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NEUROLOGIC COMPLICATIONS
OF CRITICAL ILLNESS
SERIES EDITOR
Eva Feldman, MD, PhD, FAAN, FANA
Russell N. DeJong Professor of Neurology
University of Michigan

Contemporary Neurology Series

74 NEUROLOGIC COMPLICATIONS 85 FRONTOTEMPORAL DEMENTIA

OF CRITICAL ILLNESS Bruce L. Miller, MD
Third Edition 86 AUTONOMIC NEUROLOGY
Eelco F.M. Wijdicks, MD, PhD Eduardo E. Benarroch, MD
75 CLINICAL NEUROPHYSIOLOGY 87 EVALUATION AND TREATMENT
Third Edition OF MYOPATHIES
Jasper R. Daube, MD, and Second Edition
Devon I. Rubin, MD, Editors Emma Ciafaloni, MD, Patrick F. Chinnery,
76 PERIPHERAL NEUROPATHIES IN FRCP, FMedSci, and
CLINICAL PRACTICE Robert C. Griggs, MD, Editors
Steven Herskovitz, MD, Stephen N. Scelsa, 88 MOTOR NEURON DISEASE IN ADULTS
MD, and Herbert H. Schaumburg, MD Mark Bromberg, MD
77 CLINICAL NEUROPHYSIOLIOGY OF 89 HYPERKINETIC MOVEMENT
THE VESTIBULAR SYSTEM DISORDERS
Fourth Edition Roger M. Kurlan, MD, Paul E. Green, MD,
Robert W. Baloh, MD, and and Kevin M. Biglan, MD, MPH
Kevin A. Kerber, MD 90 THE NEUROLOGY OF EYE MOVEMENTS
78 THE NEURONAL CEROID Fifth Edition
LIPOFUSCINOSES (BATTEN DISEASE) R. John Leigh, MD, FRCP, and
Second Edition David S. Zee, MD
Sara E. Mole, PhD, Ruth D. Williams, MD, 91 MIGRAINE
and Hans H. Goebel, MD, Editors Third Edition
79 PARANEOPLASTIC SYNDROMES David W. Dodick, MD, and Stephen D.
Robert B. Darnell, MD, PhD, and Silberstein, MD
Jerome B. Posner, MD 92 CLINICAL NEUROPHYSIOLOGY
80 JASPER’S BASIC MECHANISMS OF Fourth Edition
THE EPILEPSIES Devon Rubin, MD and
Jeffrey L. Noebels, MD, PhD, Jasper Daube, MD, Editors
Massimo Avoli, MD, PhD, 93 NEUROIMMUNOLOGY
Michael A. Rogawski, MD, PhD, Bibiana Bielekova, MD, Gary Birnbaum, MD,
Richard W. Olsen, PhD, and and Robert P. Lisak, MD
Antonio V. Delgado-Escueta, MD 94 PLUM AND POSNER’S DIAGNOSIS AND
81 MYASTHENIA GRAVIS AND TREATMENT OF STUPOR AND COMA
MYASTHENIC DISORDERS Fifth Edition
Second Edition Jerome B. Posner, MD, Clifford B. Saper,
Andrew G. Engel, MD MD, PhD, Nicholas D. Schiff, MD,
82 MOLECULAR PHYSIOLOGY and Jan Claassen, MD, PhD
AND METABOLISM OF THE 95 CLINICAL NEUROPHYSIOLOGY
NERVOUS SYSTEM Fifth Edition
Gary A. Rosenberg, MD Devon I. Rubin, MD, Editor
83 SEIZURES AND EPILEPSY 96 PARKINSON DISEASE
Second Edition Roger L. Albin, MD
Jerome Engel, Jr., MD, PhD 97 NEUROLOGIC COMPLICATIONS
84 MULTIPLE SCLEROSIS OF CRITICAL ILLNESS
Moses Rodriguez, MD, Orhun H. Kantarci, MD, Fourth Edition
and Istvan Pirko, MD Eelco F. M. Wijdicks, MD, PhD
NEUROLOGIC COMPLICATIONS
OF CRITICAL ILLNESS
Fourth Edition

Eelco F. M. Wijdicks, MD, PhD, FACP, FNCS

Professor of Neurology
Neurocritical Care Services
Department of Neurology, Mayo Clinic
Rochester, Minnesota
Oxford University Press is a department of the University of Oxford. It furthers
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Library of Congress Cataloging-in-Publication Data

Names: Wijdicks, Eelco F. M., 1954– author. |
Mayo Foundation for Medical Education and Research, sponsoring body.
Title: Neurologic complications of critical illness / Eelco F.M. Wijdicks.
Other titles: Contemporary neurology series.
Description: 4. | New York, NY : Oxford University Press, [2023] |
Series: Contemporary neurology series | Includes bibliographical references and index.
Identifiers: LCCN 2022040676 (print) | LCCN 2022040677 (ebook) |
ISBN 9780197585016 (hardback) | ISBN 9780197585030 (epub) |
ISBN 9780197585047 (online)
Subjects: MESH: Critical Illness | Neurologic Manifestations | Critical Care
Classification: LCC RC350 .N49 (print) | LCC RC350 .N49 (ebook) |
NLM W1 CO769N | DDC 616.8/0428—dc23/eng/20230315
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DOI: 10.1093/med/9780197585016.001.0001

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Contents

Preface xiii

PART I CRITERIA, URGENCY, AND IMPORTANCE

1. INDICATIONS FOR A NEUROLOGIC CONSULT IN

THE INTENSIVE CARE UNIT 3
CATEGORIES OF CONSULTS 4
BENEFITS OF A CONSULTATION 6

2. CONSULTING IN THE INTENSIVE CARE UNIT 9

PREPARATION AND HISTORY-TAKING 9
COMMON REQUESTS FOR CONSULTS IN THE ICU 10

PART II GENERAL CLINICAL NEUROLOGIC PROBLEMS IN

THE INTENSIVE CARE UNIT

3. ACUTE CONFUSIONAL STATE IN THE INTENSIVE CARE UNIT 19

TERMINOLOGY 20
ASSESSMENT OF DELIRIUM 21
NEUROLOGIC EXAMINATION OF THE ACUTELY CONFUSED PATIENT 23
MANAGEMENT OF DELIRIUM 24

4. COMA AND OTHER STATES OF ALTERED AWARENESS IN THE

INTENSIVE CARE UNIT 27
DEFINITIONS OF ALTERED STATES OF CONSCIOUSNESS 27
NEUROLOGIC EXAMINATION OF THE COMATOSE PATIENT 32
CAUSES OF COMA 39
NEUROLOGIC EXAMINATION IN BRAIN DEATH 39

v
vi Contents

5. NEUROLOGIC MANIFESTATIONS OF MUSCLE RELAXANTS AND

DRUGS USED FOR ANALGESIA AND ANESTHESIA IN THE
INTENSIVE CARE UNIT 47
PRINCIPLES OF PHARMACODYNAMICS AND PHARMACOKINETICS IN
CRITICAL ILLNESS 48
EFFECT OF DRUGS ON NEUROMUSCULAR JUNCTION 51
EFFECT OF DRUGS ON LEVEL OF CONSCIOUSNESS 55

6. SEIZURES IN THE INTENSIVE CARE UNIT 63

GENERALIZED TONIC–CLONIC SEIZURES 64
DRUG-INDUCED AND DRUG-WITHDRAWAL SEIZURES 64
SEIZURES AND ACUTE METABOLIC DERANGEMENTS 67
SEIZURES AND STRUCTURAL CENTRAL NERVOUS SYSTEM
ABNORMALITIES 68
CONVULSIVE STATUS EPILEPTICUS 68
NONCONVULSIVE STATUS EPILEPTICUS 72
MANAGEMENT OF SEIZURES AND STATUS EPILEPTICUS 73
OUTCOME 79

7. GENERALIZED WEAKNESS IN THE INTENSIVE CARE UNIT 85

GENERAL CONSIDERATIONS 86
DISORDERS OF THE SPINAL CORD 86
DISORDERS OF PERIPHERAL NERVES 88
DISORDERS OF THE NEUROMUSCULAR JUNCTION 92
DISORDERS OF SKELETAL MUSCLE 93

8. ACUTE FOCAL NEUROLOGIC FINDINGS AND ASYMMETRIES IN

THE INTENSIVE CARE UNIT 103
GENERAL CONSIDERATIONS IN LESION LOCALIZATION 103
BRAIN INJURY PATTERNS 108

9. ACUTE MOVEMENT ABNORMALITIES IN THE INTENSIVE CARE UNIT 111

SEMIOLOGY 112
EMERGENT AND URGENT MOVEMENT ABNORMALITIES 115
 Contents vii

PART III NEUROLOGIC COMPLICATIONS IN MEDICAL AND SURGICAL

INTENSIVE CARE UNITS AND TRANSPLANTATION UNITS

10. NEUROLOGIC COMPLICATIONS OF INVASIVE PROCEDURES IN

THE INTENSIVE CARE UNIT 123
NEUROTOXICITY OF RADIOLOGIC CONTRAST AGENTS 124
CHOLESTEROL EMBOLIZATION 124
AIR EMBOLISM 126
NEUROLOGIC COMPLICATIONS ASSOCIATED WITH SPECIFIC
PROCEDURES 127

11. NEUROLOGIC MANIFESTATIONS OF ACUTE BACTERIAL INFECTIONS

AND SEPSIS 147
BACTERIAL MENINGITIS 147
SPINAL EPIDURAL ABSCESS 151
INFECTIVE ENDOCARDITIS 154
CLOSTRIDIAL SYNDROMES 161
SEPSIS 164

12. NEUROLOGIC MANIFESTATIONS OF VIRAL OUTBREAKS 175

WEST NILE VIRUS NEUROINVASIVE DISEASE 176
TICK- AND MOSQUITO-BORNE ENCEPHALITIS 179
ENDEMIC INFLUENZA 180
SARS-COV-2 (COVID-19) PANDEMIC 183

13. NEUROLOGIC COMPLICATIONS OF CARDIAC ARREST 189

GENERAL CONSIDERATIONS IN RESUSCITATION MEDICINE 190
POSTRESUSCITATION ENCEPHALOPATHY 193
SUPPORTIVE CARE 203
SPECIFIC TREATMENT AND TARGETED TEMPERATURE MANAGEMENT 204

14. NEUROLOGIC MANIFESTATIONS OF ACID–BASE DERANGEMENTS,

ELECTROLYTE DISORDERS, AND ENDOCRINE CRISES 215
ACID–BASE DISORDERS 215
ELECTROLYTE DISORDERS 219
ENDOCRINE EMERGENCIES 232
viii Contents

15. NEUROLOGIC COMPLICATIONS OF ACUTE RENAL DISEASE 249

UREMIC ENCEPHALOPATHY 249
DIALYSIS DYSEQUILIBRIUM SYNDROME 253
POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME 255
NEUROMUSCULAR DISORDERS 260

16. NEUROLOGIC MANIFESTATIONS OF ACUTE HEPATIC FAILURE 269

GENERAL CONSIDERATIONS 270
HEPATIC ENCEPHALOPATHY 270
BRAIN EDEMA IN FULMINANT HEPATIC FAILURE 275

17. NEUROLOGIC COMPLICATIONS ASSOCIATED WITH DISORDERS

OF THROMBOSIS AND HEMOSTASIS 289
GENERAL CONSIDERATIONS 289
DISSEMINATED INTRAVASCULAR COAGULATION 290
THROMBOLYSIS AND ANTICOAGULATION 291
NEOPLASTIC COAGULOPATHIES 295
THROMBOTIC THROMBOCYTOPENIC PURPURA 297

18. NEUROLOGIC COMPLICATIONS OF ACUTE VASCULITIS SYNDROMES 305

GENERAL CONSIDERATIONS 305
LARGE-VESSEL VASCULITIS 307
POLYARTERITIS NODOSA 308
CHURG-STRAUSS SYNDROME 312
GRANULOMATOSIS WITH POLYANGIITIS 313
DRUG-INDUCED VASCULITIS 315

19. NEUROLOGIC COMPLICATIONS IN THE CRITICALLY ILL

PREGNANT PATIENT 321
NEUROLOGY OF PREGNANCY 321
ECLAMPSIA 323
HELLP SYNDROME 326
AMNIOTIC FLUID EMBOLISM 328
NEUROLOGIC COMPLICATIONS OF TOCOLYTIC AGENTS 328
 Contents ix

20. NEUROLOGIC COMPLICATIONS OF CANCER IN THE ICU 333

GOALS OF CARE IN CRITICAL ILLNESS AND ADVANCED CANCER 334
NEURO-ONCOLOGIC EMERGENCIES 334
PARANEOPLASTIC ENCEPHALITIS 336
COMPLICATIONS OF RADIATION AND CHEMOTHERAPY 338
COMPLICATIONS OF CANCER IMMUNOTHERAPY 340

21. NEUROLOGIC COMPLICATIONS OF AORTIC SURGERY 343

SCOPE OF THE PROBLEM 344
VASCULAR ANATOMY OF THE SPINAL CORD 346
NEUROLOGIC FEATURES OF SPINAL CORD INFARCTION 348
DIAGNOSTIC EVALUATION OF SPINAL CORD INFARCTION 350
THERAPEUTIC OPTIONS 353
PLEXOPATHIES 354
AORTIC DISSECTION 354

22. NEUROLOGIC COMPLICATIONS OF CARDIAC SURGERY 361

GENERAL CONSIDERATIONS 362
ISCHEMIC STROKE 366
NEUROPSYCHOLOGIC IMPAIRMENT 373
SEIZURES 374
RETINAL DAMAGE 374
PERIPHERAL NERVE DAMAGE 375

23. NEUROLOGIC COMPLICATIONS OF ACUTE ENVIRONMENTAL

INJURIES 385
THERMAL BURNS 385
SMOKE INHALATION 389
ELECTRICAL BURNS 392
LIGHTNING INJURY 393
ACCIDENTAL HYPOTHERMIA 395
HEAT STROKE 397
NEAR-DROWNING 399
x Contents

24. NEUROLOGIC COMPLICATIONS OF DRUG OVERDOSE, POISONING,

AND TERRORISM 407
THE PRESENTING EMERGENCY AND PRINCIPLES OF TREATMENT 408
SPECIFIC POISONINGS 410
BIOLOGICAL AND CHEMICAL WARFARE 419

25. NEUROLOGIC COMPLICATIONS OF TRAUMATIC BRAIN INJURY 429

CLINICAL SPECTRUM OF HEAD INJURY 430
NEURORADIOLOGIC FINDINGS IN HEAD INJURY 430
GENERAL PRINCIPLES OF MANAGEMENT 440
MANAGEMENT OF INCREASED INTRACRANIAL PRESSURE 442
MANAGEMENT OF TRAUMATIC INTRACRANIAL HEMATOMAS 444
WAR-RELATED BRAIN INJURY 446
MANAGEMENT OF TRAUMATIC CEREBRAL ANEURYSM 446

26. NEUROLOGIC COMPLICATIONS OF TRAUMA TO THE SPINE,

SPINAL CORD, AND NERVES 455
TRAUMA OF SPINE AND SPINAL CORD 455
ACUTE SPINAL CORD INJURY 464
POSTTRAUMATIC NEUROPATHIES ASSOCIATED WITH FRACTURES 467
FAT EMBOLISM SYNDROME 468

27. NEUROLOGIC COMPLICATIONS OF ORGAN TRANSPLANTATION 473

SURGICAL TECHNIQUES OF ORGAN TRANSPLANTATION 474
NEUROLOGIC COMPLICATIONS IN TRANSPLANT RECIPIENTS 479
NEUROLOGIC COMPLICATIONS OF GRAFT-VERSUS-HOST DISEASE 501

PART IV OUTCOME IN CENTRAL NERVOUS SYSTEM CATASTROPHES

28. OUTCOME OF ACUTE INJURY TO THE CENTRAL NERVOUS SYSTEM 513

DESCRIPTION OF OUTCOME CATEGORIES 514
OUTCOME IN ENCEPHALOPATHIES 516
OUTCOME IN STROKE 522
OUTCOME IN HEAD INJURY 524
 Contents xi

OUTCOME IN TRAUMATIC SPINE INJURY 525

OUTCOME IN CENTRAL NERVOUS SYSTEM INFECTIONS 525

PART V CONSULTATIVE NEUROLOGY AND END-OF-LIFE CARE IN

THE INTENSIVE CARE UNIT

29. THE NEUROLOGIST AND END-OF-LIFE CARE IN THE INTENSIVE

CARE UNIT 533
GENERAL CONSIDERATIONS 534
LEGAL ASPECTS OF WITHDRAWAL OF TREATMENT 534
DECISIONS IN WITHDRAWAL OF TREATMENT 535
WITHDRAWAL OF TREATMENT 536
WITHDRAWAL OF TREATMENT IN SPECIAL NEUROLOGIC
CIRCUMSTANCES 537
BRAIN DEATH AND ORGAN DONATION 538
CARDIAC DEATH AND ORGAN DONATION 539

30. THE NEUROLOGIST AND ICU ETHICAL DILEMMAS 545

PRINCIPLES OF COMMUNICATION WITH FAMILIES 546
HOPE 547
FUTILITY 548
GUIDING A FAMILY CONFERENCE 548
THE ETHICS OF COMPASSIONATE SEDATION 550
THE COURTS 550

Index 553
Preface

Writ large in this book is the premise that the evaluation of a critically ill patient with a neurologic
manifestation or complication is the most demanding neurology consultation. This book, when
first published in 1995, provided a practical guide for every disquieted neurologist who entered
the intensive care unit (ICU). Just about what, as a young neurologist, I would have liked to have
known. Keeping this book up to date requires multiple editions because intensive care is one of
the fastest growing and changing specialties. Now, more than 25 years later, we can look back at
the extraordinary expansion in knowledge of critical illness and better understanding of this field
of neurology. Intensivists understand the issues involved and appreciate that a neurologic com-
plication in any medical or surgically critically ill patient is a major cause of mortality and later
morbidity. If recognized in time, treatment of a neurologic complication may greatly improve the
outcome. But neurocritical care in all its forms is also at times informed uncertainty, and many
clinical observations are not understood.
The framework of consults has also changed. New diseases have appeared, such as neurologic
complications of cancer immunotherapy, and older diseases, such as cyclosporine neurotoxicity
in transplant patients, have become rare occurrences. Neurotoxicities of drugs are better under-
stood (e.g., serotonin syndrome and cefepime neurotoxicity). Recent mosquito- and tick-borne
illness (e.g., Zika virus, Chikungunya, and Eastern equine encephalitis) in the United States has
resulted in intensive care admissions. The world since 2019 has been shaken by the SARS-CoV-2
pandemic with its multiple surges and no ICU spared. The pandemic has been a revelation,
certainly since the end of 2021, when ICUs (and morale) were at a breaking point as a result of
treating an unacceptably large number of unvaccinated patients who became infected with the
delta variant. Neurologic complications of SARS-CoV-2 infection have emerged, and this damaging
respiratory virus became the most common reason to consult neurologists, who, like their colleagues
in other specialties, had the disadvantage of dealing with a new disease. It is a prime example of how
suddenly ICU populations can change and have changed again in 2023.
The new edition has responded to changes in ICU care and changes in the ICU population and
is now thoroughly updated. I have added criteria for consultation and how to co-manage patients.
A consultation is often contingent on the following five perceptions: (1) an evolving situation that
requires neurologic expertise; (2) “something” might not be recognized; (3) an unusual CT scan
that does not appear to explain the condition; (4) movements that could indicate seizures requiring
expert evaluation and electroencephalography (EEG); and (5) the patient’s condition looks grim
but needs corroboration, and the family may request a neurologic opinion. All this is addressed.
Neurologic consultations are often requested when patients remain comatose after CPR, and the
neurologist is asked to have the last word. Failure to awaken after surgery or after extended seda-
tion has been discontinued are other typical examples that trigger a request. We have an obligation
to provide the best evaluation and management when the outcome can go either way. We also
have an obligation to evaluate for futility. Neurologic consultation not only provides diagnostic,
therapeutic, and prognostic advice but may also change the approach to the patient. This is a major
responsibility and not one to be taken lightly.
This edition also has new chapters on the interpretation of focal findings, acute movement
disorders in critical illness, cancer immunotherapy, and ethical dilemmas. A separate section
on interpretation of EEG requests (and how to use it in critically ill patients) is added. Several
new drugs (direct oral anticoagulants [DOACs] and chimeric antigen receptor T-cell therapy
[CAR-T]) have made their way into the ICU and are discussed in detail because their side effects
require specific intervention. There is a wealth of new tables, algorithms, and neuroimaging. I
have added a new section of advice for practical management to each chapter to reconcile theory
and practice.

xiii
xiv Preface

ICUs are challenged with an increasingly growing (and aging) population, and admissions are
increasing. Neurologic complications will increase, too. This clinical text will be helpful to a very
wide audience of healthcare providers and, in particular, for any intensivist and general neurologist
who must manage these patients with extremely complex medical disorders, surgeries, comorbid-
ity, and with different clinical trajectories. The book is also aimed at neurointensivists who consult
in ICUs other than their own. This book reaches beyond neurology and additionally targets emer-
gency physicians, neurosurgeons, transplant and vascular surgeons, internal medicine hospitalists,
pharmacists, allied healthcare providers, and ICU nursing staff.
I appreciate the help of so many. Lea Dacy not only dutifully edited the full manuscript, but
she has always been absolutely necessary to improve the prose. I am grateful for the work by the
illustrators of Mayo Clinic Media Support service and, in particular, David Factor, who predictably
provided beautiful and informative drawings. I appreciate my long-time working relationship with
Oxford University Press, and they are peerless when it comes to academic work.
The interest in the acute neurosciences in practice is the unexpected. I have lived the subject
matter for several decades, and our neurocritical care group sees several hundred patients in ICUs
other than our own Neurosciences ICU each year. I hope the book I set out to write reflects that
experience. The diagnosis and management of neurologic complications in critical illness, in my view,
has always been one of the major pillars of neurocritical care.
March 2023
Eelco Wijdicks
PART I

Criteria, Urgency, and

Importance
Chapter 1

Indications for a Neurologic Consult

in the Intensive Care Unit

CATEGORIES OF CONSULTS
BENEFITS OF A CONSULTATION

Teams working in intensive care units (ICUs) may presenting with a de novo neurological prob-
bring in a neurologist and for all kinds of reasons.1 lem related to their illness—questions . . . and
When called to action, most neurologists enter- issues concerning the effects of antiseizure and
ing an ICU are immediately confronted with the antiparkinson medication for prior diagnosed
complexity of critical illness. The modern ICU is illness are entirely different. These patients
a unique place, with patients presenting with an are seen in consultation for diagnosis and
array of different conditions and with consultants management—often expediently—but remain
having specific expertise in handling critical ill- under the care of intensivists and surgeons.
ness. Patients enter the ICU in a life-threatening The complications observed may be quite spe-
state with failing organ systems and become cific (or mundane), but intensivists may intui-
hypotensive, hypoxemic, hypercapnic, and tachy- tively feel uncomfortable in overseeing these
cardic; the initial resuscitation generally does not new neurologic conditions themselves. They
concentrate on neurologic manifestations. Most request not only assistance in identifying the
intensivists briefly check for pupil responses or neurologic disorder but also help in manage-
major asymmetries, but they accept an altered ment. This is particularly pertinent with recur-
level of consciousness as a common consequence rent seizures or progressive neurologic decline.
of an evolving critical illness. Some manifesta- Once the patient is seen, continuous attention
tions may not be considered atypical enough is necessary, which may involve prolonged bed-
for an urgent neurologic consult. This logically side care and, later, calls at night from nursing
implies that neurologists will see a selection of staff or attending intensivists and, ultimately,
neurologic manifestations in critical illness. direct management. Interpretation of electro-
ICU consultative neurology focuses on those encephalograms and neuroimaging is often
patients admitted to medical and surgical ICUs repeatedly required.2
3
4 Part I Criteria, Urgency, and Importance

More than in any place in the hospital, ICU consultation is summarized in Table 1.1 and
consultations involve questions about de-escalating shows common clinical neurologic problems
care. The attending team and family may consider facing the intensive care specialist and consult-
withdrawing intensive care or, at least, consider ing neurologist in everyday decisions.
a do-not-resuscitate status and thus need a neu-
rologist’s input. This involvement partly reflects
the high prevalence of neurologic catastrophes
in patients with a critical illness. Frequently, the CATEGORIES OF CONSULTS
clinical situation is clear, as in persistently coma-
tose survivors after prolonged cardiopulmonary We must assume that ICU consults are urgent
arrest and in elderly patients with polytrauma or emergent. The urgency is often determined
and severe traumatic brain injury; in other situ- by an inability to understand the full clinical pic-
ations, the degree of brain injury may be more ture and particularly when the initial presenta-
difficult to ascertain. Neurologists are asked tion is disturbing. Examples are ICU consults for
to participate in family conferences, and they acutely impaired consciousness, which require
can be helpful in clarifying the bigger picture. a quick but comprehensive assessment of the
Sometimes, the neurologic complication is a cause of coma and whether it can be immediately
defining moment, and little more can be done for reversed. Upon receiving a call to consult in the
the patient. Neurologists can be conclusive and ICU, we typically expect three clinical scenarios:
advise the managing ICU team against treating acute loss of consciousness, failure of patients
a patient in a futile situation. In other situations to awaken fully after recuperation from a major
the neurologic situation could be misjudged as surgical procedure, and occasionally, coma in a
irrecoverably poor while there is a possibility for developing but undiagnosed critical illness. We
another more favorable trajectory. This is not an are often consulted to evaluate and treat delirium,
uncommon scenario, and neurologists can shed and we now have a better sense of what this acute
more light on why they think that way. Another brain dysfunction could entail.3–6
fundamental rule of ICU consultation is to prog- Any consult in a critically ill neurologic
nosticate decisively when certain but to hold back patient must proceed through the steps out-
when information is incomplete or the clinical lined in Table 1.2. Any consult in a critically
situation is not fully understood. ill patient may lead to a diagnosis not initially
Critical illness increases the probability of considered by the managing team; in our expe-
a neurologic complication, and, according to rience, this occurs rather frequently.7 These
current best estimates and excluding perva- recognized neurologic disorders may all have
sive delirious states, approximately 10–20% of major consequences diagnostically, prognosti-
patients will develop some sort of neurologic cally, and therapeutically.
manifestation. The neurology of critical illness Consultations may have a varying degree of
is an important field that requires more pro- complexity and may involve management of
spective research. The rationale for neurologic major acute neurologic injury. Consultation
may evolve from a simple question, to being
physically present, to continuously managing
Table 1.1 The field of neurology of
critical illness
Table 1.2 Essentials of a neurology
Neurologic consultation in the ICU requires a consult in the intensive care unit
broad base of medical knowledge
Neurologic consultation provides diagnostic, Assess details on severity of critical illness
therapeutic, and prognostic advice Assess blood pressure and extent of blood pressure
Neurologic consultation often involves assessment support
of abnormalities of responsiveness or seizures Assess drug administration over 5–7 days
Neurologic consultation may detect an unsuspected Verify onset of symptoms with nursing staff
neurologic disorder Assess major confounders
Neurologic consultation in the ICU may change Assess for focal localizing sign
approach to the patient Assess for movements, twitching, new rigidity
Neurologic consultation involves end-of-life Assess for drugs strongly related to movement
decisions for patients disorders
 1 Indications for a Neurologic Consult 5

Table 1.3 Reasons for a consult in the intensive care practices, it is often easier to call
intensive care unit a consultant rather than to ask for a formal con-
sult. Both parties often agree that some type of
Acutely comatose
Failure to awaken after resuscitation advice will pragmatically direct testing or treat-
Acute focal deficit ment. For the intensivist, there may be other
Acute agitation immediately pressing priorities in the complex
New seizure(s) care of the patient, and a new neurologic prob-
Acute repetitive movements lem is best solved quickly. Many of the neurology
Generalized weakness “curbsides” in the ICU are indeed simple phone
Abnormal neuroimaging calls to ask a simple question, but some ques-
Abnormal EEG tions should probably generate a formal consult.
Consultants should generally and deliberately
an acute injury to the brain or spine and, as avoid a practice of mostly taking phone calls for
such, may even involve palliation and end-of- curbsides, which are a set of quick questions that
life discussions (Table 1.3). pertain to critical illness. These include interpre-
There is a spectrum of close participation tation of a CT scan of the brain, a question about
with the consulting neurologist (Figure 1.1). electroencephalograph (EEG) interpretation, or
In some cases, a consult consists of picking up the need for EEG monitoring. Other common
the phone and asking an expert, and in many questions are how to manage neurologic medi-
cation such as antiepileptic drugs, assess the risk
of anticoagulation, or interpret specific neuro-
logic manifestations of acute neurologic disease.
It is often better to see the patient briefly and
then determine if a formal consult can be helpful.
The consulting neurologists will also have
to consider the following questions. How can
I best ask pointed questions? Am I able to
provide advice with limited information and
without having the opportunity to examine
the patient in detail? Am I confident enough
to dismiss or diagnose certain CT scan abnor-
malities? Does this clinical problem require a
close follow-up and thus a formal consultation?
Acute (STAT) consults in the ICU are the
most challenging in the hospital because (1)
decisions may have to be made in an evolving
situation; (2) the primary diagnosis may be
unclear and puzzling; (3) neurologic exami-
nation can be compromised when patients
are markedly swollen, jaundiced, immobile,
bruised, or have major operation sites or an
open chest; and (4) none of the neuroimaging
and electrophysiology results may be particu-
larly helpful. Any consulting neurologist will
ask him- or herself the following additional
questions: Are the neurologic findings com-
mensurate with the cause and degree of criti-
cal illness? Are the focal findings significant
or difficult to judge? How is neuroimaging or
electrophysiology best interpreted in the set-
ting of critical illness?2,8–10 Are there urgent
treatment options or treatment adjustments
that have not been considered? Will this neu-
Figure 1.1. Types of consultations. rologic manifestation set the patient back
6 Part I Criteria, Urgency, and Importance

permanently? Can I provide a reliable opin- • Neurologists should appreciate the pharma-
ion on the future likelihood of full depen- cology of sedative drugs and use of analgesic
dence for the patient, and could this opinion drugs to provide a better assessment.
put an end to the aggressive, constantly esca- • Direct communication with the intensivist
lating care? might provide a comprehensive clinical course
and timeline of when events occurred.
• Direct communication with the surgeon on
the surgical procedure and possible intra-
BENEFITS OF A CONSULTATION operative events can decrease evaluation time
and capture important intraoperative compli-
The need for broad knowledge of critical care
cations such as hypotension or even CPR.
could argue for a separate hospital service
• The circumstances surrounding critical ill-
staffed by experienced neurohospitalists or
ness could make the patient vulnerable to
neurointensivists. It goes to the heart of a long-
seizures. However, few patients in the ICU
standing academic and clinical question (and,
have seizures; many more undergo EEGs.
in some centers, a charged debate): Who is
Proportionality is necessary.
best qualified to see these patients? Many of
• A universal question is whether failure to
us are caught unaware by a variety of presenta-
wean from a ventilator is due to a previously
tions, and as long as experience is gained, it is
unappreciated and undiagnosed neurologic
better gained by a specialized group. We have
disorder. Early diffuse weakness in ICU may
seen several conditions emerge more clearly
be undiagnosed amyotrophic lateral sclero-
as a result of covering all ICU consults with
sis. Late diffuse weakness in ICU is often
our neurocritical care services in both Mayo-
sepsis-related or critical illness–associated
affiliated hospitals.
polyneuromyopathy.
Telemedicine could be ideal for these con-
sults,11–16 but accurate metrics will need to be
developed to show benefit. These could include
(1) seizure control, (2) acute stroke care, (3) REFERENCES
neurosurgical intervention, (4) control of intra-
cranial pressure, and (5) limiting potent seda- 1. Wijdicks EFM. Why you may need a neurologist to
tive drugs and avoiding drug-drug interactions. see a comatose patient in the ICU. Crit Care. 2016
Jun 20;20(1):193.
Ultimately, a full neurologic examination 2. Rabinstein AA. Continuous electroencephalog-
leads to new tests (EEG, somatosensory evoked raphy in the medical ICU. Neurocrit Care. Dec
potential [SSEP], CT scan, MRI, and CSF). All 2009;11(3):445–6. doi:10.1007/s12028-009-9260-6
these tests are highly neurospecific, and recom- 3. Brown CH. Delirium in the cardiac surgical ICU.
mendations of what to test or add to routine Curr Opin Anaesthesiol. Apr 2014;27(2):117–22.
doi:10.1097/ACO.0000000000000061
orders require good communication and, most 4. Ely EW, Shintani A, Truman B, et al. Delirium
importantly, accurate interpretation. as a predictor of mortality in mechanically venti-
lated patients in the intensive care unit. JAMA. Apr
2004;291(14):1753–62. doi:10.1001/jama.291.14.1753
5. Hughes CG, Patel MB, Pandharipande PP.
PRACTICAL ADVICE Pathophysiology of acute brain dysfunction:
What’s the cause of all this confusion? Curr Opin
Crit Care. Oct 2012;18(5):518–26. doi:10.1097/
• A major principle of consultation in the MCC.0b013e328357effa
ICU is to see the patient immediately rather 6. Pandharipande PP, Girard TD, Jackson JC, et al.
than paying a belated visit. A serious neuro- Long-term cognitive impairment after critical ill-
ness. N Engl J Med. Oct 2013;369(14):1306–16.
logic illness requiring immediate interven- doi:10.1056/NEJMoa1301372
tion might go unrecognized. Moreover, the 7. Mittal MK, Kashyap R, Herasevich V, Rabinstein
entire clinical picture may be unclear and AA, Wijdicks EF. Do patients in a medical or sur-
evolving, and neurologic expertise may point gical ICU benefit from a neurologic consultation?
toward the right direction. Int J Neurosci. 2015;125(7):512–20. doi:10.3109/
00207454.2014.950374
• Treatments may be inappropriate, incom- 8. Claassen J, Taccone FS, Horn P, et al. Recommendations
plete, and incorrect. Errors happen easily on the use of EEG monitoring in critically ill patients:
even in the best-equipped, well-staffed ICUs. Consensus statement from the neurointensive care
 1 Indications for a Neurologic Consult 7

section of the ESICM. Intensive Care Med. Aug 13. Lilly CM, Zubrow MT, Kempner KM, et al. Critical
2013;39(8):1337–51. doi:10.1007/s00134-013-2938-4 care telemedicine: Evolution and state of the art. Crit
9. Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Care Med. Nov 2014;42(11):2429–36. doi:10.1097/
Continuous electroencephalography in the medical CCM.0000000000000539
intensive care unit. Crit Care Med. Jun 2009;37(6):2051– 14. Weiss B, Paul N, Balzer F, Noritomi DT, Spies
6. doi:10.1097/CCM.0b013e3181a00604 CD. Telemedicine in the intensive care unit: A
10. Young GB. Continuous EEG monitoring in the ICU: vehicle to improve quality of care? J Crit Care. Feb
Challenges and opportunities. Can J Neurol Sci. Aug 2021;61:241–6. doi:10.1016/j.jcrc.2020.09.036
2009;36 Suppl 2:S89–91. 15. Welsh C, Rincon T, Berman I, et al. TeleICU inter-
11. Guinemer C, Boeker M, Furstenau D, et al. Telemedicine disciplinary teams. Crit Care Nurs Clin N Am.
in intensive care units: Scoping review. J Med Internet 2021;33:459–70.
Res. Nov 2021;23(11):e32264. doi:10.2196/32264 16. O’Shea AM, Reisinger HS, Panos R, et al.
12. Lilly CM, McLaughlin JM, Zhao H, et al. A multi- Association of interactions between Tele-critical
center study of ICU telemedicine reengineering of care and bedside with length of stay and mor-
adult critical care. Chest. Mar 2014;145(3):500–507. tality. J Telemed Telecare. 2022 Jun 29. doi:
doi:10.1378/chest.13-1973 10.1177/1357633X221107993
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 Ethics - Summary Sheet
Winter 2025 - Center

Prepared by: Teacher Brown

Date: July 28, 2025

Exercise 1: Interdisciplinary approaches

Learning Objective 1: Research findings and conclusions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 2: Practical applications and examples
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 3: Statistical analysis and interpretation
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Assessment criteria and rubrics
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Case studies and real-world applications
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Learning outcomes and objectives
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Best practices and recommendations
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 7: Research findings and conclusions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Current trends and future directions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 9: Diagram/Chart/Graph]
Note: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Part 2: Historical development and evolution
Important: Experimental procedures and results
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Literature review and discussion
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Assessment criteria and rubrics
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Fundamental concepts and principles
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 14: Experimental procedures and results
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Current trends and future directions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Case studies and real-world applications
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 17: Interdisciplinary approaches
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Key terms and definitions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Part 3: Problem-solving strategies and techniques
Important: Ethical considerations and implications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Key Concept: Theoretical framework and methodology
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 22: Diagram/Chart/Graph]
Note: Critical analysis and evaluation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 23: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Critical analysis and evaluation
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 25: Diagram/Chart/Graph]
Practice Problem 25: Best practices and recommendations
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Historical development and evolution
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Practical applications and examples
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 29: Diagram/Chart/Graph]
Definition: Theoretical framework and methodology
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Appendix 4: Current trends and future directions
Note: Theoretical framework and methodology
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 32: Critical analysis and evaluation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Practical applications and examples
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Interdisciplinary approaches
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Best practices and recommendations
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 36: Diagram/Chart/Graph]
Practice Problem 36: Case studies and real-world applications
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Fundamental concepts and principles
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 38: Diagram/Chart/Graph]
Key Concept: Interdisciplinary approaches
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Case studies and real-world applications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Part 5: Statistical analysis and interpretation
Practice Problem 40: Fundamental concepts and principles
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Historical development and evolution
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 42: Diagram/Chart/Graph]
Key Concept: Key terms and definitions
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Statistical analysis and interpretation
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Case studies and real-world applications
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Comparative analysis and synthesis
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Exercise 6: Critical analysis and evaluation
Key Concept: Learning outcomes and objectives
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Literature review and discussion
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 52: Diagram/Chart/Graph]
Definition: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Fundamental concepts and principles
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Ethical considerations and implications
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 58: Diagram/Chart/Graph]
Practice Problem 58: Interdisciplinary approaches
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Critical analysis and evaluation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Chapter 7: Assessment criteria and rubrics
Example 60: Case studies and real-world applications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Current trends and future directions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Assessment criteria and rubrics
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 63: Study tips and learning strategies
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 64: Fundamental concepts and principles
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 65: Fundamental concepts and principles
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Statistical analysis and interpretation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Theoretical framework and methodology
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 68: Assessment criteria and rubrics
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Key terms and definitions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Chapter 8: Critical analysis and evaluation
Key Concept: Best practices and recommendations
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Literature review and discussion
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Ethical considerations and implications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Study tips and learning strategies
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 75: Fundamental concepts and principles
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Comparative analysis and synthesis
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 77: Experimental procedures and results
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Assessment criteria and rubrics
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Statistical analysis and interpretation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 80: Diagram/Chart/Graph]
Appendix 9: Best practices and recommendations
Important: Comparative analysis and synthesis
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Historical development and evolution
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 82: Diagram/Chart/Graph]
Note: Problem-solving strategies and techniques
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 84: Statistical analysis and interpretation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Statistical analysis and interpretation
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Literature review and discussion
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 87: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Historical development and evolution
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 89: Case studies and real-world applications
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 90: Diagram/Chart/Graph]
Abstract 10: Experimental procedures and results
Note: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 92: Diagram/Chart/Graph]
Key Concept: Problem-solving strategies and techniques
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Critical analysis and evaluation
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 94: Case studies and real-world applications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Case studies and real-world applications
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 96: Diagram/Chart/Graph]
Definition: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Theoretical framework and methodology
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
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