Free ABPN Neurocritical Care Exam Prep

Neurologic exam in the ICU; cerebral/CSF physiology (ICP, cerebral blood flow/autoregulation); neuropharmacology (osmotic agents, antiseizure drugs, anesthetics, antihypertensives, vasopressors, inotropes, sedatives, pain medications, paralytics, thrombolytics, anticoagulants/antiplatelets, and reversal of anticoagulation after acute hemorrhage — 4F-PCC and idarucizumab remain first-line for warfarin and dabigatran; andexanet alfa/Andexxa was withdrawn from the US market effective 2025-12-22, leaving 4F-PCC as the US option for apixaban/rivaroxaban); analgesia and sedation; airway management/tracheostomy; mechanical ventilation and hemodynamic monitoring/support (IABP, temporary VADs, ECMO and their neurologic complications); shock, nutrition, and temperature control; ICU prophylaxis (volutrauma, VTE, stress ulcer, pressure injury, CAUTI/VAP, early mobility, delirium); general trauma; and pulmonary, cardiovascular, renal, infectious disease, endocrine (pituitary apoplexy, diabetes insipidus, SIADH, cerebral salt wasting), gastrointestinal, and hematologic complications in the neuro-ICU

Principles of neuroimaging (CT, MRI, CT/MR perfusion, noninvasive and conventional cerebral angiography); indications and interpretation of EEG (standard and processed), ICP monitoring, transcranial Doppler, and brain tissue oxygen monitoring; principles of multimodality monitoring; basic interpretation of EMG and CSF analysis; vascular access; thoracic echo and lung ultrasound; and brain death determination. Per the AAN/AAP/CNS/SCCM 2023 consensus guideline, an apnea test supports brain death/death by neurologic criteria only if all three criteria are met: no respirations occur, arterial pH is <7.30, AND PaCO2 is ≥60 mm Hg and ≥20 mm Hg above the patient's preapnea baseline

Coma and other states of altered consciousness (global anoxia-ischemia/post-resuscitation encephalopathy, toxic-metabolic states, ICU delirium, hypertensive encephalopathy); intracranial hypertension; acute ischemic stroke, including malignant hemispheric infarction, basilar occlusion, and reperfusion therapy (the 2026 AHA/ASA guideline recommends tenecteplase 0.25 mg/kg [max 25 mg] or alteplase 0.9 mg/kg [max 90 mg], both Class 1, within 4.5 hours, plus thrombectomy up to 24 h (2026: ASPECTS-based selection including large core; basilar ≤24 h)); intraparenchymal hemorrhage (the 2022 AHA/ASA guideline: mild-to-moderate ICH presenting with SBP 150-220 mm Hg may reasonably be lowered to a target of 140 mm Hg and maintained at 130-150 mm Hg [COR 2b]; lowering below 130 mm Hg is potentially harmful [COR 3: Harm]) and intraventricular hemorrhage; aneurysmal and non-aneurysmal SAH (nimodipine 60 mg q4h x 21 days, vasospasm/DCI); cerebral venous sinus thrombosis; spinal cord infarction; vascular anomalies; TBI (diffuse axonal injury, contusion, epidural/subdural hematoma, dissection, penetrating injury); spinal cord injury (central cord syndrome, neurogenic shock — the 2024 AO Spine/Praxis guideline suggests a MAP lower limit of at least 75-80 mm Hg without actively raising above an upper limit of 90-95 mm Hg, for 3-7 days) and unstable spine fractures; hydrocephalus; acute CNS infections; status epilepticus/seizures; acute neuromuscular disorders (Guillain-Barre syndrome, myasthenic crisis, motor neuron disease, critical illness neuromyopathy); fulminant demyelinating disease; autoimmune encephalitis; acute autonomic hyperactivity; neuro-oncology; and special populations (pregnancy-related eclampsia/PRES/RCVS, post-transplant, pediatric). Post-cardiac arrest care follows the 2025 AHA guideline: temperature control at 32-37.5 °C (Class 1), maintained for at least 36 hours (Class 2a); the TTM2 trial found 33 °C not superior to normothermia/fever prevention

Recognition and management of postoperative neurosurgical complications: seizures, pneumocephalus, hemorrhage, ischemia, infections, CSF leak, complications of external ventricular drains and lumbar drains, and cerebral hyperperfusion syndrome

Communication with families and conflict resolution; advance directives and DNR orders; the uncertainties of neuroprognostication and the risk of a self-fulfilling prophecy; palliative and end-of-life care; withdrawal and withholding of invasive care; futility; determining surrogate decision-makers; and donation after cardiac death and care of the organ donor