Neuro ICU Midlevel Orientation Checklist

Date

Reviewed

General
Intensivist
Model(Leapfrog, SCCM)
JC Core Measures
ICU Team
Organizational Structure
Admission Order Sets
Transfer Orders/Sign Out
Obtaining Consults
Notes
Daily progress
Post procedure(Angio,
Trach, EGD etc.)
Admission/transfer In
to ICU
Vascular Access
PICC Ordering
Activase Cath Set
Central Line
Consent
Time Out
Landmarks
Documentation
Complications
CDC Guidelines
Identifying Position on
CXR
Discontinuing Lines
Arterial Cannulation
Hemodynamic
Monitoring
CVP
PCWP
CO/CI
SVO2
Vigaleo(indications &
limitations)
Insertion of PAC
Mechanical Ventilation
Indications
Airway Cart
Pressure Modes
Volume Modes
PRVC
APRV
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Neuro ICU Midlevel Orientation Checklist

HFOV
Date

Reviewed

Weaning/Weaning
Protocol
Complications
Ventilator Bundle
Auto-Peep
Nitric Oxide
Trach Mgmt/Post op
Nutrition
Enteral
Keofeed
Confirming Placement
Nutrition
Recommendations
Formulas
Residuals
Bowel Regime
Parental
TPN Orders
Labs
Electrolyte Replacement
Potassium
Calcium
Phos
Mag
Protocol
Infectious Disease
Fever Workup
Differential Diagnosis
Fever
Infectious
Causes
Noninfectious
Causes
Dx & Rx CAP
Dx & Rx HCAP
Dx & Rx UTI
Dx & Rx Abdominal
Sepsis
Dx & Rx Skin & Soft
Tissue
Dx & Rx BSI/CLAB
Dx & Rx Meningitis
Dx & Rx of C-Diff

Neuro ICU Midlevel Orientation Checklist

Administration of
Blood Products
PRBC
FFP
Platelets
Cryo
Factor VII
Vit K/Protamine
DDAVP
Complications

Common ICU
Emergencies
Shock/Hypotension
Differential Dx
Workup/Diagnostics
Labs(CBC, BMP,
CE, Lactic, MVO2, ABG,
CXR, T&C)
Sepsis
Surviving Sepsis
Guidelines
Sepsis Bundle
Source Control
Empiric Antimicrobials
Goal Directed Rx
Vasopressor Selection
Adrenal Insufficiency
Diagnosis
Treatment
Hypovolemic
Colloid/Crystalloids
End Points of
Resuscitation
Transfusion Triggers
Cardiogenic
Systolic vs Diastolic
Failure
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Neuro ICU Midlevel Orientation Checklist

Preload
Afterload
Inotropy
Diagnostic Tests
TEE(call Fellow OC)
Chest Pain
Diff Dx
CXR, MIU, EKG
Acute MI/ACS
Date

Reviewed

Abdominal Pain
Diff Dx
Acalculous
choleystitis
Diagnostic Eval
GIB
Upper vs Lower
Labs
PPI Infusion
Tachyarrhythmias
Sinus Tach Diff Dx
A-Fib/Flutter
Amiodarone
Diltiazem
Labs/EKG
Adenosine
B Blockers
Lyte
Replacement(protocols)
Acute Dyspnea
Diff Dx
Diagnostic Eval
ARDS/ALI
Definition
Rx
Vent
Modes(APRV/HFOV)
P/F Ratio
CXR Interpretation
ABG Interpretation

Neuro ICU Midlevel Orientation Checklist

ARF
Prerenal
Acute Renal
Post Renal
Diagnostic
Eval(UA/US, FeNa)
RRT
Hyperglycemia
Insulin Protocols
DKA
Etiology
Date

Reviewed

Delirium
Etiology
Eval(CAM)
Avoid Benzos
Haldol/Risperadol
Pain/Sedation
Sedation Policy
Benzos(Ativan vs
Versed)
Narcotics
Reversal Agents
Propofol(avoid in RF)
Precedex
Riker Scale
NMBA
Agent Selection
Combined
Analgesia/Sedation
TOF
BIS
Complications
Neuro
Exam
GCS
CN
Motor
Sensory
Cerebellar
Neuromonitoring
ICP Monitor if GCS <9
EVD/Ventriculostomy
Drains CSF
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Neuro ICU Midlevel Orientation Checklist

Routine
Care(BioPatch)
Placement(tip lateral
ventricle)
Camino/Subarachnoid
Bolt
SjO2

TBI
Epidural
Temporal or
Parietal Skull Fxx
Arterial
CT-concave, does
not cross suture
lines
> 30 cc evacuation
< 30 cc & < 15
mm thickness w
GCS > 8 non
operative
Subdural
Tears in Bridging
Veins
Concave lesion
Cross suture lines,
not falx
> 10mm or shift >
5 mm evacuated
GCS < 9, ICP
monitor
Traumatic SAH
DTICH(Delayed traumatic
intracerebral hematoma)
DAI
**Avoid Hypoxemia &
Hypotension**
Brain Trauma Foundation
Guidelines
Antiseizure Prophylaxis(7
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Neuro ICU Midlevel Orientation Checklist

days)
Autonomic Dysfunction
Syndrome/ADS
Storming
HTN, ^ HR, ^ RR,
posturing, profuse
sweating
IV Morphine(if
intubated)
Propranolol,
clonidine
Intracranial HTN
CPP
ICP
(<20 if skull intact, < 15
w flap)
PCO2 Goals
Body Positioning

Date

Reviewed

Hyperosmolar Rx
1. Mannitol
Osmo < 320, >5 -1
cc/kg IV bolus
2. 3% Saline
3. 23%(NP or
Resident only)
Herniation Syndromes
Temp Control
Metabolic
Suppression(sedation,
pentobarb)
Decompressive
Craniectomy
Flap care
Helmet from Orthotics
Sign for bed
Hypothermia
Order Set
Induction
Maintenance
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Neuro ICU Midlevel Orientation Checklist

Shivering
Management
Rewarming

CEA
Complications(Hematom
a, MI)
DBS
` Bleeding
BP Control

Stroke
Stroke Center
NIH Stroke Scale
Hemorrhagic
SAH
Etiology
Ruptured vs Non
Ruptured
Grading Scales
Hunt & Hess
Fisher
Dx
CT(cornerstone of Dx)
LP if CT (-)
MRI
MRA(sensitivity 56% if <
5mm)
CTA
Cerebral Angio(look for
cause)20-25% NO source
SAH(cont.)

Date

Reviewed

Pre Angio (NVIR Order

Set)
Prevention of CIN
Post Angio Care
Closure Devices
Acute Mgmt
Cardiopulmonary
Stabilization
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Neuro ICU Midlevel Orientation Checklist

Mgmt of Complications
Hydrocephalus(EVD)
Seizures
Vasospasm(Day 310)
Goal is to
reduce ischemic
damage
Triple H
Therapy(hypervolemia,
HTN, hemodilution)
Magnesium
TCD
Nimodipine 60mg Q4 x
21 days
Prevention of
Rebleeding
Surgical Intervention
/Clipping
Non surgical Intervention
Embolization/Coiling
Risks(aneurysmal
perforation, ischemic
complications,
hemorrhage, recurrence)
MCA aneurysms difficult
to Rx w/ coils
Onyx
BP Control(< 150/160)
avoid Nipride
Cardene gtt
PRN Hydralazine &
Labetalol
ECG Changes
Hyponatremia
SIADH
Dx
Rx
Cerebral Salt Wasting
Dx
Rx

Date

Reviewed

Hyponatremia Rx
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Neuro ICU Midlevel Orientation Checklist

3% Saline
(Na/Osmo/Central
Line)
Salt Tabs
Florinef
Fluid Restriction
Intracerebral
Hemorrhage
Etiology
BP Control
Reverse Coagulopathy
OR
IVH(occurs 45% of Pts w
spontaneous ICH)
Primary(confined to
ventricles)
Secondary(extension
of an ICH)
EVD
CLEAR Trial(IV TPA)
Ischemic
Cardiogenic Embolic
Cryptogenic
Diagnostic
CT/MRI
Carotid US
TTE(Bubble study)
Supportive Care
Control Fever/Fever
Protocol
Glucose Control(>140)
BP Management
MAP 90-110, x SBP > 220
NIH Stroke Scale
Dysphagia Screen
Nutrition
Infection Prevention
Bowel & Bladder
DVT/PE Prevention
PT/OT/Speech
TPA
BP control (Goal 180230)
Labetalol/Hydralazine/Car
dene

10

Neuro ICU Midlevel Orientation Checklist

Date

Reviewed

MERCI retrieval Device

When TPA
contraindicated or no sig
improvement
Time to Procedure < 7
hrs
Penumbra
IA tPA(MCA occlusions)
No Heparin/ASA within
24 hrs
Inclusion/Exclusion(within
6 hrs)
Hypothermia(32-34)
Protocol
Shivering
NIH Stroke Scale
Dysphagia Screen
Antiplatelet Rx
ASA within 48 hrs if NO
TPA
Induced HTN
Complications
Hemorrhagic
Conversion
Seizures
Repeat CT within 24
hrs
ICU until Repeat CT
OK
Spinal Cord Injury
ABC
Immobilization
Diagnostic
ASIA Scale(pg 109)
Types of SCI(pg 110-111)
Cervical Collars
Miami J
Aspen
Rx
Methylprednisolone
Must be within 8
hrs of injury
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Neuro ICU Midlevel Orientation Checklist

Infusion over 23
hrs if started < 3
hrs, 47 hrs if 3-8
hrs
Closed Reduction
Halo
Tongs
Open Stablization
Harrington Rods
CD rods
Date

Reviewed

Neurogenic Shock
hypotension,
bradycardia, reflex
vasodilation,
hypothermia
Dopamine, Levo
Pacer(rare)
Lesions above T6
Autonomic Dysreflexia
Acute HTN
Severe pounding
HA
Perspiration above
level of lesion
Identify Cause
Nutrition
Bowel/Bladder
DVT Prophylaxis
Pulmonary Toilet
Rotorest bed
Spasticity
CNS Infections
Meningitis
Bacterial
Strep Pneumo,
Neisseria, Staph)
CSF-^ WBC, ^
Protein, Decreased
Glucose
Rx Abx
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Neuro ICU Midlevel Orientation Checklist

Viral
Aseptic
Sl ^ WBC, Protein
Nl, Glucose Nl
Encephalitis(Herpes,
West Nile)
Brain Abscess
DX- LP, CT w contrast
Rx - antibiotics

Seizures
Dx,- Tox Screen, CMP,
EEG, CT, LP
EEG(24 must be
approved by neurology)
Rx- benzo, antiepileptic
drugs(AEDs)
Pentobarb(Requires
Vigaleo)
2012 Guidelines
Brain Tumors

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Neuro ICU Midlevel Orientation Checklist

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Neuro ICU Midlevel Orientation Checklist

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