Neurologic Injuries

Traumatic Brain Injury

The fellow should be able to:
  • Demonstrate competency in the initial management of patients with traumatic brain injury including level of care and need for transfer
  • Understanding the role of hyperosmolar therapy and difference in hypertonic saline vs mannitol on patient outcomes
  • Understand the indications for intracranial pressure monitoring
  • Demonstrate the ability to manage a patient with elevated intra-cranial pressure using a stepwise approach
  • Utilize advanced ICP monitoring devices in the management of a patient with a TBI
  • Describe the role of external ventricular drains in TBI, the management of EVDs, and the complications associated with EVDs
  • Understand the role of seizure prophylaxis in TBI, indications, and controversies
  • Recognize the long-term effect of TBI, understand strategies to mitigate TBI, and assist patients suffering from the effects of TBI
  • Understand the diagnosis of death by neurologic criteria
Resources

 

Spine and Spinal Cord Injury

The fellow should be able to:
  • Demonstrate an understanding of the management of cervical, thoracic, and lumbar spine trauma including the role of operative vs non-operative treatment strategies
  • Describe the role of CT and MRI in cervical spine trauma
  • Recognize the controversies of cervical spine clearance in the unexaminable patient
  • Describe the acute and long-term complications of spinal cord injury and management of these injuries
  • Describe the role of blood pressure management in spinal cord injury and recognize the controversies associated with this strategy
  • Discuss the role of diaphragm pacing in high spinal cord injury
Resources
  • Topic Summary
  • Overview Article:
    • Wang TY, Park C, Zhang H, et al. Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature. Front Surg. 2021; 8: 98736.
  • Additional Resources:
    • Schroeder GD, Vaccaro AR, Welch WC, et al. Best Practices Guidelines: Spine Injury. American College of Surgeons Committee on Trauma. March 2022.
    • Blood pressure augmentation
      • Hawryluk G, Whetstone W, Saigal R, et al. Mean arterial blood pressure correlates with neurological recovery after human spinal cord injury: analysis of high frequency physiologic data. J Neurotrauma. 2015.
      • Saadeh YS, Smith BW, Joseph JR, et al. The impact of blood pressure management after spinal cord injury: a systematic review of the literature. Neurosurg Focus. 2017.
    • Corticosteroids
      • Fehlings MG, Wilson JR, Tetreault LA, et al. A Clinical Practice Guideline for the Management of Patients with Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate. Global Spine Journal. 2017.
    • Venous thromboembolism prophylaxis
      •  Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd: Consortium for Spinal Cord Medicine. Top Spinal Cord Inj Rehabil. 2016.

Blunt Cerebrovascular Injury

The fellow should be able to:
  • Demonstrate an understanding of the risk factors and incidence of BCVI in trauma
  • Describe the role of screening criteria and differences between screening systems
  • Understand the screening options for BCVI and limitations of each modality
  • Discuss the BCVI grading system and outcomes associated with BCVI
  • Describe treatment options for BCVI and controversies associated with treatment
Resources