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Exam Number : NCC
Exam Name : Certified in NeuroCritical Care (ABEM)
Vendor Name : Certification-Board
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NCC exam Format | NCC Course Contents | NCC Course Outline | NCC exam Syllabus | NCC exam Objectives


The following are specific diseases, conditions, and clinical syndromes commonly managed by a neurointensivist:

A. Cerebrovascular Diseases

1. Infarction and ischemia

• Massive hemispheric infarction

• Basilar artery occlusion and stenosis

• Carotid artery occlusion and stenosis

• Crescendo TIAs

• Occlusive vasculopathies (Moya-Moya, sickle cell)

• Spinal cord infarction

2. Intracerebral hemorrhage

• Supratentorial

• Cerebellar

• Brainstem

• Intraventricular

3. Subarachnoid hemorrhage - aneurysmal and other Vascular malformations

• Arteriovenous malformations

• AV fistulas

• Cavernous malformations

• Developmental venous anomalies

4. Dural sinus thrombosis

5. Carotid-cavernous fistulae

6. Cervical and cerebral arterial dissections

B.Neurotrauma

1. Traumatic brain injury

• "Diffuse axonal injury"

• Epidural hematoma

• Subdural hematoma

• Skull fracture

• Contusions and lacerations

• Penetrating craniocerebral injuries

• Traumatic subarachnoid hemorrhage

2. Spinal cord injury

• Traumatic injury (transection, contusion, concussion)

• Vertebral fracture and ligamentous instability

C. Disorders, Diseases, Seizures, and Epilepsy

1 . Seizures and epilepsy

• Status epilepticus (SE) Convulsive

Non-convulsive (partial-complex and "subtle" secondarily generalized SE) Myoclonic

2. Neuromuscular diseases

• Myasthenia gravis

• Guillain-Barre syndrome

• ALS

• Rhabdomyolysis and toxic myopathies

• Critical illness myopathy and neuropathy

3. Infections

• Encephalitis (viral, bacterial, parasitic)

• Meningitis (viral, bacterial, parasitic)

• Brain and spinal epidural abscess

4. Toxic-metabolic disorders

• Neuroleptic malignant syndrome/malignant hyperthermia

• Serotonin syndrome

• Drug overdose and withdrawal (e.g., barbiturates, narcotics, alcohol, cocaine, acetaminophen).

• Temperature related injuries (hyperthermia, hypothermia)

5. Inflammatory and demyelinating diseases

• Multiple sclerosis (Marburg variant, transverse myelitis)

• Neurosarcoidosis

• Acute disseminated encephalomyelitis (ADEM)

• CNS vasculitis

• Chemical or sterile meningitis (i.e. posterior fossa syndrome, NSAID induced)

• Central pontine myelinolysis

• Others

6. Neuroendocrine disorders

• Pituitary apoplexy

• Diabetes insipidus (including triple phase response)

• Panhypopituitarism

• Thyroid storm and coma

• Myxedema coma

• Addisonian crisis

D. Neuro-oncology

1 . Brain tumors and metastases

2. Spinal cord tumors and metastases

3. Carcinomatous meningitis

4. Paraneoplastic syndromes

E.Encephalopathies

1. Eclampsia, including HELLP Syndrome

2. Hypertensive encephalopathy

3. Hepatic encephalopathy

4. Uremic encephalopathy

5. Hypoxic-ischemic and anoxic encephalopathy

6. MELAS

F.Clinical syndromes

1.Coma

2. Herniation syndromes with monitoring & ICP

3. Elevated intracranial pressure and Intracranial hypotension/hypovolemia

4. Hydrocephalus detection & treatment

5. Cord compression

6. Death by neurologic criteria, end of life issues, and organ donation

7. Vegetative state

8. Dysautonomia (cardiovascular instability, central fever, hyperventilation)

9. Reversible posterior leukoencephalopathy

10. Psychiatric emergencies (psychosis)

G. Perioperative Neurosurgical Care

H.Pharmacotherapeutics

II. General Critical Care: Pathology, Pathophysiology, and Therapy

A. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy

1. Shock (hypotension) and its complications (vasodilatory and cardiogenic)

2. Myocardial infarction and unstable coronary syndromes

3. Neurogenic cardiac disturbances (ECG changes, stunned myocardium)

4. Cardiac rhythm and conduction disturbances; use of antiarrhythmic medications; indications for and types of
pacemakers

5. Pulmonary embolism

6. Pulmonary edema: cardiogenic versus noncardiogenic (including neurogenic)

7. Acute aortic and peripheral vascular disorders (dissection, pseudoaneurysm)

8. Recognition, evaluation and management of hypertensive emergencies and urgencies

9. Calculation of derived cardiovascular parameters, including systemic and pulmonary vascular resistance,
alveolararterial gradients, oxygen transport and consumption

B.Respiratory Physiology, Pathology, Pathophysiology and Therapy

1.Acute respiratory failure

• Hypoxemic respiratory failure (including ARDS)

• Hypercapnic respiratory failure

• Neuromuscular respiratory failure

2. Aspiration

3. Bronchopulmonary infections

4. Upper airway obstruction

5. COPD and status asthmaticus, including bronchodilator therapy

6. Neurogenic breathing patterns (central hyperventilation, Cheyne-Stokes respirations)

7. Mechanical ventilation

• Positive pressure ventilation (BIPAP)

• PEEP, CPAP, inverse ratio ventilation, pressure support ventilation, pressure control, and non- invasive ventilation

• Negative pressure ventilation

• Barotrauma, airway pressures (including permissive hypercapnia)

• Criteria for weaning and weaning techniques

8. Pleural Diseases

• Empyema

• Massive effusion

• Pneumothorax

9. Pulmonary hemorrhage and massive hemoptysis

10. Chest X-ray interpretation

11. End tidal C02 monitoring

12. Sleep apnea

13. Control of breathing

C. Renal Physiology,Pathology, Pathophysiology and Therapy

1.Renal regulation of fluid and water balance and electrolytes

2.Renal failure: Prerenal, renal, and postrenal

3.Derangements secondary to alterations in osmolality and electrolytes

4. Acid-base disorders and their management

5.Principles of renal replacement therapy

6. Evaluation of oliguria and polyuria

7.Drug dosing in renal failure

8. Management of rhabdomyolysis

9. Neurogenic disorders of sodium and water regulation (cerebral salt wasting and SIADH).

D. Metabolic and Endocrine Effects of Critical Illness

1. Enteral and parenteral nutrition

2. Endocrinology

• Disorders of thyroid function (thyroid storm, myxedema coma, sick euthyroid syndrome)

• Adrenal crisis

• Diabetes mellitus

Ketotic and hyperglycemic hyperosmolar coma Hypoglycemia

3. Disorders of calcium and magnesium balance

4. Systemic Inflammatory Response Syndrome (SIRS)

5. Fever, thermoregulation, and cooling techniques

E.Infectious Disease Physiology, Pathology, Pathophysiology and Therapy

1. Antibiotics

• Antibacterial agents

• Antifungal agents

• Antituberculosis agents

• Antiviral agents

• Antiparasitic agents

2. Infection control for special care units

• Development of antibiotic resistance

• Universal precautions

• Isolation and reverse isolation

3. Tetanus and botulism

4. Hospital acquired and opportunistic infections in the critically ill

5. Acquired Immune Deficiency Syndrome (AIDS)

6. Evaluation of fever in the ICU patient

7. Central fever

8. Interpretation of antibiotic concentrations, sensitivities

F.Physiology, Pathology, Pathophysiology and therapy of Acute Hematologic Disorders

1 . Acute defects in hemostasis

• Thrombocytopenia, thrombocytopathy

• Disseminated intravascular coagulation

• Acute hemorrhage (GI hemorrhage, retroperitoneal hematoma)

• Iatrogenic coagulopathies (warfarin and heparin induced)

2. Anticoagulation and fibrinolytic therapy

3. Principles of blood component therapy (blood, platelets, FFP)

4. Hemostatic therapy (vitamin K, aminocaproic acid, protamine, factor VIla)

5. Prophylaxis against thromboembolic disease

6. Prothrombotic states

G. Physiology, Pathology, Pathophysiology and Therapy of Acute Gastrointestinal (GI) and Genitourinary (GU)

Disorders

1. Upper and lower gastrointestinal bleeding

2. Acute and fulminant hepatic failure (including drug dosing)

3. Ileus and toxic megacolon

4. Acute perforations of the gastrointestinal tract

5. Acute vascular disorders of the intestine, including mesenteric infarction

6. Acute intestinal obstruction, volvulus

7. Pancreatitis

8. Obstructive uropathy, acute urinary retention

9. Urinary tract bleeding

H. Immunology and Transplantation

1. Principles of transplantation (brain death, organ donation, procurement, maintenance of organ donors, implantation)

2. Immunosuppression, especially the neurotoxicity of these agents

I. General Trauma and Burns

1. Initial approach to the management of multisystem trauma

2. Skeletal trauma including the spine and pelvis

3. Chest and abdominal trauma - blunt and penetrating

4. Burns and electrical injury

J. Monitoring

1. Neuromonitoring

2. Prognostic, disease severity and therapeutic intervention scores

3. Principles of electrocardiographic monitoring

4. Invasive hemodynamic monitoring

5. Noninvasive hemodynamic monitoring

6. Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space,
compliance, resistance, capnography)

7. Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient)

8. Use of computers in critical care units for multimodality monitoring

K. Administrative and Management Principles and Techniques

1. Organization and staffing of critical care units

2. Collaborative practice principles, including multidisciplinary rounds and management

3. Emergency medical systems in prehospital care

4. Performance improvement, principles and practices

5. Principles of triage and resource allocation, bed management

6. Medical economics: health care reimbursement, budget development

L. Ethical and Legal Aspects of Critical Care Medicine

1. Death and dying

2. Forgoing life-sustaining treatment and orders not to resuscitate

3. Rights of patients, the right to refuse treatment

4. Living wills, advance directives; durable power of attorney

5. Terminal extubation and palliative care

6. Rationing and cost containment

7. Emotional management of patients, families and caregivers

8. Futility of care and the family in denial

M. Principles of Research in Critical Care

1. Study design

2. Biostatistics

3. Grant funding and protocol writing

4. Manuscript preparation

5. Presentation preparation and skills

6. Institutional Review Boards and HIPAA

Ill. Procedural Skills

A. General Neuro-Critical Care

1 . Central venous catheter placement; dialysis catheter placement

2. Pulmonary artery catheterization

3. Management of mechanical ventilation, including CPAP/BiPAP ventilation

4. Administration of vasoactive medications (hemodynamic augmentation and hypertension lysis)

5. Maintenance airway and ventilation in nonintubated, unconscious patients

6. Interpretation and performance of bedside pulmonary function tests

7. Direct laryngoscopy

8. Endotracheal intubation

9. Shunt and ventricular drain tap for CSF sampling

10. Performance and interpretation of transcranial Doppler

11. Administration of analgosedative medications, including conscious sedation and barbiturate anesthesia

12. Interpretation of continuous EEG monitoring

13. Interpretation and management of ICP and CPP data

14. Jugular venous bulb catheterization

15. Interpretation of Sjv02 and Pbt02 data

16. Management of external ventricular drains

I 7. Management of plasmapheresis and IVIG

18. Administration of intravenous and intraventricular thrombolysis

19. Interpretation of CT and MR standard neuroimaging and perfusion studies and biplane contrast neuraxial
angiography

20. Perioperative and postoperative clinical evaluation of neurosurgical and interventional neuroradiology patients

21. Performance of lumbar puncture and interpretation of cerebrospinal fluid results

22. Induction and maintenance of therapeutic coma and hypothermia



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Certification-Board NeuroCritical study tips

 

Changes in Board Certification Could Excellerate Vascular Surgery Training

Certification and Accreditation

Certification in vascular surgery (VS) in the United States is currently the responsibility of the American Board of Surgery (ABS), which is also responsible for certification in general surgery (GS). The ABS is one of 24 certifying boards that are members of the American Board of Medical Specialties (ABMS). As such, it is responsible for certifying those surgeons who are found to be qualified after meeting specific training requirements and completing an examination process. Certification in VS is specifically overseen by the Vascular Surgery Board (VSB), a component board of the ABS. Details of the ABS and VSB structure can be found on their Web site ( www.absurgery.org ). It should be noted that the ABS is responsible for certification of individuals and is not responsible for hospital credentialing or surgeon reimbursement.

Accreditation of VS training programs in the United States is the responsibility of the Accreditation Council for Graduate Medical Education (ACGME), which develops accreditation standards and reviews accredited programs for compliance. In VS and GS, this is done by the Residency Review Committee for Surgery (RRC-S), one of 26 specialty-specific review committees of the ACGME. Details of the ACGME and RRC-Surgery structures can be found on their Web site ( www.acgme.org ). It should be noted that the RRC-S is responsible for establishing minimal training requirements in VS training programs but is not responsible for individual surgeon certification. However, surgeons seeking certification by an ABMS board must successfully complete an ACGME-accredited residency training program.

Currently, VS is a specialty board of the ABS, such that primary certification in GS is required before a secondary certificate in VS can be obtained. Similarly, completion of an ACGME-accredited residency program in GS is a prerequisite for VS training in an ACGME-accredited program. However, recertification in GS is not required to maintain certification in VS.

Vascular. 2004;12(6):359-361. © 2004 BC Decker, Inc.

Cite this: Changes in Board Certification Could Excellerate Vascular Surgery Training - Medscape - Nov 01, 2004.


Four Tips To Network Strategically And Unlock Board Opportunities

International Leadership Advisor and Executive Coach, CEO of Rose Cartolari Consulting. I help senior executives lead in turbulent times.

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For many senior-level executives, getting on a board seems to be the go-to next career move. It allows you to grow as well as gives you the chance to make significant contributions to an organization at a different level.

Ask any expert and they will tell you that one critical part of finding and getting a position on a board is your ability to mobilize your network. However, even with this skill, getting on a board can be very challenging, partly because of how competitive the market is becoming, but also because often, board positions are filled through "closed" networks, a.k.a. word of mouth.

So what are some tangible tips to help you navigate the complexities of board appointments and increase your chances of success? In my experience, there are four that stand out.

1. Make sure your network is diverse.

The old adage says, "If you can’t beat them, join them!" I find this resonates, especially for women who are looking to get onto boards that are heavily loaded with men—think the much-discussed "old boys’ network." For these women and others, my advice is: Make friends with "old boys."

People recruit for boards from the talent pools they have access to. Make sure that a broad range of people have access to you and know about your interest and qualifications to be on a board; become part of their network.

Of course, networking within your industry and creating a tribe of like-minded people is important for many reasons, but you also want to make sure that you have as broad a reach as possible. So go out of your way to meet a wide range of people from other backgrounds and sectors who can open doors to board opportunities otherwise unavailable to you.

At the very least, a diverse network broadens your perspective and increases your visibility among more potential board recruiters.

2. Focus on creating meaningful relationships.

If networking were just about exchanging business cards and saying hello to a number of strangers, they could all be great networkers. But those who have strong, vibrant networks are those who are able to engage authentically and establish a genuine connection with others. How can you do this? By asking questions and listening deeply.

So many people go to networking events hoping to come away with many contacts. However, what I see to be much more effective is taking the time to understand a few others' interests, goals and challenges. Bring your whole self to the conversation, engage—and only offer support, help and ideas when and if appropriate. Leaving an event with one or two solid "new friends" is a big win. Then, you must nurture this seed that you have planted by continuing meaningful conversations and exchanges.

It takes a lot of time and investment to build genuine connections with people like influencers, executives and established board members. But it is well worth it if it means you can enhance your credibility and reputation and make yourself a top-of-mind candidate when board positions become available.

3. Get educated.

Besides creating a great knowledge base that will significantly strengthen your candidacy for board positions, taking classes, workshops and seminars on key board issues, such as governance, strategic planning, risk management and financial strength, will show your commitment to "doing it right." And it will put you in front of experts in the area in which you are interested (each of whom has their own network).

It will also connect you with a community of people who are in the same boat as you. These people can help you prepare, practice and network, and support you in your board search.

4. Be bold, clear... and specific.

Perhaps the hardest part of networking is actually tapping into your network and being clear about what you are asking them. Here it pays to do your homework: Who are you going to ask for what? Help with your pitch? Background information on a company? An introduction?

Remember, you cannot be clear and ask for referrals from people with whom you don’t have a relationship, so make sure you have cultivated that relationship first. But once you have, do not hesitate to let people who can open doors for you provide referrals. Be confident, concise and clear.

For example: "Susie, I am looking for a board position in a company such as X, where I can contribute Y and Z. I know you have a lot of connections and insight into this industry, and I would love it if you could connect me with the right people who could help me with my goal."

Remember to be specific about the industry and type of board you are interested in, as well as the experiences and skills you bring to the table. Also, make a clear case as to why you are a great candidate, and make sure you provide any necessary materials, such as your board bio or a summary of your accomplishments, to facilitate the referral process.

The key here is to make it easy for the other person to know what exactly they have to say about you and to which kinds of people/boards.

Conclusion

Securing a board position takes time and planning, but most of all, it requires a strategic and proactive approach to networking. Although networking is a long-term investment, it is worth it; so be patient, persistent and authentic in your interactions.

With the right combination of networking skills and dedication, you can become visible to boards and find the opportunities you're looking for.

Forbes Coaches Council is an invitation-only community for leading business and career coaches. Do I qualify?


National Board for Certification in Occupational Therapy

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Redefining how to maintain a strong culture is more than an exercise at the National Board for Certification in Occupational Therapy (NBCOT). It is how it draws strength to face challenges while boldly forging ahead with innovative products and services. NBCOT offers their employees a hybrid working model. No one decision determines how NBCOT succeeds, particularly while adapting to a constantly shifting work environment. NBCOT maintains a trusting environment. All employees earn the same benefits, particularly time off. It practices “family first.”  If any employee experiences a family emergency, he/she takes care of it first. NBCOT understands that time is a precious commodity and one of its most important assets. Employees enjoy a fixed 35-hour work week where “extra” is not only ignored, but discouraged. Every employee enjoys more than 30 days off a year, with the entire office closed the last week of December. It limits PTO carry-over and monitor and encourage full use of time off. A well-rested and happy employee is a productive employee. Laughter is heard often, which is evidence of a team extremely comfortable with each other, so challenges and problems are dealt with efficiency and humor. The NBCOT team likes going to work. The feeling is the result of a carefully nurtured culture maintained by thousands of decisions to ensure that NBCOT remains an extraordinary workplace.


 




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References :


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