Ceribell Training Flashcards
Describe a Level 1 Trauma Hospital, 3-4 main points
24 Hour IN HOUSE coverage by general surgeons, prompt availability of trauma surgeons, neurosurgery, Emergency medicine, Critical care, and pediatrics
Referral resource for communities in nearby regions
Have tech and equipment a level 2 does not
Likely a hub for receipt of transfers and usually the “hub” for a health system IDN
They keep the sickest of the sick patients
Describe a Level 2 Trauma Hospital, 3-4 main points
24 hour immediate (on call, not on location) coverage by general surgeons
Tertiary care needs: may refer cardiac and other surgeries to a Level 1 Center
Likely transfer patients to nearby level 1
Compare Level 3 Trauma centers to Level 4 Trauma centers
Level 3 has 24/7 immediate coverage by emergency med, and on call general surgery. Provides back up care for rural and community hospitals. Transfer patients to level 1+2
Level 4 main focus is trauma support and fast transfer to a higher level trauma center
What are our Level 1 Call Points? 6 departments
Neuro ICU (Neurointensivist, Neurocritical care fellows, Neurosurgeons)
Medical ICU (cardiac arrests,sepsis, etc) Don’t overlook
Surgical ICU (TBIs)
Stroke Team
ED
Epileptologist
What are our Level 2 Call Points?
ALL ICUs (ICU Medical Director, Intensivists, ICU APPs)
Neurosurgery? If they work with TBI/Tumor
Stroke Team
ED
Neurohospitalist?
Epileptologist/Reading Neurologists
Likely have 1-2 EEG Techs - need to assess hours/coverage days
What are our Level 3 Call Points?
All ICUs
Stroke Team
ED
Epileptologist/Reading Neurologists
How can Ceribell help lower Level Trauma Centers with transfers? / Making sure transfers are accepted?
Provides the team with clear cut DATA that the patient is having a NCS / NCSE.
removes the guessing game
How can Ceribell help a center avoid unnecessary transfers? 3 typical scenarios
Maybe they couldn’t do 12 or 24 hour EEG studies previously? Patient would have needed a transfer. But with Ceribell - they can put a headband on for a 12-24 hour test and keep them on site
Ceribell can also RULE OUT NCS/NCSE to show it isn’t necessary to transfer
Patient is confirmed to have NCS/NCSE by Ceribell (EEG otherwise not available). Leads to quicker treatment and effectiveness of meds. Seizure activity subsisdes, and patient can stay at current hospital
What are the two main types of strokes?
Ischemic (Ih-scheme-ick) and Hemorrhagic
What is an Ischemic Stroke? How is it treated?
Usually caused by a clot. Something is creating a blockage of blood flow to the brain.
Treated with expensive, high risk blood thinner. Typically less sever than Hemorrhagic
What is a Hemorrhagic stroke? How is it treated?
Active bleeding in the brain. Usually requires surgical intervention to stop the bleeding
Name the 4 types of Stroke Centers
Acute Stroke Ready Hospital
Primary Stroke Center
Thrombectomy-Capable stroke center
Comprehensive stroke center
Define Acute Stroke Ready Hospitals
Least acute of the 4 stroke centers.
Can take a stroke patient, give a clot busting med, and then transfer out.
Rarely retains stroke patients.
Define Primary Stroke Centers
Can accept and keep most Ischemic strokes. Will transfer out most hemorrhagic strokes
Define Thrombectomy-Capable Stroke Center
Can accept and keep Ischemic strokes (Even thosee that require thrombectomy Surgical removal of a blood clot)
Still transfer out most hemmorhagic strokes
What is a thrombectomy?
Surgical removal of a blood clot
Define Comprehensive Stroke Center
Keeps ALL strokes. Highest end Stroke service
What providers are found in General/Mixed/Medical ICU’s?
Intensivists (Provides care for critically ill patients)
Pulmonologists (Lung conditions)
What providers are found in Neuro ICU?
Neurointensivists
Stroke Neurologists
Neurosurgery
Epilepsy
What providers are found in Cardiac ICU/ CVICU? Two main types
Intensivists
Cardiac Surgeons
Midlevels/fellows
What providers are found in Surgical ICU/Trauma ICU?
Surgeons
Anesthesia
Ortho
What patients are treated in General/Mixed/Medical ICUs?
Sepsis, Cardiac Arrests, Substance Use Disorders/Overdose
What patients are treated in Neuro ICUs?
Brain Tumors
Strokes
What patients are treated in Cardiac ICUs?
Cardiovascular intervention
Cardiac surgery
Open heart procedures
What patients are treated in Surgical ICUs?
Trauma
Traumatic brain injuries
falls
Difference between Trauma level designations?
Level 1s keep all patients. Levels 2 and 3 transfer
Level 1 typically have better neurodiagnostic coverage
4 Main Impacts Ceribell has on Patient Transfers?
Ruling in can help with rapid, more effective treatment
Ruling in can help expedite the patient to where they need to go (Transfer acceptance)
Ability to do 24 hour studies
Ruling out - potential to avoid unnecessary transfer for high suspicion
Main difference between Comprehensive and Primary stroke center accreditations?
Comprehensive - keeps all strokes
Primary - keeps Ischemic strokes (Clots) transfers out hemorrhages
What are the 4 main types of ICUs? What are their main patient/conditions they treat?
Medical - Sepsis, toxic/metabolic, cardiac arrest
Surgical/Trauma - Complex TBIs
Neuro - Neuro deficits, epilepsy, brain tumors
Cardiac - cardiac surgeries, cath lab interventions
2 Minute Pitch to an ED Provider - what do they want to hear?
What is Ceribell? How will it benefit them and their patients? Does/How does it work? When do they use it? Do they have to put it on? TIME TIME TIME
Stroke Neurologists - overview?
Expertise in stroke and cerebrovascular disease.
Usually on at the hospital/on call 24/7
Can do “wet reads”
They understand and are passionate about “Time is Brain”
Understand the necessity for having something quickly at the bedside. May be familiar with AI Technologies
Who/what are Hospitalists?
Focus on all aspects of care a patient receives while in the hospital, coordinate care b/w multiple specialists.
Follow a patient throughout their stay
What is the best time to Cold Call in the ED?
Early in the morning before they get really busy. Right before shift change (~6-6:30am)
What % of Cardiac Arrest patients could be experiencing NCSE? Non Convulsive Status Epilepticus
10-30%
Heart Attack vs. Sudden Cardiac Arrest - what are the causes? What is the risk of death?
Heart attack: Circulation issue, blocked blood supply to the heart. Classic “chest pain, shortness of breath heart attack” Many patients survive with early and appropriate treatment
Sudden Cardiac Arrest: Electrical issue. Abnormal heart rythym called ventricular fibrillation. Victims lose consciousness and may be found gasping for air. Death can occur within minutes without an AED
Describe a toxic/metabolic patient. What is TME?
TME - Toxic-Metabolic Encephalopathy
Results from an acute cerebral dysfunction due to different metabolic disturbances including meds or drugs. Leads to altered consciosness, from delirium to coma
What is ETOH?
Alcohol Withdrawal - during withdrawal, when the suppressive activity of alcohol is removed - your brain will be more susceptible to seizures than it normally would
What is the prevalence of seizures in ETOH patients?
~20%
What % of seizures in critically ill patients are unrecognized at the bedside? Since manifestations are often absent or subtle. Can only be diagnosed with EEG
60-90%
What do Non Convulsive Seizures look like? 7 main symptoms
Altered Mental state
Unusual Behavior
Myoclonus
Speech Disturbance
Anxiety, Agitation, and/or delirium
Extrapyramidal Signs - like dystonia, movement, tremor
Hallucinations
What is Myoclonus?
Sudden, brief involuntary twitching or jerking of a muscle or group of muscles
What is AMS? What is standard workup for AMS? Where can Ceribell fit in?
Altered Mental Status
Glucose fingerstick –>Monitor Vital Signs –>Head CT Scan –> Order Lab Tests
Opportunity to add Continuous EEG Monitoring at the end of this workflow. Why wouldn’t you? You can put it on immediately and monitor
Describe Psychogenic Non-epileptic (PNEs) seizures and Ceribell use?
Visible active convulsions but nonepileptic
Prioritize Neurology to review the EEG. Never suggest the Clarity algorithm is perfect for these patients. Neurology must read so that nothing is missed
Difference b/w strokes and seizures?
Strokes are a result of a blocked or ruptured blood vessel in the brain
Seizure is due to abnormal electrical activity in the brain
What are the patient indications for POC EEG that resonate BEST with the ED?
AMS
Stroke Vs Seizure
Post Ictal (Prior convulsive seizure)
Toxic metablic (ETOH Withdrawal)
What are the main driving mindsets of the ICU?
“Organized Chaos”
ICU wants to UNDERSTAND THE UNDERLYING REASONS FOR THEIR PATIENT’S ILLNESS - think full system, head to toe.
Patients regularly undergo a neuro workup to understand “Neurological Deficits”
What are the best times to call on the ICU for Day shift and night shift?
Day shift: after 10/11am-4pm (May be able to catch ICU attending before rounds 7a-8am)
Night Shift: 5am-6:30am OR 9-11PM
ICU - What are interdisciplinary rounds?
Take place at least once a day. Sometimes 2x. Essentially multidisciplinary review of patients, current states, and developing care plans for patient.
“Wouldn’t it be helpful if you had Ceribell data prior to rounding on the patient?”
NEVER interrupt morning rounds unless you’ve been asked