NCCEd: Neurocritical Care Education for Residents

Objective: Recognize clinical signs and symptoms suggestive of decompensated heart failure

Rationale: Neurosurgical patients often have relevant comorbid cardiac disease. Conventional management of several acute neurosurgical illnesses often entails liberal fluid administration, which may exacerbate heart failure and contribute to poorer outcomes. Furthermore, treatment of atrial fibrillation (see next learning objective) is impacted by whether heart failure is present.

Objective: Identify the indications for therapeutic anticoagulation for atrial fibrillation

Objective: Weigh the risk/benefit profile for delaying therapeutic anticoagulation for atrial fibrillation

Objective: Identify the indications for thrombolysis and therapeutic anticoagulation for pulmonary embolism

Objective: Weigh the risk/benefit profile for delaying thrombolysis and/or therapeutic anticoagulation for pulmonary embolism

Rationale: Neurosurgical patients are at high risk of developing pulmonary embolism and atrial fibrillation. The standard treatments of thrombolysis and therapeutic anticoagulation are typically contraindicated in the acute postoperative period. However, complex situations exist (e.g. emerging obstructive shock and progression to cardiac arrest) and require a careful weighing of the risks and benefits to identify the optimal treatment plan.