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MAYO CLINIC CRITICAL AND NEUROCRITICAL CARE BOARD REVIEW

MAYO CLINIC SCIENTIFIC PRESS

Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade

Edited by James R. Hebl, MD, and Robert L. Lennon, DO

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MAYO CLINIC CRITICAL AND NEUROCRITICAL CARE BOARD

REVIEW

M. Wijdicks, MD, PhD

Chair, Division of Critical Care Neurology

Mayo Clinic, Rochester, Minnesota

Professor of Neurology

Mayo Clinic College of Medicine and Science

James Y. Findlay, MB, ChB

Consultant, Department of Anesthesiology and Perioperative Medicine

Mayo Clinic, Rochester, Minnesota

Associate Professor of Anesthesiology

Mayo Clinic College of Medicine and Science

William D. Freeman, MD

Consultant, Departments of Critical Care Medicine, Neurology, and Neurosurgery

Mayo Clinic, Jacksonville, Florida

Professor of Neurology and of Neurosurgery

Mayo Clinic College of Medicine and Science

Ayan Sen, MD

Chair, Department of Critical Care Medicine

Mayo Clinic Hospital, Phoenix, Arizona

Assistant Professor of Emergency Medicine and of Medicine

Mayo Clinic College of Medicine and Science

The triple-shield Mayo logo and the words MAYO, MAYO CLINIC, and MAYO CLINIC SCIENTIFIC PRESS are marks of Mayo Foundation for Medical Education and Research

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Library of Congress Cataloging-in-Publication Data

Names: Wijdicks, Eelco F. M., 1954– editor. | Findlay, James Y., editor. | Freeman, William D., editor. | Sen, Ayan

Title: Mayo Clinic critical and neurocritical care board review / [edited by] Eelco F M Wijdicks, James Y Findlay, William D Freeman, Ayan Sen

Other titles: Critical and neurocritical care board review

Description: New York, NY : Oxford University Press, 2019. | Includes bibliographical references and index.

Identifiers: LCCN 2019005581| ISBN 9780190862923 (pbk.) | ISBN 9780190862930 (updf) | ISBN 9780190862947 (epub) | ISBN 9780190862954 (on-line)

Subjects: | MESH: Critical Care | Study Guide

Classification: LCC RC86.9 | NLM WX 18.2 | DDC 616.02/8076 dc23

LC record available at https://lccn loc gov/2019005581

Mayo Foundation does not endorse any particular products or services, and the reference to any products or services in this book is for informational purposes only and should not be taken as an endorsement by the authors or Mayo Foundation. Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the

publication This book should not be relied on apart from the advice of a qualified health care provider

The authors, editors, and publisher have exerted efforts to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, readers are urged to check the package insert for each drug for any change in indications and dosage and for added wordings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have US Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice.

Preface

Physicians have cared for patients with acute illnesses throughout history. The terminology related to these patients has changed. Sick patients became critically ill patients, and all needed intensive care. After the devastating poliomyelitis epidemics of the 1950s, a new specialty of critical care medicine emerged. Initially, respiratory care units were created for the patients affected by this severe illness, but soon they were transformed into intensive care units. Trauma units and transplant units soon followed. Specialized care for patients with acute neurologic or neurosurgical disease was established in parallel with these developments, but many of the early neuroscience intensive care units were redesigned wards. Specialized physicians and nursing staff delivered multidisciplinary care, recognizing that no one group could function well alone. Inevitably, critical care for the sickest patients was the only option to give them a fighting chance to survive.

In the United States, the Society of Critical Care Medicine brought the specialty clearly into focus in the early 1970s, and training program guidelines soon were developed in the United States and abroad. The Neurocritical Care Society was founded in 2002, and accreditation was established through the American Academy of Neurology (United Council of Neurologic Subspecialties). Most importantly, the American Board of Medical Specialties has approved creation of a neurocritical care subspecialty, and Accreditation Council for Graduate Medical Education–accredited fellowships and a new board examination are planned.

Currently, the neurocritical care board examination combines neurocritical care with general intensive care, and questions are equally divided between the 2 subjects. Accordingly, combining both areas of expertise in a single volume is appropriate.

The chapters in this book correspond with the key disorders suggested by the United Council of Neurologic Subspecialties to be studied in preparation for the examination and to assist with the critical care board examination. The book is not only detailed in basic pathophysiologic content but also describes major disorders and syndromes and their management. Because of its

unprecedented complete coverage of acute neurologic disorders, it is equally useful as preparation for the critical care medicine board examination.

The success of board review books hinges on clarity of the presented information, and we focused on conciseness and readability. Readers find tables, explanatory drawings, and bullet points useful, and thus we included them throughout while keeping the text specific and informative. We edited the entire text, and we sought expert advise to fill in our gaps in knowledge or to verify our additions. All chapters were written and closely edited by Mayo Clinic faculty. The references are up-to-date and include many guidelines.

Board review books have multiple disclaimers, as does this one. Use of this book alone will not guarantee passing the examination(s), and additional texts should be consulted. The book has more than 500 multiple-choice practice questions and answers. References are included with each answer. The questions are of the type used on the board examination. Reviewing the questions may improve one’s ability to take the board examination, but we all appreciate that (in essence) passing an examination is directly related to sufficient knowledge of the topics. We hope you will benefit from studying this text. It should appeal to any aspiring intensivist in training. We enjoyed selecting the material for you, and we definitely learned a few things along the way. We hope this book will help you pass the examination.

JY Findlay

WD Freeman A Sen

Table of Contents

Contributors

Section I: Fundamentals of Critical Care

1 • Respiratory Physiology in Critical Illness

Minkyung Kwon, MD and Jose L. Diaz-Gomez, MD

2 • Mechanical Ventilation: Basic Modes

Amelia A. Lowell, RRT, RCP

3 • Mechanical Ventilation: Advanced Modes

Amelia A. Lowell, RRT, RCP and Bhavesh M. Patel, MD

4

• Cardiovascular System in the Critically Ill Patient

Juan G. Ripoll Sanz, MD; Norlalak Jiramethee, MD; and Jose L. DiazGomez, MD

5 • Renal Function in Critically Ill Patients

Pramod K. Guru, MBBS, MD

6 • Nutrition in Critical Illness

Angela N. Vizzini, RDN, LD/N and Mireille H. Hamdan, RDN, LD/N

Section I: Questions and Answers

Section II: Fundamentals of Neurocritical Care

7 • Neurologic Examination in Neurocritical Illness

Eelco F. M. Wijdicks, MD, PhD

8 • Intracranial Pressure

Eelco F. M. Wijdicks, MD, PhD and William D. Freeman, MD

9 • Cerebrospinal Physiology

Joseph Zachariah, MD

10

• Cerebral Circulation and Cerebral Blood Flow

Arnoley S. Abcejo, MD and Jeffrey J. Pasternak, MD

11

• Consequences of Anoxia and Ischemia to the Brain

Jennifer E. Fugate, DO

12

• Consequences of Acute Metabolic Changes to the Brain

Sherri A. Braksick, MD and Sara E. Hocker, MD

13

• Consequences of Acute Hypertension to the Brain

Katherine M. Oshel, MD and Hani M. Wadei, MD

14

• Coma and Other Altered States of Consciousness

Eelco F. M. Wijdicks, MD, PhD

15

• Neuromuscular Respiratory Failure

Maximiliano A. Hawkes, MD and Eelco F. M. Wijdicks, MD, PhD

16

• Neurogenic Breathing Patterns

Eelco F. M. Wijdicks, MD, PhD

17

• Neurogenic Cardiac Manifestations

Sherri A. Braksick, MD and Eelco F. M. Wijdicks, MD, PhD

18 • Paroxysmal Sympathetic Hyperactivity

Kevin T. Gobeske, MD, PhD

Section II: Questions and Answers

Section III: Critical Care Disorders

Pulmonary Disorders

19 • Acute Respiratory Distress Syndrome

Richard K. Patch III, MD and James Y. Findlay, MB, ChB

20 • Pulmonary Embolism: An Overview

Brandon T. Nokes, MD and Rodrigo Cartin-Ceba, MD

21 • Asthma in the Critically Ill Patient

Jonathan J. Danaraj, DO and Augustine S. Lee, MD

22

• Chronic Obstructive Pulmonary Disease Exacerbation

Isabel Mira-Avendano, MD and Minkyung Kwon, MD

23

• Pleural Diseases in Critical Care Medicine

Karthika R. Linga, MBBS and Neal M. Patel, MD

24

• Pulmonary Malignancy

Ali A. Zaied, MD and Margaret M. Johnson, MD

25

• Pulmonary Hypertension and Right-Sided Heart Failure in the Critically Ill

Charles D. Burger, MD

Circulatory and Cardiovascular Disorders

26

• Anaphylaxis and Anaphylactic Shock

Megan S. Motosue, MD and Gerald W. Volcheck, MD

27

• Cardiogenic Shock

Robert A. Ratzlaff, DO and Jason L. Siegel, MD

28

• Acute Coronary Syndrome

Siva S. Ketha, MD and Juan Carlos Leoni Moreno, MD

29

• Cardiac Rhythm and Conduction Disturbances

Yahaira Ortiz Gonzalez, MD and Fred Kusumoto, MD

30

• Hypertensive Emergencies

Denzil R. Hill, MD and James A. Onigkeit, MD

31

• Cardiopulmonary Resuscitation

Richard K. Patch III, MD

32

• Vascular Emergencies of the Aorta

Tariq Almerey, MD; January F. Moore; and Houssam Farres, MD

Acute Endocrine Disorders

33 • Pituitary Apoplexy

Sherri A. Braksick, MD

34

• Diabetes Insipidus

Dana Erickson, MD

35

• Panhypopituitarism

Diane Donegan, MB, BCh and Irina Bancos, MD

36

• Thyroid Disorders in the Intensive Care Unit

John E. Moss, MD

37 • Glycemic Control in Neurocritically Ill Patients

Carla P. Venegas-Borsellino, MD; Michael A. Pizzi, DO, PhD; and Santiago Naranjo-Sierra, MD

38 • Adrenal Insufficiency in Neurocritically Ill Patients

Carla P. Venegas-Borsellino, MD and Santiago Naranjo-Sierra, MD

Gastrointestinal Disorders

39 • Acute Gastrointestinal Hemorrhage

Pablo Moreno Franco, MD and Philip E. Lowman, MD

40 • Paralytic and Obstructive Ileus

Juan M. Canabal, MD

41 • Acute Liver Failure

James Y. Findlay, MB, ChB and Eelco F. M. Wijdicks, MD, PhD

42

• Acute Perforations of the Gastrointestinal Tract

Levan Tsamalaidze, MD and John A. Stauffer, MD

43 • Acute Vascular Disorders of the Intestine

Omar Y. Mousa, MBBS and Surakit Pungpapong, MD

44 • Abdominal Compartment Syndrome

Daniel J. Johnson, MD

Renal Disorders

45 • Acute Kidney Injury

Ankit Sakhuja, MBBS and Kianoush B. Kashani, MD

46 • Acid-Base Disorders

Onur Demirci, MD

47 • Drug Dosing in Renal Failure

Daniel A. Jackson, PharmD, RPh

48 • Principles of Renal Replacement Therapies

Peter M. Fitzpatrick, MD

49 • Disorders of Water and Electrolyte Balance

Yuzana Zaw, MBBS and Mira T. Keddis, MD

Hematologic and Inflammatory Disorders

50 • Anemia and Blood Transfusion

Joy D. Hughes, MD; Mariela Rivera, MD; and Myung S. Park, MD, MS

51 • Hematologic and Oncologic Complications in the Intensive Care Unit

Carl A. Ruthman, MD and Jose C. Yataco, MD

52 • Thrombocytopenia and Thrombocytopathy

Gretchen Johns, MD

53 • Disseminated Intravascular Coagulation: Clinical Diagnosis and Management

Prakash Vishnu, MBBS and Sikander Ailawadhi, MD

54 • Diagnosis and Management of Acquired Bleeding Disorders

Rajiv K. Pruthi, MBBS

55 • Anticoagulation Monitoring and Reversal

Theresa N. Kinard, MD

56 • Therapeutic Plasma Exchange for Acute Hematologic Disorders

Jill Adamski, MD, PhD

57 • Rheumatologic and Autoimmune Emergencies

Megan L. Krause, MD and Kevin G. Moder, MD

Sepsis and Other Infectious Diseases

58 • Infectious Diseases Complicating Critical Care

David A. Sotello Aviles, MD and Walter C. Hellinger, MD

59 • Antibiotics in the Intensive Care Unit

David A. Sotello Aviles, MD and Walter C. Hellinger, MD

60 • Sepsis and Septic Shock

Charles R. Sims III, MD and Thomas B. Comfere, MD

Dermatologic Concerns

61 • Dermatologic Emergencies in the Intensive Care Unit

Matthew R. Hall, MD

62

Trauma and Burns

• Initial Approach to the Management of Multisystem Trauma

David S. Morris, MD

63 • Chest and Abdominal Trauma

Joy D. Hughes, MD and David S. Morris, MD

64 • Skeletal Trauma

Joshua S. Bingham, MD and Kevin J. Renfree, MD

65 • Burns and Electrical Injuries

Brandon T. Nokes, MD and Ayan Sen, MD

Cardiothoracic Critical Care

66

• Cardiothoracic Surgery and Postoperative Intensive Care

Juan G. Ripoll Sanz, MD and Robert A. Ratzlaff, DO

67

• Mechanical Circulatory Assist Devices

Ayan Sen, MD and Bhavesh M. Patel, MD

68 • Extracorporeal Membrane Oxygenation

J. Kyle Bohman, MD and Gregory J. Schears, MD

69

• Cardiac Pacing in the Intensive Care Unit

J. William Schleifer, MD; Farouk Mookadam, MB, BCh; and Harish

Ramakrishna, MD

Transplant Critical Care

70 • Clinical Management of Heart Transplant Recipients

Arzoo Sadiqi, BS and Jama Jahanyar, MD, PhD

71 • Critical Care of Heart-Lung and Lung Transplant Recipients

Ramachandra R. Sista, MD

72 • Clinical Management of Liver Transplant Recipients

Bhargavi Gali, MD

73 • Clinical Management of Kidney Transplant Recipients

James A. Onigkeit, MD

74 • Small Intestinal Transplant

Ayan Sen, MD

Toxicity and Toxins

75 • Serotonin Syndrome

Kevin T. Gobeske, MD, PhD and Eelco F. M. Wijdicks, MD, PhD

76 • Neuroleptic Malignant Syndrome and Hyperthermia

J. Ross Renew, MD and Monica Mordecai, MD

77 • Clinical Toxicology: Selected Drugs of Abuse and Chemical and Biological Warfare Agents

Matthew D. Sztajnkrycer, MD, PhD

Section III: Questions and Answers

Section IV: Neurocritical Illness

Acute Cerebrovascular Disorders

78 • Diagnosis and Management of Hemispheric Infarction

Sanjeet S. Grewal, MD and Benjamin L. Brown, MD

79 • Basilar Artery Occlusion

Michael R. Pichler, MD and Jennifer E. Fugate, DO

80 • Carotid Artery Disease

Nnenna Mbabuike, MD and Rabih G. Tawk, MD

81 • Adult Primary Central Nervous System Vasculitis

Carlo Salvarani, MD; Robert D. Brown Jr, MD, MPH; and Gene G. Hunder, MD

82 • Intracerebral and Intraventricular Hemorrhage

Oana Dumitrascu, MD and Maria I. Aguilar, MD

83 • Aneurysmal Subarachnoid Hemorrhage

Giuseppe Lanzino, MD and Biagia La Pira, MD

84 • Intracranial Arteriovenous Malformations

Kelly D. Flemming, MD and Michael J. Link, MD

85 • Cerebral Venous and Dural Sinus Thrombosis

Sara E. Hocker, MD

86 • Cervical Arterial Dissection

Bart M. Demaerschalk, MD

Traumatic Brain and Spine Injury

87 • Traumatic Brain Injury and Spinal Cord Injury

Maya A. Babu, MD

88 • Traumatic Epidural and Subdural Hematomas

Patrick R. Maloney, MD and Michelle J. Clarke, MD

89 • Unstable Spinal Fractures

William E. Clifton III, MD and Mark A. Pichelmann, MD

Acute Central Nervous System Infections

90 • Encephalitis

Allen J. Aksamit Jr, MD

91 • Acute Bacterial Meningitis

Eelco F. M. Wijdicks, MD, PhD

92 • Brain Abscess and Spinal Epidural Abscess

Selby G. Chen, MD

Acute Neuromuscular Disorders

93 • Myasthenia Gravis

Maximiliano A. Hawkes, MD and Eelco F. M. Wijdicks, MD, PhD

94 • Guillain-Barré Syndrome

Eelco F. M. Wijdicks, MD, PhD

95 • Amyotrophic Lateral Sclerosis

Jennifer M. Martinez-Thompson, MD and Nathan P. Staff, MD, PhD

96 • Rhabdomyolysis and Toxic Myopathies

Justin C. Kao, MB, ChB and Margherita Milone, MD, PhD

97 • Myopathy and Neuropathy Acquired in the Intensive Care Unit

Priya S. Dhawan, MD and Jennifer A. Tracy, MD

Miscellaneous Disorders of Acute Brain Injury

98 • Status Epilepticus

99

Christopher P. Robinson, DO, MS and Sara E. Hocker, MD

• Posterior Reversible Encephalopathy Syndrome

Sudhir V. Datar, MBBS and Jennifer E. Fugate, DO

100 • Demyelinating Disorders of the Central Nervous System

Aurelia A. Smith, MD and Brian G. Weinshenker, MD

101

• Rapidly Progressive Dementia and Coma

Prasuna Kamireddi, MBBS; Jason L. Siegel, MD; and Dennis W. Dickson, MD

Neuro-oncology

102

• Brain and Spine Tumors

Mithun Sattur, MBBS; Matthew E. Welz, MS; and Bernard R. Bendok, MD

103

• Neoplastic Meningitis

Alyx B. Porter, MD

104

• Autoimmune Encephalitis

Eslam Shosha, MB, BCh and Sean J. Pittock, MD

105

• Radiation Therapy

Sameer R. Keole, MD

Postoperative Neurosurgery

106 • Intensive Care After Spinal Surgery

Clarence B. Watridge, MD

107

• Intensive Care After Craniotomy

Kelly Gassie, MD; Belinda G. Bradley, APRN; Robert E. Wharen Jr, MD; and Betty Y. S. Kim, MD, PhD

108

• Intensive Care After Neuroendovascular Procedures

Mithun Sattur, MBBS; Chandan Krishna, MD; Bernard R. Bendok, MD; and Brian W. Chong, MD

Section IV: Questions and Answers

Section V: Imaging in Critical Illness

109

• Radiography and Computed Tomography of the Chest

Barbara L. McComb, MD

110 • Abdominal Radiography

Joseph G. Cernigliaro, MD and David J. DiSantis, MD

111

• Fluoroscopy: Principles and Safety

David M. Sella, MD; Glenn M. Sturchio, PhD; and Beth A. Schueler, PhD

112 • Ultrasonography

Santiago Naranjo-Sierra, MD and Lauren K. Ng Tucker, MD

113 • Transesophageal Echocardiography

Ryan C. Craner, MD; Farouk Mookadam, MB, BCh; and Harish

Ramakrishna, MD

Section V: Questions and Answers

Section VI: Procedures

Airway Procedures and Modes of Ventilation

114

• Basics of Airway and Oxygen Delivery Devices

Andrew W. Murray, MD

115

• Endotracheal Intubation Procedures

Matthew J. Ritter, MD

116

• Noninvasive Positive Pressure Ventilation

Karen W. Hampton, MS, RRT

117 • Tracheostomy

Saba Ghorab, MD and David G. Lott, MD

118

• Diagnostic and Interventional Bronchoscopy in the Intensive Care Unit

Cesar A. Keller, MD

Cardiovascular and Cardiopulmonary Monitoring and Access

119

• Electrocardiographic Monitoring

Pragnesh P. Parikh, MD and K. L. Venkatachalam, MD

120

• Hemodynamic Monitoring

Hannelisa E. Callisen, PA-C; Stacy L. Libricz, PA-C, MS; and Ayan

Sen, MD

121

• Pulmonary Artery Catheterization

Philip E. Lowman, MD

122

• Thoracentesis and Chest Tubes

Staci E. Beamer, MD

123 • Central Line Placement

Nicholas D. Will, MD and W. Brian Beam, MD

124

• Interventional Radiology Procedures

Rahmi Oklu, MD, PhD

Neuromonitoring and Procedures

125

• Intracranial Pressure Monitoring and External Ventricular Drainage

Maya A. Babu, MD and John L. D. Atkinson, MD

126

• Lumbar Puncture

Christina C. Smith, APRN

127

• Lumbar Drain

Jamie J. Van Gompel, MD

128

• Intraventricular Drug Administration

William W. Horn Jr, APRN and Benjamin L. Brown, MD

129

• Transcranial Doppler Ultrasonography

Mark N. Rubin, MD

130 • Electroencephalography

Amy Z. Crepeau, MD

131

• Essentials of Multimodal Brain Monitoring

Jennifer E. Fugate, DO

132

• Essentials of Cranial Neuroimaging

E. Paul Lindell, MD

Section VI: Questions and Answers

Section VII: Pharmacotherapeutics

133 • Anticonvulsant Drugs

Anteneh M. Feyissa, MD and Jeffrey W. Britton, MD

134 • Effects of Targeted Temperature Management on Drugs

Lauren K. Ng Tucker, MD

135 • Sedation and Analgesia

Juan G. Ripoll Sanz, MD and Jose L. Diaz-Gomez, MD

136 • Inotropes, Vasopressors, and Antihypertensive Agents

Juan N. Pulido, MD

137 • Antibiotics, Antivirals, and Antifungals

David A. Sotello Aviles, MD and Walter C. Hellinger, MD

Section VII: Questions and Answers

Section VIII: Ethics in the Neurointensive Care Unit

138 • Palliative and End-of-Life Care in the Intensive Care Unit

Maisha T. Robinson, MD

139 • Communicating With Families

Cory Ingram, MD

140 • Brain Death

Eelco F. M. Wijdicks, MD, PhD

141 • Minimally Conscious State and Persistent Vegetative State

David T. Jones, MD

142 • Ethical Concerns and Care Before Organ Donation

Diane C. McLaughlin, APRN, ARNP and Lauren K. Ng Tucker, MD

Section VIII: Questions and Answers

Index

Contributors

Arnoley S. Abcejo, MD

Senior Associate Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science

Jill Adamski, MD, PhD

Chair, Division of Laboratory Medicine, Mayo Clinic Hospital, Phoenix, Arizona; Associate Professor of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science

Maria I. Aguilar, MD

Consultant, Department of Neurology, Mayo Clinic, Scottsdale, Arizona; Associate Professor of Neurology, Mayo Clinic College of Medicine and Science

Sikander Ailawadhi, MD

Consultant, Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science

Allen J. Aksamit Jr, MD

Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Professor of Neurology, Mayo Clinic College of Medicine and Science

Tariq Almerey, MD

Research Fellow in Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida

John L. D. Atkinson, MD

Consultant, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; Professor of Neurosurgery, Mayo Clinic College of Medicine and Science

Maya A. Babu, MD

Resident in Neurosurgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota

Present address: Harvard Medical School, Boston, Massachusetts

Irina Bancos, MD

Consultant, Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science

W. Brian Beam, MD

Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science

Staci E. Beamer, MD

Senior Associate Consultant, Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Surgery, Mayo Clinic College of Medicine and Science

Bernard R. Bendok, MD

Chair, Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona; Professor of Neurosurgery, Mayo Clinic College of Medicine and Science

Joshua S. Bingham, MD

Fellow in Reconstructive Surgery, Mayo Clinic School of Graduate Medical Education and Instructor in Orthopedics, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona

J. Kyle Bohman, MD

Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science

Belinda G. Bradley, APRN

Lead Nurse Practicioner, Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida

Sherri A. Braksick, MD

Fellow in Critical Care Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester,

Minnesota

Present address: University of Kansas Medical Center, Kansas City, Kansas

Jeffrey W. Britton, MD

Chair, Division of Epilepsy, Mayo Clinic, Rochester, Minnesota; Professor of Neurology, Mayo Clinic College of Medicine and Science

Benjamin L. Brown, MD

Senior Associate Consultant, Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Neurosurgery, Mayo Clinic College of Medicine and Science

Robert D. Brown Jr, MD, MPH

Chair, Division of Stroke and Cerebrovascular Diseases, Mayo Clinic, Rochester, Minnesota; Professor of Neurology, Mayo Clinic College of Medicine and Science

Charles D. Burger, MD

Consultant, Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida; Professor of Medicine, Mayo Clinic College of Medicine and Science

Hannelisa E. Callisen, PA-C

Physician Assistant, Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, Arizona

Juan M. Canabal, MD

Senior Associate Consultant, Department of Transplantation, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science

Rodrigo Cartin-Ceba, MD

Consultant, Department of Critical Care Medicine, Mayo Clinic, Scottsdale, Arizona; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science

Joseph G. Cernigliaro, MD

Chair, Division of Abdominal Imaging, Mayo Clinic, Jacksonville, Florida; Associate Professor of Radiology, Mayo Clinic College of Medicine and Science

Selby G. Chen, MD

Senior Associate Consultant, Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Neurosurgery, Mayo Clinic College of Medicine and Science

Brian W. Chong, MD

Consultant, Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona; Associate Professor of Radiology, Mayo Clinic College of Medicine and Science

Michelle J. Clarke, MD

Consultant, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; Professor of Neurosurgery and of Orthopedics, Mayo Clinic College of Medicine and Science

William E. Clifton III, MD

Resident in Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida

Thomas B. Comfere, MD

Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science

Ryan C. Craner, MD

Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science

Amy Z. Crepeau, MD

Consultant, Department of Neurology, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Neurology, Mayo Clinic College of Medicine and Science

Jonathan J. Danaraj, DO

Resident in Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida

Sudhir V. Datar, MBBS

Division of Critical Care Neurology, Wake Forest University Medical Center, Winston-Salem, North Carolina; Assistant Professor of Neurology and of

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