I. Problem/Challenge.
Hospitalists will likely be increasingly responsible for the co-management of neurosurgical patients and should be familiar with the most common neurosurgical procedures and managing potential medical complications.
II. Identify the Goal Behavior.
III. Describe a Step-by-Step approach/method to this problem.
Pre-Operative Evaluation
Step 1: Determine Revised Cardiac Risk Index (RCRI) score
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Step 2: Assess patient’s functional exercise capacity
Tumor Resection
Intracranial Hemorrhage
Spinal Decompression and Fusion
DVT Prophylaxis
IV. Common Pitfalls.
Anticoagulation and antiplatelet therapy:
– Discuss with neurosurgeon before starting anything that could increase bleeding risk
Volume management in patients with subarachnoid hemorrhages:
– Balancing risk of vasospasm with cardiopulmonary status
Antihypertensive management:
– Titrating BP meds too fast
Long-term steroid use:
– GI prophylaxis, glycemic control, counseling on muscle wasting/confusion/increased bleeding risk
V. National Standards, Core Indicators and Quality Measures.
No national standards/benchmarks established yet.
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