ABEM Neurocritical Care study guide
ABEM Neurocritical Care · Work through your exam, one topic at a time.
Neurocritical Care is one of the subspecialty credentials administered within the American Board of Emergency Medicine (ABEM) certification framework. ABEM describes its certifications as assurance that emergency physicians have the knowledge and skills to deliver the highest quality care, and its site maintains a dedicated subspecialty pathway alongside primary emergency medicine certification. Candidates are emergency physicians who have pursued additional fellowship training and who intend to manage critically ill patients with primary neurologic injury: ischemic and hemorrhagic stroke, traumatic brain and spinal cord injury, status epilepticus and neuromuscular respiratory failure, and the systemic complications that accompany prolonged neurocritical illness. A defensible study plan mirrors that clinical spread - cerebrovascular disease and trauma first, because time-critical decisions dominate there, then seizures and neuromuscular disorders, neuromonitoring, neuroimaging and bedside procedures, and finally general critical care and neuroprognostication, which draw on everything else. The ABEM Neurocritical Care study guide has 5 sections and about 1,472 words.
01Cerebrovascular Disease and Stroke
Acute ischemic stroke is a time-critical emergency. Know the eligibility windows: intravenous thrombolysis (alteplase or tenecteplase) generally within 4.5 hours of last known well, with selected patients treatable after wake-up stroke if advanced imaging shows salvageable tissue.
312 words, about 2 min02Traumatic Brain Injury and Spinal Cord Injury
TBI care rests on preventing secondary injury: avoid hypotension (systolic below 90–100 mmHg) and hypoxia (SpO2 below 90%), maintain cerebral perfusion pressure (CPP = MAP − ICP), and treat elevated ICP in a stepwise fashion. Targets: ICP below 22 mmHg, CPP 60–70 mmHg.
295 words, about 1 min03Seizures, Status Epilepticus, and Neuromuscular Disorders
Status epilepticus is a medical emergency: treat convulsive seizures lasting five minutes or more, and consider electrographic status after ten minutes. Give a benzodiazepine first-lorazepam 0.1 mg/kg (usually 4 mg) or midazolam-repeated once, then a second-line agent: levetiracetam 60 mg/kg, fosphenytoin 20 mg PE/kg, or valproate 40 mg/kg.
273 words, about 1 min04Neuromonitoring, Neuroimaging, and Neurocritical Care Procedures
Invasive ICP monitoring-external ventricular drain (EVD) or parenchymal monitor-guides therapy when the neurologic exam is unreliable. The EVD is also therapeutic for hydrocephalus.
306 words, about 2 min05General Critical Care, Systemic Complications, and Neuroprognostication
Neurocritical care patients die from systemic complications as often as from the brain injury. Manage oxygenation and ventilation, avoiding both hypoxia and hypercapnia; use lung-protective ventilation for ARDS.
286 words, about 1 min