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Exam Number : NCC
Exam Name : Certified in NeuroCritical Care (ABEM)
Vendor Name : Certification-Board
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NCC test Format | NCC Course Contents | NCC Course Outline | NCC test Syllabus | NCC test 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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If an ISA CAP® or CCST® applicant feels he/she became wrongly denied certification, long-established or renewal, from the CAP or CCST program, then he/she has the right to enchantment.

Appeals approaches

All appeals can be in writing.

  • The be aware of enchantment should be dropped at the Certification Board, addressed to the consideration of the ISA government Director, via the shut of company on the twenty first day after the receipt date of the note of denied certification.
  • The attraction should include the date the be aware of denied certification changed into bought and need to state the explanations the applicant believes the denied certification turned into in error.
  • The enchantment should still indicate whether or now not the applicant requests a hearing.
  • If a listening to is requested, the applicant must clarify why a listening to is needed, determine the issues to be resolved at a hearing, checklist names of potential witnesses, and establish documentation and different proof to be brought at the hearing before the Board.
  • The Chair of the Certification Board will choose a three-member panel of the Board to develop into the evaluation Panel, one among whom can be appointed Chair and should be the final vote within the adventure of a tie during the ruling.
  • procedures

    The evaluate Panel will test the attraction and any request for a hearing. The overview Panel will grant a hearing in reference to the attraction, if requested.

    hearing
  • The Chair of the test Panel will examine the time and location of the listening to within ninety days after choice that a hearing is warranted and will notify the applicant within the first 21 days. The applicant can be notified of the listening to time and location at least 20 days prior to the time determined for the listening to.
  • The applicant can be represented by information or signify him/herself on the listening to. The applicant can also present witnesses and documents and may go-verify any witness.
  • The evaluate Panel can also accept as true with any facts it deems vital without regard to strict utility of prison guidelines of facts.
  • The applicant is entreated to post a written short (4 copies) 10 days ahead of the hearing to the Certification Board, addressed to the consideration of the ISA executive Director, for distribution to the panel in guide of his/her position. although, written briefs are not required.
  • Deposition
  • If the applicant or overview Panel desires to take a deposition earlier than the hearing of any voluntary witnesses who can't attend the listening to, the deposition of a witness can be applied for in writing to the Chair of the evaluation Panel together with a written consent signed with the aid of the knowledge witness that she or he will supply a deposition for one birthday party and a statement to the impact that the witness can't attend the listening to along with the reason for such unavailability.
  • The birthday party in search of to take the deposition of a witness shall state in aspect as to what the witness is expected to testify.
  • If the Chair of the review Panel is convinced that such deposition from a probable witness should be central to the challenge in query earlier than the Panel, then the Chair will authorize the taking of the deposition. The Chair will additionally designate a member of the Panel to be latest on the deposition.
  • The deposition may well be taken orally or through video. Any refusal of the taking of the deposition by the Chair will likely be reviewed with the aid of the Panel on the request of the applicant.
  • The birthday party asking for the deposition will pay for the cost related with taking the deposition.
  • The applicant could be notified of the outcome of the evaluation Panel inside 30 days of the assembly.

    remaining review
  • If the evaluate Panel makes a decision opposed to the applicant, the applicant may attraction to the full Certification Board for a closing test via the close of business on the twenty first day after the word of choice is issued. Such attraction shall comply with the identical strategies as the initial enchantment to the extent feasible with the Chair of the Board serving because the Chair of the remaining test Panel. The Chair will once once again opt for a 3-member panel, one among whom shall be himself, to develop into the evaluation Panel, and the remaining vote within the adventure of a tie right through the ruling can be his.
  • If the applicant doesn't petition the Board for overview or request a listening to before the Board related to the advice of rejection of the utility within the time allowed by using these suggestions, the usual resolution by using the test Panel shall stand.

  •  



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