Pharmacologic Neurostimulant Therapy in Acute Traumatic Brain Injury – Should the Seizure Risk Preclude Therapy?

Written By: Megan E. Barra, PharmD, BCPS, BCCCP; Brian L. Edlow, MD

The efficacy of pharmacologic stimulant therapy in patients with severe traumatic brain injury (TBI) was demonstrated in a 2012 randomized...

Leading Insights

Neurocritical Care in Erbil, Iraq

Written By: Bnar Shawki, MD, MBChB, F.I.C.M.S, FIPP; Firas Abdulmajeed, MBChB

The population of Iraq is 37,203,000, according to WHO data from 2016. Life expectancy at birth in that year was 68/72 (male/female). The...

Leading Insights

Reflections on Teaching Emergency Neurological Life Support Course at Two Major Hospitals in Phnom Penh, Cambodia

Written By: Ariana Barkley, MD; Jonathan Medina-Beckwith, DNP, ARNP, NP-C; Abhijit Lele, MBBS, MD, MS, FNCS

Neurocritical care educational initiatives for staff at two hospitals in Phnom Penh, Cambodia emerged as a capacity development initiative that...

Leading Insights

Reversal of Factor Xa Inhibitors: Prothrombin Complex Concentrates or Andexanet?

Written By: Danielle Marut, PharmD; Jessica Traeger, PharmD, BCCCP

The use of oral factor Xa inhibitors, including rivaroxaban and apixaban, has increased over the last several years. Historically, strategies for...

Leading Insights

Tech Corner: Continuous Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage

Written By: Sydney Moseley, MD; Hussein Alshammari, MD; Scott Woolf, DO; Fawaz Al-Mufti, MD

The authors have no actual or potential conflict of interest in relation to the topics discussed in this column. This article may discuss non-FDA...

Leading Insights

New Collaborations in Neurocritical Care: CAR T Cell Therapy and Beyond

Written By: Daniel B. Rubin, MD, PhD; Henrikas Vaitkevicius, MD

As the field of neurocritical care becomes increasingly recognized as essential to the care of patients with serious neurologic injury, we are...

Leading Insights

Role of the Neurocritical Care Consultant in Perioperative Care of Cardiothoracic Surgery Patients – Neuromonitoring and Clinical Cases

Written By: Jonathan Gomez; Aarti Sarwal; John Bennett; Chandrika Garner; Adrian Lata; Charles Tegeler IV

Neurological complications in the perioperative period of cardiothoracic (CT) interventions occur in about 50-60 percent of patients. These...

Leading Insights

Certification for Nurses: Recognition for Knowledge and Skill

Written By: Wendy Dusenbury, DNP, APRN, FNP-BC, AGACNP-BC, ANVP-BC, CNRN; Anne W. Alexandrov, PhD, AGACNP-BC, ANVP-BC, NVRN-BC, CCRN, FAAN; Fern Cudlip, MSN,FNP-BC, CNRN, NVRN-BC, ANVP-BC, FNCS; Audrey Paulson, DNP, FNP-BC, CCRN, CNRN, SCRN

Many of the RNs and APRNs who hold membership in the Neurocritical Care Society (NCS) have membership and certification from other organizations...

Leading Insights

Tech Corner: Bridging the Gap Between the ICU Bedside and the EEG Interpreter: The Brain’s Rorschach Simplified and Brain Stethoscopes

Written By: Scott Woolf, DO; Sydney Moseley, MD; Hussein Alshammari, MD; Fawaz Al-Mufti, MD

Clinical, subclinical and non-convulsive seizures (NCSZs) are commonplace in critically ill patients — and even more common in patients in...

Leading Insights

The Neurosciences at SCCM Congress

Written By: Winnie Lau, MD

No one was expecting rain in San Diego, but that did not stop the hordes of intensivists and critical care providers from converging on SCCM 2019....

Leading Insights

ASEA UNINET Teaching Course on Neurocritical Care Medicine at the University of Karachi, Pakistan

ASEA UNINET Teaching Course on Neurocritical Care Medicine at the University of Karachi, Pakistan Dr. Panjwani Center for Molecular Medicine and...

Leading Insights

The Neurosciences Intensive Care Unit at Mayo Clinic Saint Marys Campus

Written By: Eelco Wijdicks, MD, PhD; Alejandro Rabinstein, MD; Sara Hocker, MD; Jennifer Fugate, DO

The Neurosciences Intensive Care Unit (neuro-ICU) at Mayo Clinic Rochester was arguably one of the first combined neurology-neurosurgery intensive...

Leading Insights

All Seizures Are Not Shaking and All Shakings Are Not a Seizure

Written By: Audrey Paulson, DNP

Electroencephalograms (EEGs) are usually placed on the patient by the EEG tech, and the process takes at least 30 minutes. It is then read by the...

Leading Insights

NeuroCardiac Comprehensive Care Clinic Seeks to Define and Detect Neurological, Psychiatric and Functional Sequelae in Cardiac Arrest Survivors

Written By: Sachin Agarwal, MD, MPH; Alex Presciutti, MA; Deepti Anbarasan, MD; Linda S. Golding, MA, BCC; Marykay Pavol, PhD

Goals and Vision of the Program Life after cardiac arrest is like “walking around without a net.”1 Despite improved...

Leading Insights

Submission to the NIH Stroke Trials Network (StrokeNet)

Written By: Andrew M. Naidech, MD, MSPH

Randomized clinical trials (RCTs) are a keystone of modern medicine and considered the gold standard for determining if an intervention produces...

Leading Insights

Tele-Neurocritical Care: The Evolution, Differentiation and Limitations of a New Medical Field

Written By: Fawaz Al-Mufti, MD; Francisco Gomez, MD; Corey Scurlock, MD, MBA; Chad Cole, MD, MSc

Editor’s Note: The authors have no actual or potential conflict of interest in relation to the topics discussed in this column. This article...

Leading Insights

Transcranial Doppler Ultrasonography Holds Promise in Monitoring Patients with Traumatic Brain Injury

Written By: Katherine Salisbury; Aarti Sarwal, MD

Traumatic brain injuries (TBI) are a major cause of hospitalization and death in the United States, with an estimated 1.7 million people...

Leading Insights

Utility of Transesophageal Echocardiography in Cardiac Arrest

Written By: Chandrika R Garner, MD, FASE; Rohesh J Fernando, MD; Aarti Sarwal, MD, FNCS, FAAN; Jose L. Diaz-Gomez, MD, FCCM, FASE

The use of point of care ultrasound (POCUS) or focused cardiac ultrasound (FOCUS) during cardiac arrest is increasingly reported in emergency and...

Leading Insights, International

Featured Program: Neurointensive Care in Liberec, Czech Republic

Written By: Vera Spatenkova, MD, PhD

The neurointensive care unit (NICU) of the Neurocenter at the Regional Hospital in Liberec is the first combined neurological and neurosurgical...

Leading Insights, Pharmacy

Hyperchloremia in the Neurocritically Ill Patient

Written By: Shivani Ghoshal, MD; Caroline Der Nigoghossan, PharmD, BCCCP

Intravenous crystalloid administration is one of the most common interventions performed in critically ill patients. However, during the last...

Leading Insights

Neuromuscular Electrical Stimulation for ICU Acquired Weakness (ICUAW)

Written By: Francisco Gomez, MD; Mohammad El-Ghanem, MD; Fawaz Al-Mufti, MD

The authors have no actual or potential conflict of interest in relation to the topics discussed in this column. This article may discuss non-FDA...

Leading Insights, Resident/Fellow

Locking it Down: Securing Your Ideal First Job

Written By: Jennifer A. Kim

There are some initial major decision points, including whether you want academic or private, if you have geographic limitations or...

Leading Insights, Resident/Fellow

Climbing Up the Ladder: Advice on Achieving Mid-Career and Leadership Success

Written By: Jennifer A. Kim

While career advice is often geared toward the training and early job stages, the roadmap to success throughout the remainder of one’s...

Leading Insights, Resident/Fellow

Forging Ahead: Tips on Applying for the Neurocritical Care Fellowship Match

Written By: Anand Venkatraman; Alexis Steinberg, MD

Applying for your fellowship can be one of the most stressful times during residency. If it weren’t hard enough to have to navigate a busy...

Leading Insights, Resident/Fellow

Laying a Strong Foundation: How to Flourish as a Young Attending

Written By: Jennifer A. Kim

Securing one’s first job as an attending is an exciting time! The first few years of being an attending form a crucial foundation for...

Leading Insights

Choosing Wisely® Initiative: A Nursing Perspective

Written By: Briana Witherspoon, DNP, ACNP; Karen March, MN, RN, CCRN

In 2012, the American Board of Internal Medicine (ABIM) Foundation partnered with Consumer Reports to create Choosing Wisely®, an initiative...

Leading Insights, Ethics

Withdrawal of Care: Who Decides? A Comparison of US and UK Cases

Written By: Piotr Tekiela; Lauren Ottenhoff; Michael Schneck

With the steady rise of high acuity complex cases, physicians are increasingly finding themselves navigating the legal system about decisional...

Leading Insights

NEWS Review

Written By: Aimee Aysenne, MD, MPH; Kyle Hobbs, MD

Antihypertensive medications are ubiquitous in ICUs. Still, complete understanding of the effect on the brain in neurologically patients is not...

Leading Insights

Career Advice Series: The Journey to Success

Written By: Jennifer A. Kim

In this issue of Currents, I am very excited to share a four-article series offering career advice, from applying to fellowship to becoming a...

Leading Insights

Tech Corner: Non-Invasive Detection of Large Vessel Occlusion in Setting of Acute Ischemic Stroke

Written By: Francisco Gomez, MD; Jessy Walla, MD; Fawaz Al-Mufti, MD

With the recent expansion in the endovascular treatment window for ischemic stroke, the need for improved triaging on all levels has become most...

Leading Insights, POCUS

Point-of-Care Ultrasound Case Pearl in Neurocritical Care

Written By: Gabriel Prada, MD; Jose L. Diaz-Gomez, MD; Aarti Sarwal, MD

Point-of-care ultrasound (POCUS) is ultrasonography performed by the provider in real time at the bedside to help clinical decision making. POCUS...

Leading Insights

Electronic Medical Records Errors and Legal Pitfalls

Written By: PJ Papadakos, MD, FCCM, FAARC

Over the last decade, electronic medical records (EMRs) have rapidly become the adapted documentation standard in part due to federal and...

Leading Insights

Extended Window of Treatment in Acute Stroke Is Not for All—Brain Imaging Is Critical

Written By: Ryan Hakimi, DO, MS; David S Liebeskind, MD; Tatjana Rundek, MD, PhD; Andrei V. Alexandrov, MD

The mortality rate associated with stroke has markedly declined over the past two decades from the second to the fifth most common cause of death...

Leading Insights, International

Featured Program: Neurocritical Care at the Paulo Niemeyer State Brain Institute (IECPN) in Rio de Janeiro, Brazil

Written By: Pedro Kurtz, MD, PhD

Paulo Niemeyer State Brain Institute (IECPN) was inaugurated in 2013 as Brazil’s first public hospital/institute entirely dedicated to the...

Leading Insights

The State of Neurocritical Care Simulation Training: Have We Fallen Behind?

Written By: Catherine Albin, MD; Deepa Malaiyandi, MD

Simulation in critical care training has exploded over the last decade, but its application to neurocritical care has been met with some...

Leading Insights

Featured Program: Neurocritical Care at the University of Wisconsin

Written By: Darsie Marin, MD; Tarula Erick, MD; Medow Joshua, MD, MSc

The University of Wisconsin School of Medicine and Public Health is situated on a large medical campus on the west end of the University of...

Leading Insights

Lancet Neurology Commission on TBI Presented at European Parliament

Written By: Andrew I.R. Maas; David K. Menon

The Lancet Neurology Commission on Traumatic Brain Injury (TBI) was presented at the European Parliament in Brussels on Nov. 7, 2017. The...

Leading Insights

Tech Corner: Detection of Subarachnoid Hemorrhage Induced Cerebral Vasospasm: Electroencephalography and Cranial Accelerometry

Written By: Fawaz Al-Mufti, MD

Brain ischemia secondary to cerebral vasospasm is managed by increasing arterial blood pressure, infusing vasodilators and performing cerebral...

Leading Insights, POCUS

Point of Care Ultrasonography: An Indispensable Tool for the Neurocritical Care Team

Written By: Neha S. Dangayach, MD; Harpreet Singh Grewal, MD; Gabriel Prada, MD; Jose L. Diaz-Gomez, MD; Aarti Sarwal, MD

Vascular access with point of care ultrasonography (POCUS) is now considered to be standard of care and has greatly reduced iatrogenic...

Leading Insights, Literature Watch

Survey of Neurocritical Care Fellowship Directors Reveals Preference for Transition to ACGME Accreditation

Training in neurocritical care (NCC) is currently ineligible for accreditation by the Accreditation Council for Graduate Medical Education...

Leading Insights

Artificial Intelligence: Applications in Neurocritical Care

Written By: Fawaz Al-Mufti, MD; James Lee, MD; Kiwon Lee, MD

Critical care medicine is the art of managing extreme complexity. This is especially the case in neurocritical care due to the inherent...

Leading Insights

Neurocritical Care in Ecuador

Written By: Nelson J. Maldonado, MD; Manuel Jibaja, MD; Claudio Scherle, MD; Jose I. Suarez, MD

Ecuador is a South American country straddling the equator and crisscrossed by the Andean Mountain Range. It has a population of 14.5 million, and...

Leading Insights

Wake Forest Neuro ICU Brings Innovation in Simulation in Testing a New ICU

Written By: Aarti Sarwal, MD; Janet Crumpler, RN, MSN, CNRN; Terri Gordon, RN, BSN, CCRN

Wake Forest Baptist Medical Center built a 24-bed neuro ICU in 2016 to accommodate a growing census and acuity of patients housed in the older...

Leading Insights, Ethics

Ethics Corner: End-of-Life Ethics

Written By: Ariane Lewis, MD

Patients admitted to neurointensive care units frequently suffer sudden, unexpected and severe brain injuries that render them unable to...

Leading Insights

Patient and Family-Centered Care in Neurocritical Care – A Patient and Provider Perspective

Written By: G. Morgan Jones, PharmD, BCPS, BCCCP

From the Eyes of the Provider No patient has left a lasting impact on my career like Nick Chambers. Nick was a 25-yearold transferred to our...

Leading Insights

Precision Medicine for Neurocritical Care: the NICIS Symposium Comes to America

Written By: Jose I Suarez, MD; Robert D Stevens, MD, Ph.D. ; Jan Claassen, MD, Ph.D. ; Tarek Sharhar, MD

The importance of big data and precision medicine in neurocritical care and stroke was the theme of the Neuroscience in Intensive Care...

Leading Insights

Wake Forest Neuro ICU: Impressions of a Visiting Professor

Written By: Andrew Chang

Music and medicine have a unique synergy. While it may seem obvious that music is concerned primarily with the art of communication, it has taken...

Leading Insights

Tech Corner: Non-Invasive Cerebral Oximetry — So NIRS Yet So Far

Written By: Fawaz Al-Mufti, MD; Neha Dangayach

Near-infrared spectroscopy (NIRS) is an optical technology based on differential absorption and scattering of near infra-red spectrum light (650...

Leading Insights

Unregulated Drugs and the Neuro ICU

Written By: Peter J. Papadakos, MD, FCCM, FCCP, FAARC, FNIV

Over the last decade, many unregulated drugs have appeared on the marketplace and have adversely affected our patients. We are all familiar with...