Module information
Module details
- Title
- EEG in the Intensive Care Setting
- Type
- Specialist
- Module code
- S-N-S4
- Credits
- 10
- Phase
- 3
- Requirement
- Compulsory
Aim of this module
To provide the trainees with a fundamental theoretical and practical background in neurophysiological science, assessment and rehabilitation in the intensive care environment that is essential for clinical practice.
Work-based content
Training activities
| # | Learning outcome | Training activity | Type | Action |
|---|---|---|---|---|
| # 1 | Learning outcome 2 |
Training activities
Plan and prepare to conduct an EEG recording in adults for the following conditions:
|
Type DTA | Action View |
| # 2 | Learning outcome 2 |
Training activities
Plan and prepare to conduct EEG recording in children for three of the following conditions:
|
Type DTA | Action View |
| # 3 | Learning outcome 2,4 |
Training activities
Adapt and explain EEG procedures to patients and carers to ensure cooperation with the diagnostic testing |
Type ETA | Action View |
| # 4 | Learning outcome 1,2,3,4 |
Training activities
Prepare patient and perform an EEG recording in adults the following conditions:
|
Type DTA | Action View |
| # 5 | Learning outcome 1,2,3,4 |
Training activities
Prepare patients and perform an EEG recording in children for the following conditions:
|
Type DTA | Action View |
| # 6 | Learning outcome 2,3 |
Training activities
Adapt EEG procedures as appropriate to patient state and surroundings |
Type ETA | Action View |
| # 7 | Learning outcome 1, 4, 5 |
Training activities
Interpret, annotate and produce a full factual report for patients with:
|
Type ETA | Action View |
| # 8 | Learning outcome 1, 4, 5 |
Training activities
Interpret, annotate and produce a full factual report in a patient suffering from one of the following conditions:
|
Type DTA | Action View |
| # 9 | Learning outcome 4,6 |
Training activities
Select and present a patient pathway to a multidisciplinary team/colleagues for a patient you have seen from one of the conditions:
|
Type DTA | Action View |
| # 10 | Learning outcome 4,6 |
Training activities
Review evidence base for continuous and serial EEG use in critically ill patients and feedback to colleagues |
Type DTA | Action View |
Assessments
Complete 2 Case-Based Discussions
Complete 2 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Conduct infection control and health and safety assessment as appropriate for an investigation.
- Record EEG in the unconscious patient.
- Annotate EEG changes during the administration of medication.
- Undertake reactivity assessment in the unconscious patient.
- Measure head in accordance with a recognised system.
- Apply/remove an electrode in accordance with local protocol.
Observed Clinical Event Titles
- Evaluate, discuss urgency of referral and plan for EEG recording with colleagues.
- Gain appropriate consent for patients lacking capacity.
- Obtain a patient history.
- Explain the EEG procedure to a carer/relative.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Identify features of normal and abnormal adult and paediatric EEGs within the intensive care setting. |
| 2 | Prepare patients and environments for testing, maintaining safety and patient dignity. |
| 3 | Perform EEG recordings in an intensive care setting, with modifications depending on the nature of the patient, including sequential activation procedures, maintaining patient safety. |
| 4 | Demonstrate effective and compassionate communication skills with all stakeholders including patients and the multidisciplinary team. |
| 5 | Generate a range of factual reports on a range of conditions. |
| 6 | Appraise the evidence base for EEG use in critically ill patients. |
| 7 | Describe patient pathways relating to EEG in an intensive care setting. |
Clinical experiences
Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.
Activities
- Observe the use of quantitative EEG monitoring for seizure detection.
- Shadow a healthcare professional caring for a critically ill patient.
- Attend an intensive care unit ward round/multidisciplinary team meeting and critically appraise the process of admission, diagnosis and treatment.
- Observe a neurological examination of a critically ill patient.
- Observe the use of other neurological techniques to evaluate neurocritically ill patients e.g. intracranial pressure monitoring (ICP), transcranial doppler or cerebral dialysis.
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Describe the anatomy and blood supply of the cerebral cortex and brainstem.
- Describe the pathophysiology and management of the unconscious patient.
- Critically appraise the neurophysiology techniques that can be used in the assessment of critically ill patients.
- Critically evaluate the clinical uses of the EEG in the critically ill patient.
- Describe the effects drugs and changes of other physiological variables have on the EEG.
- Critically appraise the use of quantitative analysis to assist in continuous EEG monitoring in intensive care units.
Indicative content
- Brain anatomy and its blood supply
- Management of the unconscious patient on the intensive care unit:
- Clinical neurological examination
- Evaluation of the level of consciousness and level of sedation.
- Scoring systems
- General nursing, nursing procedures and techniques
- Intensive care environment:
- Electrical safety, patient safety, infection control and sterile fields
- Intensive care equipment
- The electroencephalogram in the critically ill patient:
- Expert consensus and guidelines
- Common EEG patterns in the critically ill
- Standardise terminology
- Criteria for electrographic seisures, convulsive and non-convulsive status
- Electrode types used in the intensive care unit for the recording of the electroencephalogram
- Electrode placement
- Recording of other physiological variables:
- Electrocardiogram pulse, respiration and oximetry
- Tremor, myoclonic jerks and eye movement
- Artefact and interference identification and elimination:
- Main interference, respirators, infusion pumps and water in respiration tube
- Electrical beds, percussion and vibration beds and respiratory therapy devices
- Dialysis and ECMO equipment
- Monitors and other devices
- Effect of other physiological variables and mechanism of effect on the EEG and evoked potentials:
- Blood pressure, heart rate, respiration rate and metabolic state
- Liver and renal function
- Electrolytes, temperature and raised intracranial pressure
- Pathophysiology and management of common critical care conditions that require EEG assessment:
- Anoxic brain damage, traumatic brain injury, cerebral vascular events, encephalitis and meningitis
- Metabolic, septic and toxic encephalopathies
- Seizures, status epilepticus – clinical and subclinical
- Disorder of consciousness: awake but unaware patient, minimally conscious patient and locked-in syndrome
- Brain death and irreversible cerebral damage
- Use of the EEG in patients (adults and children) with altered mental status
- Use of the ICU EEG for:
- Assessment of encephalopathy severity
- Prognostication/outcome prediction
- Assessment of therapy efficacy and sedation monitoring
- Technical requirements and instrumentation for the continuous monitoring of the EEG on the intensive care unit
- Drugs used on the intensive care unit and their effect on the EEG
- Evidence based practice for the use of serial vs continuous EEG in ICU
- Basic signal processing and interpretation: quantitative EEG
- Theory of quantitative EEG and its use for continuous EEG monitoring
- Use of trends in ICU EEG monitoring
- Use of quantitative EEG for seisure detection and ischaemia monitoring
- Display and trends, and trends’ quality control
- Artefact identification
- Interpretation and report of ICU EEG:
- Use of terminology
- Relationship of patterns with acute presentations and seizure risk
- Reporting for ICU vs reporting for neurologists/neurophysiologists
- Importance of the clinical context