An ISNACC Initiative for Early Management of Neurological Emergencies

KiranJangra, MD, DM

Kiren Jangra, MD, DM

Keshav Goyal, MD, DM
Keshav Goyal, MD, DM

Kiran Jangra, MD, DM
Organizing Secretary, Second ANC 2019 Chandigarh
Assistant Professor, Division of Neuroanaesthesia
Department of Anaesthesia and Intensive Care
Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh, India

Keshav Goyal, MD, DM
National Coordinator, ANC
Additional Professor, Department of Neuroanaesthesiology and Critical Care
All India Institute of Medical Sciences (AIIMS), New Delhi, India

Time is brain! The first few hours following acute neurological emergencies are crucial; they warrant a standardized approach. However, each region of the world would have different set of problems and their unique way of management. We have been a witness to several clinical scenarios which could have had a different course of outcome, had an appropriate simple intervention been done at the primary care level. To address these challenges, a course was designed in the Indian context by the Department of Neuroanaesthesiology and Critical Care. Named as the AIIMS Neurological Life Support (ANLS), it was endorsed by the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC). The aim of ANLS is to help anesthesiologists, physicians, surgeons and intensivists who come in contact with such patients at first instance. The first course was conducted on January 28-29, 2017; another two courses followed and were organized during 2017 and 2018. The ANLS course had an overwhelming response from the participants from different parts of India. Soon, ISNACC could realize the requirement of such a course to be conducted in every part of India on a regular basis. During the Governing Council meeting of the ISNACC, it was decided to reformulate the course based on the feedback obtained by the participants and take it forward to the remotest corners of India in the name of Acute Neuro Care (ANC). The first ANC course was successfully conducted during the national conference of ISNACC held at Gurgaon on February 13-14, 2019.

The second ANC coursewas held during August 24-25, 2019 at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (Figure 1) by the Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care. The two-day course began with a pretest for the delegates; the objective was to assess their pre-existing knowledge of the subject. The scientific proceedings started with airway, breathing and circulation (ABC) where delegates were taught to manage the airway in neurologically ill patients in the emergency department. This was followed by brainstorming interactive sessions on the care of comatose patients, focused neurological examination, traumatic brain injury (TBI), and traumatic spine injury (TSI). After the lectures were over, the delegates were divided into four skill stations with six candidates in each group and were rotated. The skill stations included demonstrations of ABC (Figure 2), care of comatose patients, TBI, and TSI. The different gadgets for securing airway and oxygenation were demonstrated on the mannequin. The delegates were trained to manage endotracheal intubation during acute neurological emergencies with adequate care of the cervical spine. Different case scenarios were discussed and demonstrated in the other skill stations. Post-lunch sessions began with an interesting lecture on basics of radiology followed by lectures on acute ischemic stroke (AIS), neuropharmacology, intracranial hemorrhage (ICH), and subarachnoid hemorrhage (SAH). After tea break, four parallel skill stations about these topics were held during which case-based managements were discussed.

On the second day, the course started with the revision of radiological basics. Thereafter, a lecture about basics and utility of ultrasound (USG) in neurological emergencies was held. Later, there were interactive lectures on various neurological emergencies such as raised intracranial pressure (ICP) and herniation, status epilepticus, non-traumatic weakness, and meningitis and encephalitis. These sessions were followed by a hands-on skill station using USG on a group of volunteers, demonstrating the utility of USG in the management of neurological emergencies. Other topics of this session were carried out in the other skill stations which included case-based management of status epilepticus, meningitis/encephalitis, and non-traumatic weakness.

At the end, the participants were evaluated on the knowledge acquired with this course by organizing an open quiz. Course completion certificates were distributed among all the participants and the quiz winners were awarded with mementos. The ANC course was concluded with feedback from the delegates.

Figure 1

Figure 1: Second ANC Course at PGIMER, Chandigarh

Figure 2

Figure 2: Second ANC Course at PGIMER, Chandigarh

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