This course is a comprehensive overview for experienced IOM Specialists preparing for the Certification in Neurophysiologic Intraoperative Monitoring (CNIM®) Board Examination.
The topics covered include:
- Principles of Evoked Potentials,
- Upper and Lower SSEPs,
- Brainstem Auditory Evoked Potentials,
- Transcranial Motor Evoked Potential,
- Patient Preparation
- Intraoperative Monitoring Phase
- Instrumentation Concepts
- Neuroanatomy and Neurophysiology,
- Anesthesia Concepts,
- Post-operative Phase,
- Ethics and Professional Issues
16 ASET CEUs
Principles of Evoked Potentials and Instrumentation
A detailed explanation of instrumentation and technical concepts is provided and a comprehensive explanation of each modality is covered. Topics presented on instrumentation include: near-field vs far-field recording methods, stimulus types and characteristics, calibration, polarity, amplification (recording gain, display gain, sensitivity), and filters. The averaging process will be explained in detail. You will learn how the analysis time, sampling rate, dwell time in order to determine horizontal resolution and how to calculate each. Vertical resolution and the number of voltage levels expressed as bit capacity will be explained. You will gain an understanding of the signal-to-noise ratio and its effect on the resolution of the signal.
Upper Extremity Somatosensory Evoked Potentials
A comprehensive review of upper extremity SSEP concepts are covered such as: anatomy and physiology of the median/ulnar nerves, somatosensory pathway, electrode placement, instrument parameters, montage construction, and peak identification. Extensive time will be spent reviewing troubleshooting techniques.
Lower Extremity Somatosensory Evoked Potentials
We will begin with an introduction of the lower extremity SSEP followed by anatomy and physiology of the lower extremity somatosensory pathway, electrode placement, instrument parameters, montage construction, and peak identification. Extensive time will be spent reviewing troubleshooting techniques.
Brainstem Auditory Evoked Potentials BAEPs
Lectures on Brainstem Auditory Evoked Potentials begin with an in depth overview of anatomy and physiology of the brainstem and auditory pathways, electrode placement, instrument parameters, montage construction, and peak identification. Reviewed will be rarefaction, condensation and alternating click polarity. Extensive time will be spent reviewing troubleshooting techniques.
Overview of Patient Preparation
A review of intraoperative procedures to determine the structures at risk and the modalities that should be monitored is covered in detail. Additional topics include medical terminology, evoked potential, EEG, and EMG correlates to clinical entities and risks associated with specific disorders, central and peripheral neuroanatomy, and risks associated with specific disorders/surgical procedures. Review medical conditions that may affect the monitoring or the outcomes. Infection control, ACNS Guidelines, effects of instrument settings (e.g. filters, sensitivity, gain), montage modifications, and discussion of electrical safety.
Intraoperative Monitoring Phase
The focus now shifts to monitoring the patient in the operating room. Students will learn electrode placement systems (e.g. 10 – 20), electrode application techniques (e.g. paste, collodion, needle electrodes) and factors affecting impedance. Baseline values and significant changes are discussed in detail. Effects of drugs/anesthetic agents on recordings, troubleshooting techniques, digital instrumentation concepts (signal to noise ratio, sampling rate, A-D conversion), and artifact identification and elimination is reviewed. The components of each evoked potential modality, waveforms, significant surgical events (e.g. clamping, rotation, distraction), surgery specific monitoring protocols, and documentation and communication and are covered in detail.
Students will become acquainted with the recording equipment by learning gain/sensitivity, high and low frequency filters (HFF/LFF), principles of differential amplification, polarity, near-field/far field recording methods and potential nomenclature, analog-to-digital conversion specifically horizontal (sampling rate, dwell time, aliasing, CMRR, polarity) and vertical (bit capacity ) resolution. You will learn the different types of stimulation used for Somatosensory Evoked Potentials, Trans Cranial electrical Motor Evoked Potentials, EMG, and Auditory Evoked Potentials.
Neuroanatomy and Neurophysiology Related to IONM
You will learn the brain and brainstem structures, anatomy of the vertebral column, auditory pathway, motor and sensory pathways of the spinal cord, muscles and nerve root innervation, and peripheral nerves associated with monitoring and cranial nerves. Anatomy of the motor pathway and neurophysiology of the corticospinal tract are discussed in detail.
You will learn about anesthesia agents (e.g. narcotics, barbiturates, inhalational anesthesia, neuromuscular blockade), methods of delivery, sedation issues, MAC and efffects on recordings. You will also learn how the BIS monitor is used and indications for and interpretation of cerebral oximetry. Students will also learn the physiological variables monitored by the anesthesia specialist and how these can effect monitoring.
Topics involving the post-operative phase to include: Infection control, MSDS/OSHA standards, maintenance of equipment, ACNS guidelines, safety considerations, and appropriate cleaning and disinfection of electrodes and equipment are covered.
Ethics and Professional Issues
Contraindications for specific modalities, allergies and sensitivies (e.g.latex, tape), ABRET Code of Ethics, and HIPAA standards are presented.