Critical Care Core Lecture Series

Developed by John M. Oropello, MD, Program Director of the Critical Care Medicine Program, the Critical Care Core Lecture Series incorporates speakers from all disciplines of critical care from pulmonary, palliative, neurocritical, and cardiology. Lectures are recorded and available for fellows to be downloaded at any time.

Neurocritical Care Core Lecture Series

To complement the Critical Care Core Lecture Series and cover all recommended neurocritical care core topics by the United Council for Neurologic Subspecialties, the Neurocritical Care Core Lecture Series includes reviews and updates of evidence-based neurocritical care clinical protocols, morbidity-mortality conferences, system-wide neurocritical care case conferences, and lectures by our core and interdisciplinary faculty.

Research Lecture Series

The Research Lecture Series focuses on the fundamentals of both clinical and outcomes research. The goal of the series is to equip fellows with knowledge to design and complete academic projects during their fellowship training and to prepare them for thriving academic careers.

Procedural Competencies

Trainees in the Neurocritical Care Fellowship learn core critical care procedures through didactics and simulation and get ample bedside experience. Fellows will graduate being comfortable with the following critical care procedures:

• Point of Care Ultrasound
  All fellows are given the opportunity to attend the New York Point of Care Ultrasound (POCUS) course at the start of their fellowship. An integral part of our daily neurocritical care rounds, fellows get ample experience in the practice, interpretation, and applications of POCUS, including critical care echocardiography, lung ultrasound, screening for deep vein thrombosis, and fundamental protocols.
• Venous Access
  Fellows perform central venous catheterization on the subclavian, internal jugular, and femoral veins with the use of ultrasound. Mannequins are used to teach subclavian and internal jugular catheterization, and all fellows rotate on the Central Venous Access Service to place central lines, dialysis catheters, and peripherally inserted central catheters using ultrasound and fluoroscopy.
• Airway
  All fellows start by learning the airway in simulation, rotating with anesthesia in their first year to learn the straightforward airway. The Neuroscience Intensive Care Unit (NSICU) performs all their own intubations and fellows will have many opportunities to get experience. Fellows participate in airway simulations ranging from basic airway management to difficult airways and learn techniques for tracheostomy and cricothyrotomy. Percutaneous tracheostomies are performed at the bedside by the NSICU, allowing fellows to become proficient in this procedure.
• Bronchoscopy
  Bronchoscopy simulation is designed to enable fellows to practice the proper technique for performing a bronchoscopy, including setting up the field, maneuvering the scope through left and right main bronchi, secondary and tertiary bronchi, performing bronchoalveolar lavage, and collecting respiratory culture samples. There are plenty of opportunities to perform bronchoscopy at the bedside, including for tracheostomy and for diagnostic or therapeutic reasons.
• Transcranial Dopplers
  As a high-volume cerebrovascular center and liver transplant center, every neurocritical care fellow will learn to perform and interpret Transcranial Dopplers (TCDs).

Understanding electroencephalography (EEG) is a very important part in managing critically ill patients, as seizures or status epilepticus are commonly encountered. Often non-convulsive, these seizures may only be revealed by continuous EEG monitoring. Continuous monitoring and quantitative analysis is also useful in patients with acute neurological problems to detect ischemia, other acute changes in brain function, and long-term trends.

Neurocritical care fellows participating in this track will learn fundamentals about EEG interpretation and monitoring, with a particular focus on intensive care unit (ICU) EEG monitoring, including quantitative EEG monitoring. Fellows provide a consult service for the evaluation and management of patients in the ICU, especially for patients with seizures or status epilepticus. In the weekly conference with neuroscience intensive care unit staff, residents, and students, fellows present a brief talk about various topics or journals and present the week’s interesting electroencephalography cases for discussion. During this training period, fellows are encouraged to participate in research. After six months in the Critical Care EEG Monitoring Track and six months of supervised experience, fellows are eligible to obtain the American Board of Clinical Neurophysiology: Critical Care EEG certification.

Curriculum

During the rotation, fellows are directly involved in the management of patients with seizures or status epilepticus in the ICUs at The Mount Sinai Hospital. They will develop an understanding of the pathophysiology of seizures and status epilepticus, as well as guidelines-based management for patients in status epilepticus.

Fellows gain knowledge of the indications and utility of critical care EEG monitoring and develop the skills to interpret critical care EEG monitoring along with quantitative EEG data. They will also learn to identify artifacts in the EEG recordings. In addition to clinical responsibilities, the fellow will participate in critical care EEG conferences and educational sessions, as well as critical care EEG quality assurance/performance improvement initiatives. They will also have the opportunity to engage in critical care EEG research and ongoing studies.

The Neurotrauma Track provides an immersive experience at NYC Health + Hospitals/Elmhurst Hospital Center, one New York City’s busiest Level I Trauma Centers. Elmhurst Hospital Center is an affiliate of the Icahn School of Medicine at Mount Sinai and the tertiary care center for western Queens, serving a population of over one million residents. The Neurosurgery Department at Elmhurst has one of the highest neurotrauma volumes in the city, each year managing approximately 300 traumatic brain injury and 100 spine trauma cases and performing over 75 neurotrauma surgeries. The department is fully staffed by three neurosurgery attendings, two neurosurgery residents, and several physician assistants.

Neurocritical Care fellows participating in the Neurotrauma Track play an integral role in the management of acute traumatic brain and spine injury patients at Elmhurst Hospital Center and learn how to provide neurotrauma interdisciplinary care. Fellows round with the neurosurgery team on critically ill neurosurgical patients in the Surgical-Trauma Intensive Care Unit and serve as the medical and critical care lead for patients in the Neurosurgical Step-Down Unit. Fellows have the opportunity to perform routine bedside neurosurgical procedures, including the placement, troubleshooting, and management of external ventricular drains, intracranial multimodality monitors, and twist-drill craniotomies for the bedside evacuation of subacute/chronic subdural hematomas. Additionally, fellows are encouraged to scrub in with the neurosurgery team on neurotrauma and other emergent neurosurgical cases.

Fellows actively participate in neurotrauma conferences, quality assurance and performance improvement, and neurotrauma research during their rotation, including acting as a liaison to the New York Neurotrauma Consortium. The department has a full-time clinical research coordinator and is involved in several ongoing head and spine injury studies.

Curriculum

During the rotation, fellows are directly involved as consultants in the management of acute traumatic brain and spine injury patients in the ICU and Neurosurgery Step-Down Units. Fellows develop an understanding of the pathophysiology of acute traumatic brain and spine injuries and guidelines-based management for these patients. They will also gain knowledge of the indications, advantages, and disadvantages of various neuromonitoring modalities, including invasive and non-invasive technologies.

Fellows also develop the clinical and technical skills needed for the placement, management, and troubleshooting of bedside neurosurgical procedures/devices, such as external ventricular drains, intracranial multimodality monitors, and twist drill craniotomies for subdural hematoma evacuations. They will develop an understanding of the indications for surgery following head and spine trauma and have the opportunity to participate in surgical procedures and post-op management.

In addition to clinical responsibilities, fellows participate in neurotrauma conferences and educational sessions, as well as neurotrauma quality assurance/performance improvement initiatives. They will also have the opportunity to engage in traumatic brain injury and spine injury research and ongoing studies.

Fellows in the Cerebrovascular Track train at The Mount Sinai Hospital, a Joint Commission-certified comprehensive stroke center with over 100 large vessel occlusion thrombectomy cases annually and a Center of Excellence for Subarachnoid Hemorrhage. They also train at Mount Sinai West, Mount Sinai’s Center of Excellence for Intracerebral Hemorrhage and a Joint Commission-designated stroke center.

Curriculum

During the track, fellows rotate through the stroke and endovascular services. They will gain skills in triaging acute strokes from throughout the Mount Sinai Health System and working up etiologies of cryptogenic stroke through their work on the Vascular Neurology service. They will also develop an understanding of the decision-making regarding thrombectomy and will get hands-on experience in the angiography suite.

Fellows participate in dedicated conferences through the divisions of Vascular Neurology and Endovascular Neurosurgery, and pursue research projects with mentors from either or both divisions. They also engage in quality assurance and performance improvement initiatives in both divisions.