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.
Juan
Pramod
Eelco
Sherri
Eelco
16
Maximiliano A. Hawkes, MD and Eelco F. M. Wijdicks, MD, PhD
• 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 Rhythmand 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
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
Trauma and Burns
62
• Initial Approach to the Management of MultisystemTrauma
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 SystemVasculitis
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 SystemInfections
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
97
• Rhabdomyolysis and Toxic Myopathies
Justin C. Kao, MB, ChB and Margherita Milone, MD, PhD
• 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
Christopher P. Robinson, DO, MS and Sara E. Hocker, MD
99
• 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
111
112
113
Joseph G. Cernigliaro, MD and David J. DiSantis, MD
• Fluoroscopy: Principles and Safety
David M. Sella, MD; Glenn M. Sturchio, PhD; and Beth A. Schueler, PhD
• Ultrasonography
Santiago Naranjo-Sierra, MD and Lauren K. Ng Tucker, MD
• 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
Index
Ethical Concerns and Care Before Organ Donation
Diane C. McLaughlin, APRN, ARNP and Lauren K. Ng Tucker, MD
Section VIII: Questions and Answers
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
WilliamE. 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 Anesthesiology, Wake Forest School of Medicine
Bart M. Demaerschalk, MD
Consultant, Department of Neurology, Mayo Clinic Hospital, Phoenix, Arizona; Professor of Neurology, Mayo Clinic College of Medicine and Science
Onur Demirci, MD
Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Priya S. Dhawan, MD
Resident in Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Present address: University of British Columbia, Vancouver, British Columbia
Jose L. Diaz-Gomez, MD
Consultant, Departments of Critical Care Medicine, Anesthesiology, and Neurosurgery, Mayo Clinic, Jacksonville, Florida; Associate Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Present address: Private Practice
Dennis W. Dickson, MD
Consultant, Departments of Laboratory Medicine and Pathology and of Neuroscience, Mayo Clinic, Jacksonville, Florida; Professor of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science
David J. DiSantis, MD
Senior Associate Consultant, Department of Radiology, Mayo Clinic, Jacksonville, Florida; Professor of
Radiology, Mayo Clinic College of Medicine and Science
Diane Donegan, MB, BCh
Research Collaborator in Endocrinology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Oana Dumitrascu, MD
Fellow in Vascular Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
Dana Erickson, MD
Consultant, Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, Minnesota; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science
HoussamFarres, MD
Consultant, Division of Vascular Surgery, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Surgery, Mayo Clinic College of Medicine and Science
Anteneh M. Feyissa, MD
Senior Associate Consultant, Department of Neurology, Mayo Clinic, Jacksonville, Florida; Assistant 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
Peter M. Fitzpatrick, MD
Consultant, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Kelly D. Flemming, MD
Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Associate Professor of Neurology, Mayo Clinic College of Medicine and Science
WilliamD. 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
Jennifer E. Fugate, DO
Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Neurology, Mayo Clinic College of Medicine and Science
Bhargavi Gali, MD
Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Kelly Gassie, MD
Resident in Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Saba Ghorab, MD
Resident in Otolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
Kevin T. Gobeske, MD, PhD
Resident in Critical Care Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Sanjeet S. Grewal, MD
Resident in Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Pramod K. Guru, MBBS, MD
Senior Associate Consultant, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Matthew R. Hall, MD
Consultant, Department of Dermatology, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Dermatology, Mayo Clinic College of Medicine and Science
Mireille H. Hamdan, RDN, LD/N
Dietician, Clinical Nutrition Services, Mayo Clinic, Jacksonville, Florida; Instructor in Nutrition, Mayo Clinic College of Medicine and Science
Karen W. Hampton, MS, RRT
Respiratory Therapist, Respiratory Services, Mayo Clinic, Jacksonville, Florida
Maximiliano A. Hawkes, MD
Fellow in Critical Care Neurology, Mayo Clinic School of Graduate Medical Education and Assistant Professor of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Walter C. Hellinger, MD
Chair, Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science
Denzil R. Hill, MD
Senior Associate Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Instructor in Anesthesiology, Mayo Clinic College of Medicine and Science
Sara E. Hocker, MD
Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Associate Professor of Neurology, Mayo Clinic College of Medicine and Science
WilliamW. Horn Jr, APRN
Nurse Practitioner, Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
Joy D. Hughes, MD
Research Fellow in General Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Gene G. Hunder, MD
Emeritus Professor of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Cory Ingram, MD
Senior Associate Consultant, Division of Community Palliative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Family Medicine and of Palliative Medicine, Mayo Clinic College of Medicine and Science
Daniel A. Jackson, PharmD, RPh
Pharmacist, Pharmacy Services, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Pharmacy, Mayo Clinic College of Medicine and Science
Jama Jahanyar, MD, PhD
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
Norlalak Jiramethee, MD
Fellow in Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Gretchen Johns, MD
Consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science
Daniel J. Johnson, MD
Chair, Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona; Associate Professor of Surgery, Mayo Clinic College of Medicine and Science
Margaret M. Johnson, MD
Consultant, Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, Florida; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science
David T. Jones, MD
Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Neurology, Mayo Clinic College of Medicine and Science
Prasuna Kamireddi, MBBS
Research Trainee, Department of Neurology, Mayo Clinic, Jacksonville, Florida
Justin C. Kao, MB, ChB
Fellow in Advanced Clinical Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Kianoush B. Kashani, MD
Consultant, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota; Professor of Medicine, Mayo Clinic College of Medicine and Science
Mira T. Keddis, MD
Consultant, Division of Nephrology, Mayo Clinic, Scottsdale, Arizona; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Cesar A. Keller, MD
Emeritus Professor of Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Sameer R. Keole, MD
Consultant, Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Radiation Oncology, Mayo Clinic College of Medicine and Science
Siva S. Ketha, MD
Research Collaborator, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Betty Y. S. Kim, MD, PhD
Consultant, Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; Associate Professor of Neurosurgery and Assistant Professor of Neuroscience, Mayo Clinic College of Medicine and Science
Theresa N. Kinard, MD
Consultant, Department of Laboratory Medicine, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science
Megan L. Krause, MD
Fellow in Rheumatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Chandan Krishna, MD
Senior Associate Consultant, Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Neurosurgery, Mayo Clinic College of Medicine and Science
Fred Kusumoto, MD
Consultant, Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida; Professor of Medicine, Mayo Clinic College of Medicine and Science
Minkyung Kwon, MD
Resident in Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Giuseppe Lanzino, MD
Consultant, Departments of Neurologic Surgery and Radiology, Mayo Clinic, Rochester, Minnesota; Professor of Neurosurgery, Mayo Clinic College of Medicine and Science
Biagia La Pira, MD
Research Trainee, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota Present address: Private practice, Rome, Italy
Augustine S. Lee, MD
Chair, Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, Florida; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science
Juan Carlos Leoni Moreno, MD
Consultant, Department of Transplantation, Mayo Clinic, Jacksonville, Florida; Instructor in Medicine, Mayo Clinic College of Medicine and Science
Stacy L. Libricz, PA-C, MS
Physician Assistant, Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, Arizona; Instructor in Medicine, Mayo Clinic College of Medicine and Science
E. Paul Lindell, MD
Consultant, Department of Radiology, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Radiology, Mayo Clinic College of Medicine and Science
Karthika R. Linga, MBBS
Fellow in Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Michael J. Link, MD
Consultant, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; Professor of Neurosurgery, Mayo Clinic College of Medicine and Science
David G. Lott, MD
Consultant, Department of Otolaryngology-Head & Neck Surgery/Audiology, Mayo Clinic, Scottsdale, Arizona; Associate Professor of Otolaryngology, Mayo Clinic College of Medicine and Science
Amelia A. Lowell, RRT, RCP
Clinical Respiratory Care Specialist, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Philip E. Lowman, MD
Consultant, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida; Instructor in Medicine, Mayo Clinic College of Medicine and Science
Patrick R. Maloney, MD
Research Collaborator, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
Jennifer M. Martinez-Thompson, MD
Senior Associate Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Neurology, Mayo Clinic College of Medicine and Science
Nnenna Mbabuike, MD
Fellow in Endovascular Neurosurgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Present address: University of Pennsylvania Medical Center, Altoona, Pennsylvania
Barbara L. McComb, MD
Emeritus Associate Professor of Radiology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Diane C. McLaughlin, APRN, ARNP
Nurse Practitioner, Department of Neurology, Mayo Clinic, Jacksonville, Florida; Instructor in Neurology, Mayo Clinic College of Medicine and Science
Margherita Milone, MD, PhD
Consultant, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Professor of Neurology, Mayo Clinic College of Medicine and Science
Isabel Mira-Avendano, MD
Consultant, Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Kevin G. Moder, MD
Consultant, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Associate Professor of Medicine, Mayo Clinic College of Medicine and Science
Farouk Mookadam, MB, BCh
Consultant, Department of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona; Professor of Medicine, Mayo Clinic College of Medicine and Science
January F. Moore
Special Project Associate, Division of Vascular Surgery, Mayo Clinic, Jacksonville, Florida
Monica Mordecai, MD
Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Pablo Moreno Franco, MD
Consultant, Department of Transplantation, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
David S. Morris, MD
Consultant, Division of Trauma, Critical Care, & General Surgery, Mayo Clinic, Rochester, Minnesota
Present address: Intermountain Medical Center, Murray, Utah
John E. Moss, MD
Consultant, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Megan S. Motosue, MD
Resident in Allergy and Immunology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Omar Y. Mousa, MBBS
Fellow in Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education and Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Andrew W. Murray, MD
Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, Arizona; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Santiago Naranjo-Sierra, MD
Visiting Research Fellow in Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
Present address: Hospital Pablo Tobon Uribe, Medellín, Colombia
Lauren K. Ng Tucker, MD
Consultant, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida; Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
Brandon T. Nokes, MD
Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
Rahmi Oklu, MD, PhD
Chair, Division of Interventional Radiology, Mayo Clinic Hospital, Phoenix, Arizona; Professor of Radiology, Mayo Clinic College of Medicine and Science
James A. Onigkeit, MD
Consultant, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine and Science
Yahaira Ortiz Gonzalez, MD
Resident in Cardiovascular Diseases, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Katherine M. Oshel, MD
Consultant, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida; Instructor in Medicine, Mayo Clinic College of Medicine and Science
Pragnesh P. Parikh, MD
Consultant, Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida; Assistant
