Certification in Neurophysiologic Intraoperative Monitoring CNIM® Board Preparation Course
2 - Day Course - 16 ACE Credits
Cost - $595.00
This course is a comprehensive overview for experienced IOM Specialists preparing for the Certification in Neurophysiologic Intraoperative Monitoring (CNIM®) Board Examination. Topics covered include: Patient Preparation, Intraoperative Monitoring, Instrumentation Concepts, Neuroanatomy and Physiology Related to IOM, Anesthesia Concepts, Postoperative Phase, and Ethics and Professional Issues
OVERVIEW OF PATIENT PREPARATION
The course begins with a review of intraoperative procedures to determine the structures at risk and the modalities that should be monitored. 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 MONITORING
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.
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