Neurological Emergencies Information for Medical Students
The book chapter below is included in the book The Medical Student Survival Guide (2nd edition) written by Kristin E. Harkin, MD, Jeremy T. Cushman, MD, MS. This book, with more than 75 chapters, serves as a comprehensive medical student guide to the specialty of Emergency Medicine. It provides a great resource in all aspects of Emergency Medicine including its history, as well as information regarding training, research, fellowships, subspecialties, lifestyle, wellness, careers and much more.
Edward
P. Sloan, MD, MPH, FACEP
Chairman
and President, Foundation for Education and Research in Neurological
Emergencies (FERNE);
Professor,
Department of Emergency Medicine,
Andrew
S. Jagoda, MD, FACEP
Treasurer,
Foundation for Education and Research in Neurological Emergencies (FERNE);
Chicago, IL.
Professor,
Department of Emergency Medicine, Mount Sinai
Charrise M O'Neill,
RN, BS, CCRC
Executive Director,
Foundation for Education and Research in Neurological Emergencies
(FERNE);
Background:
There are many varied neurological emergencies that
lead to significant morbidity and mortality for Emergency Department patients. Patient outcomes can be optimized by the
delivery of excellent care by emergency physicians during the first hours after
the onset of symptoms, including timely diagnosis, treatment, consultation, and
disposition.
Academic Emergency Medicine published in 2005 a report describing the status of neurological
education in Emergency Medicine residency training programs. Brian A. Stettler, MD, and associates
conducted a survey of all 126 residency programs to determine what methods were
being used to educate residents on neurological emergencies. The group concluded that the primary method
of educating residents to treat neurological emergencies is through didactic
lectures, and that expanding clinical rotations or electives to enhance
education in neurological emergencies also warrants future attention.
There are a number of neurological
emergency disease states that are commonly treated by emergency physicians in
the Emergency Department. These disease
states include:
§
Seizure
and status epilepticus
§
Traumatic
Brain Injury
§
Acute
Ischemic Stroke
§
Intracerebral
and Subarachnoid Hemorrhage
§
CNS
Infection
§
Headache
Syndromes
§
Spinal
Injury
§
Neuropsychiatric
Disorders
The following information
outlines how Emergency Medicine residents in training and new faculty and
practitioners can optimize education in this content area.
Neurological
Emergencies Fellowship Training:
Currently, there exists only one
As of July, 2006, two fellowship positions exist for
a two-year fellowship that will combine the traditional one year neurovascular
fellowship with an additional year of neuro-critical care training. To find out more information, please contact Arthur
M. Pancioli, MD at arthur.pancioli@uc.edu.
Neurological Emergencies Education:
Foundation for Education and Research in Neurological
Emergencies (FERNE)
FERNE
is a group of emergency physicians with an interest in optimizing the care of neurological
emergency patients through the following:
promoting excellent emergency care for patients with neurological
emergencies, support for quality neurological emergencies research, and the
provision of state-of-the-art educational programs for student, resident, faculty,
and practitioners of Emergency Medicine.
FERNE also suing technology to break down the barriers of space and time
for those who wish to become educated in this content area.
To
date, through collaboration with organizations such as AAEM, ACEP, EMRA, and
SAEM, FERNE has provided over 400 lectures in the management of patients with
neurological emergencies by 180 speakers at 65 meeting both in the
FERNE
also has collaborated successfully with the Emergency Medicine Foundation in
providing over $250,000 in grants to support research in the optimal care of
patients with neurological emergencies.
FERNE is currently working with the EMF to study the effects of the
Katrina disaster on the provision of emergency care in the
FERNE
encourages any students, residents, faculty or practitioners to contact us if
there is an interest in posting a clinically useful patient case on the FERNE
website or in developing a local or regional meeting for emergency care
providers.
EmedHome
The mission of EMedHome.com
is to provide a user-friendly clinical resource that is designed to be the premier
educational website for emergency physicians. Launched in February 2000,
EMedHome was created by an independent emergency physician, and in March 2003,
the Accreditation Council for Continuing Medical Education accredited EMedHome.com
as a provider of Continuing Medical Education for Physicians. EMedHome.com
provides education in the area of neurological emergencies in conjunction with
FERNE. The website is http:www.emedhome.com.
Neurological
Emergencies Research:
Emergency Medicine
Foundation and
Foundation for Education and
Research in Neurological Emergencies
Directed Research in Neurological Emergencies Grant
The Directed Neurological
Emergencies Grant Program awards up to
$25,000 annually. The program is jointly sponsored by the Emergency
Medicine Foundation (EMF) and the Foundation for Education and Research in
Neurological Emergencies (FERNE). Applicants may apply for up to $25,000 of the
funds. The grants are awarded to researchers in established emergency medicine
research programs to support research specifically in the topic of neurological
emergencies. The goal of this directed grant program is to fund clinical research ion the treatment of
acute disorders of the neurological system, such as the identification and treatment
of diseases and injury to the brain, spinal cord and nerves. The EMF and FERNE encourage interested
emergency physicians to submit applications for clinical research in the key
content areas of emergency care for neurological emergencies patients at: http://my.acep.org/site/PageServer?pagename=wp2_homepage
Neurological Emergencies Treatment Trials Network
One route is for
investigator-initiated studies, which would be reviewed by an Ad Hoc Review
group or Study Section. This review group/study section would include members
from the Executive Committee of the network.
Studies funded by non-governmental entities such as industry can be
proposed directly to the Executive Committee. The inclusion of NINDS staff on
the Executive Committee insures the infrastructure being funded by NIH/NINDS
provides the appropriate scientific return on the investment. Information on this research network can be
found at http://nett.umich.edu/nett/welcome.
Neurological Emergencies Guidelines:
National Guideline Clearinghouse
The National Guideline Clearinghouse™ (NGC) is a public resource for
evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research
and Quality (AHRQ), U.S. Department of Health and Human Services.
NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now
American
These ACEP
board-approved documents describe the College’s policies on the clinical
management of presenting symptoms, specific illnesses or injuries. The
College’s Clinical Policies Committee develops each guideline. Many guidelines and policy statement related
to neurological emergencies, such as seizures, traumatic brain injury, and
stroke are located on the ACEP website at http://www.acep.org/webportal/PracticeResources/ClinicalPolicies/.
Neurological Emergencies Useful Organizations and
Websites:
National Institutes of Health
The NIH Blueprint for
Neuroscience Research aims to develop new tools, resources, and training
opportunities to accelerate the pace of discovery in neuroscience research. This information can be found at: http://neuroscienceblueprint.nih.gov/.
National Institute of Neurological Disorders and
Stroke
The mission of NINDS is to reduce
the burden of neurological disease - a burden borne by every age group, by
every segment of society, and by people all over the world. The NINDS website
homepage can be found at http://www.ninds.nih.gov/index.htm.
Websites
The organizations listed
below work closely with Emergency Medicine physicians and welcome them as part
of their constituency. The following Web
sites can provide healthcare professionals with information about the treatment
of stroke, seizures, traumatic brain injury, and other neurological
emergencies.
Society of Academic Emergency Medicine (SAEM)
Emergency Medicine Residents’ Association (EMRA)
National Association of
http://www.aan.com/professionals
Brian Attack Coalition
National Stroke Association (NSA)
American Stroke Association (ASA)
http://www.strokeassociation.org
The
Epilepsy Foundation of
http://www.epilepsyfoundation.org
NINDS Traumatic Brain Injury Information Page
http://www.ninds.nih.gov/disorders/tbi/tbi.htm
http://www.cdc.gov.hode.do/id/0900f3ec8000dbdc
International Brain Injury Association
http://www.internationalbrain.org
Brain Trauma Foundation
Neurological Emergencies Career Opportunities:
There are numerous
opportunities for emergency physicians to pursue a career with a focus on the
optimal treatment of patients with neurological emergencies. These opportunities include:
§
Educating
within an EM residency program or your hospital on optimal neurological
emergencies patient care.
§
Conducting
neurological emergencies research with EMF/FERNE funding or other sources of
funding.
§
Working
with NETT to conduct neurological emergencies research.
§
Collaborating
with industry in developing new products for use in managing patients with
neurological emerencies.
§
Networking
within your hospital with other providers of neurological emergency care to
develop guidelines for optimal patient care.
§
Being
a member of the ACEP Clinical Policies Committee in order to develop guidelines
that optimize neurological emergencies patient care.
§
Working
with the SAEM Neurological Emergencies Interest Group in promoting research and
education in this area of interest.
§
Working
with FERNE or other organizations to optimize this patient care.
Conclusions:
There are many opportunities to pursue a career in
Emergency Medicine with a focus in the optimal care of patients with
neurological emergencies. Whether the
work involves research, education, or the development of state-of-the-art
treatment guidelines, a focus in this treatment area will enhance your career
in Emergency Medicine and make the care of these critically ill and injured
patients maximally fulfilling.
For further information, please feel free to email us
at edsloan@uic.edu,
andy.Jagoda@msnyuhealth.org,
or coneill2@uic.edu.