Intraoperative Neuromonitoring List

There always seems to be a couple things that get people on the CNIM exam, and I’ve compiled a neuromonitoring list. First is the little extra’s that we don’t think about much when we’re in the OR. These are a little easier to know now that ever facility requires you to go through so much credentialing, but things like fire safety, being compliant and other hospital precautions have a long-standing history of getting people on the CNIM.

The other area seems to be the cases that people new to the field haven’t had the opportunity to see. A lot of people are visual learners and need something real to associate with what they’re learning. If not, then it’s just words.

So I’ve looked up some free CNIM and DABNM resources on the internet for you to look over while preparing for the CNIM. It might not be everything you need to know, but will at least help introduce new topics and allow you to see where you might need to focus more time. These are all outgoing links, so I have no control over those websites. I’ll try to do some periodic upkeep on the links, but I promise nothing.

Infection Control

http://www.texashste.com/documents/curriculum/sterile_technique.pdfHIPAA

Patient safety and quality improvement act

http://www.pso.ahrq.gov/statute/pl109-41.htm

HIPAA privacy rules

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

HIPAA security rules

http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html

HIPAA training manuals

http://www.hhs.gov/ocr/privacy/hipaa/understanding/training/index.html

 

Joint Commission

Surgical site infection control

http://www.jointcommission.org/implementation_guide_for_npsg070501_ssi_change_project/

Patient safety goals

http://www.jointcommission.org/standards_information/npsgs.aspx

Universal protocol

http://www.jointcommission.org/standards_information/up.aspx

 

CNIM competency, skills standards and IONM practice guidelines

http://www.aset.org/files/public/IONM_National_Competency_Skill_Standards_Approved_2011.pdf

https://c.ymcdn.com/sites/www.asnm.org/resource/resmgr/docs/practice_guidelines_for_the_.pdf

 

Electrical

FFT

http://jama.jamanetwork.com/article.aspx?articleid=391249

Differential amps

 

Physiology

Q and A notes on general neurophysiology

http://student.ttuhsc.edu/peertutoring/msi/Neuro/Block%201/neurophys_studyguide.rtf

Ach

http://www.biologymad.com/nervoussystem/synapses.htm

Neurons

http://neuroscience.uth.tmc.edu/s1/introduction.html

Action potentials

http://neuroscience.uth.tmc.edu/s1/chapter01.html

http://neuroscience.uth.tmc.edu/s1/chapter02.html

iii. http://neuroscience.uth.tmc.edu/s1/chapter03.html

Neuromuscular junction

http://neuroscience.uth.tmc.edu/s1/chapter04.html

Synaptic transmission

http://neuroscience.uth.tmc.edu/s1/chapter06.html

Neurons

http://neuroscience.uth.tmc.edu/s1/chapter08.html

Ach

http://neuroscience.uth.tmc.edu/s1/chapter11.html

Amino acid neurotransmitters

http://neuroscience.uth.tmc.edu/s1/chapter13.html

 

Anatomy

General neuroanatomy – go through the different labs seen in the drop down menu at the top of the page

http://www.columbia.edu/itc/hs/medical/neuroanatomy/neuroanat/

Blood supply to the brain

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CC0QFjAA&url=https%3A%2F%2Flmco.brightidea.com%2Fct%2Fgetfile.bix%3Fa%3DOD4812%26f%3DC95F5175-CF9F-4EE8-837C-90AD75ECCD61&ei=5a2qUe-aEoiQ9QTIhIGQDA&usg=AFQjCNFvaA64cJqDWRqKEZiFPE5gW2B27w&sig2=545szFBsL_PpMTrXBD7dlA&bvm=bv.47244034,d.eWU&cad=rja

Overview of nervous system

http://neuroscience.uth.tmc.edu/s2/chapter01.html

Nervous system Q and A

http://medicaltextbooksrevealed.s3.amazonaws.com/files/17007-53.pdf

Somatosensory system

http://neuroscience.uth.tmc.edu/s2/chapter02.html

Spinal cord anatomy

http://neuroscience.uth.tmc.edu/s2/chapter03.html

Somatosensory pathways

http://neuroscience.uth.tmc.edu/s2/chapter04.html

Somatosensory processes

http://neuroscience.uth.tmc.edu/s2/chapter05.html

Pain

http://neuroscience.uth.tmc.edu/s2/chapter06.html

Pain tracts

http://neuroscience.uth.tmc.edu/s2/chapter07.html

Pain modulation

http://neuroscience.uth.tmc.edu/s2/chapter08.html

Olfaction

http://neuroscience.uth.tmc.edu/s2/chapter09.html

Auditory system

http://neuroscience.uth.tmc.edu/s2/chapter12.html

http://neuroscience.uth.tmc.edu/s2/chapter13.html

Visual system

http://neuroscience.uth.tmc.edu/s2/chapter15.html

Overview of motor system

http://neuroscience.uth.tmc.edu/s3/chapter01.html

Motor pathways

http://neuroscience.uth.tmc.edu/s3/chapter02.html

Motor cortex

http://neuroscience.uth.tmc.edu/s3/chapter03.html

BG

http://neuroscience.uth.tmc.edu/s3/chapter04.html

Cerebellum

http://neuroscience.uth.tmc.edu/s3/chapter05.html

Disorders of the motor system

http://neuroscience.uth.tmc.edu/s3/chapter06.html

Ocular motor systems

http://neuroscience.uth.tmc.edu/s3/chapter07.html

http://neuroscience.uth.tmc.edu/s3/chapter08.html

Differentiate radiculopathy vs. peripheral nerve lesion

http://www.auroramed.com/dotAsset/412305.pdf

Anatomy and pathology images and general overview

http://usmlefasttrack.com/category/usmle-fast-track-first-aid-for-usmle-step-1/

Find anatomy and physiology videos on his page

http://www.youtube.com/user/DoctorNajeeb/videos

Find anatomy and physiology videos on his page

http://www.youtube.com/user/professorfink?feature=watch

Skull and Spinal vertebrae

iii. https://www.youtube.com/watch?v=lXdKHIqU0ck

Cranial nerves

http://www.youtube.com/watch?v=lyfWea2rDsE

iii. http://www.youtube.com/watch?v=U0egf7IrG_g

http://www.youtube.com/watch?v=a4WQsYUZmk8

http://www.youtube.com/watch?v=C3QB_mR2yhA

http://www.youtube.com/watch?v=HaGc05XurmU

vii. http://www.youtube.com/watch?v=es_qEkkGxU8

viii. http://www.youtube.com/watch?v=HI3r8t-2vmg

http://www.neuroanatomy.wisc.edu/coursebook/CNreview.pdf

Head and neck anatomy

http://www.youtube.com/watch?v=yJNUI5HC1fs

http://www.youtube.com/watch?v=mMtpJjTZOwY

iii. http://www.youtube.com/watch?v=XH4bnJcEoq8

Brain

http://www.youtube.com/watch?v=hhSk1mf_bM4

http://www.youtube.com/watch?v=cGhwQxFn3YU

iii. http://www.youtube.com/watch?v=u7rVxiUD6yk

http://www.youtube.com/watch?v=LawBwrKDyiA

http://www.youtube.com/watch?v=b9uoSOcF9lg

http://www.youtube.com/watch?v=DvS9Dq-QxcI

vii. http://www.youtube.com/watch?v=kn-3d8YiNRM

viii. http://www.youtube.com/watch?v=EU0jRuxEgFo

http://www.youtube.com/watch?v=A3-NLQATnv0

Spinal cord

http://www.youtube.com/watch?v=p-uFLKfxJOA

http://www.youtube.com/watch?v=KuffZZ2c_sk

iii. http://www.youtube.com/watch?v=r9lyh5hUBYA

http://www.youtube.com/watch?v=1Uqp5ZjZeds

http://www.youtube.com/watch?v=NS8BjcKySF8

http://www.youtube.com/watch?v=O3xbCKH77XA

vii. http://www.youtube.com/watch?v=E9IRrtptjAQ

viii. http://www.youtube.com/watch?v=E9IRrtptjAQ

http://www.youtube.com/watch?v=AOJiim64dO4

Lumbosacral plexus

http://www.youtube.com/watch?v=-lOsZCNj0Q8

http://www.youtube.com/watch?v=LjXMqQ9jJws

iii. http://www.youtube.com/watch?v=N69GvVh2vV4

http://www.youtube.com/watch?v=_FTxO5vhS-k

http://www.youtube.com/watch?v=fO81nbCA9Nk

vii. http://www.youtube.com/watch?v=LKdMTsCPtEo

Brachial plexus

http://www.youtube.com/watch?v=Jd35FKUNtds

http://www.youtube.com/watch?v=U3U1XGKtB0k

iii. http://www.youtube.com/watch?v=5tEPkpJE1ao

Peripheral nerves

iii. http://www.youtube.com/watch?v=mdfPR8KqEbw

Motor pathway

http://www.youtube.com/watch?v=IzucLMcalR8

Sensory pathway

http://www.youtube.com/watch?v=66xI_M0l2BU

Basal Ganglia

http://www.youtube.com/watch?v=J3po7dUCCoE

Internal capsule

http://www.youtube.com/watch?v=aVlGRTEmNTQ

Brain stem

http://www.youtube.com/watch?v=OvIf1r9Qf2A

Cerebral arteries

http://www.youtube.com/watch?v=ofiq1_I–4M

Inner ear

 

Anesthesia

Drug overview

http://books.google.com/books?id=YWF59Uv4B_4C&pg=PT76&lpg=PT76&dq=intraoperative+neuromonitoring+barbiturates&source=bl&ots=aj92UQDXlk&sig=9C6bYKFU4_q8SXuQuBZPuwZPSN8&hl=en&sa=X&ei=99SHUee7FofM9gSI0ICQDw&ved=0CEsQ6AEwAw

http://anesthesiologyinfo.com/articles/01072002.php

iii. http://files.sld.cu/anestesiologia/files/2011/12/neuro-monitoring.pdf

Anesthesia on evoked potentials overview

http://jvsmedicscorner.com/Anaesth-Management_files/Anaesthesia%20and%20Evoked%20potential%20review.pdf

Anesthesia on MEP

http://neuromonitoring.files.wordpress.com/2011/09/anesthesiamep_sloan.pdf

http://www.spectrummedicalgroup.com/ps/library/libdocs/evokedpotentialsA.pdf

MEP loss with precedex

http://www.ncbi.nlm.nih.gov/pubmed/20460997

Anesthesia on EEG

http://files.sld.cu/anestesiologia/files/2011/12/neuro-monitoring.pdf

Nitrous on MEP

http://www.anesthesia-analgesia.org/content/82/4/744.full.pdf

Propofol on MEP

http://bja.oxfordjournals.org/content/91/4/493.full

Anesthesia on SSEP

http://jvsmedicscorner.com/Anaesth-Management_files/Anaesthesia%20and%20Evoked%20potential%20review.pdf

Remi- and Fent on SSEP

http://www.anesthesia-analgesia.org/content/92/6/1510.full.pdf+html

Anesthesia on DBS

http://anesthesia.ucsf.edu/neuroanesthesia/residents/respdf/Anesthesia%20and%20DBS.pdf

Barbiturates

 

General neuromonitoring and guidelines

http://www.surgicalneurologyint.com/article.asp?issn=2152-7806;year=2012;volume=3;issue=4;spage=174;epage=187;aulast=Stecker

http://neuromonitoring.files.wordpress.com/2011/02/intraopmedscape.pdf

http://c.ymcdn.com/sites/www.asnm.org/resource/resmgr/position_statements/emg.pdf

http://c.ymcdn.com/sites/www.asnm.org/resource/resmgr/position_statements/aep.pdf

http://c.ymcdn.com/sites/www.asnm.org/resource/resmgr/position_statements/sep.pdf

http://c.ymcdn.com/sites/www.asnm.org/resource/resmgr/position_statements/eeg.pdf

http://www.acns.org/practice/guidelines

http://ether.stanford.edu/library/neuroanesthesia/Journal%20Articles/NeuroMonitoring.pdf

 

10-20 System

http://www.diytdcs.com/tag/1020-positioning/

 

SSEP

SSEP overview

http://img529.imageshack.us/img529/8746/raccomandazionisep.pdf

SSEP can predict loss of motor function in the cord

http://www.ncbi.nlm.nih.gov/pubmed/8217175

http://www.ncbi.nlm.nih.gov/pubmed/18829232

Maybe not as well in the cortex – http://journals.lww.com/neurosurgery/Abstract/1992/07000/Pure_Motor_Hemiparesis_with_Stable_Somatosensory.24.aspx

False negative SSEP

http://books.google.com/books?id=6zJoAYx0j5QC&pg=PA167&lpg=PA167&dq=false+negatives+with+SSEPs+nuwer+1995+0.063%25&source=bl&ots=SwURUdWdqm&sig=Fwpc7Y_l3KnXeKgL2enqScqhdhY&hl=en&sa=X&ei=5LeHUaboKIHA8AS6mYG4BQ&ved=0CD4

Q6AEwAg#v=onepage&q=false%20negatives%20with%20SSEPs%20nuwer%201995%200.063%25&f=false

 

MEP

MEP overview

http://www.acns.org/pdf/guidelines/Guideline-15.pdf

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=4&ved=0CEkQFjAD&url=http%3A%2F%2Fwww.springer.com%2Fcda%2Fcontent%2Fdocument%2Fcda_downloaddocument%2F9781461403074-c1.pdf%3FSGWID%3D0-0-45-1267445-p174133680&ei=FrXBUYyTFIf28gSptIG4Cg&usg=AFQjCNGswFjMJKVkf5c5NgrjSRV8IB_ZBg&sig2=xkJmihGdL7nAlPw9PSZALQ&bvm=bv.47883778,d.eWU

iii. http://neuromonitoring.files.wordpress.com/2011/02/intraopmedscape.pdf

MEP collateral circulation

http://books.google.com/books?id=J60w57EylNcC&pg=PA170&lpg=PA170&dq=collateral+circulation+motor+evoked+potentials&source=bl&ots=qYjHc9RN5k&sig=nD0g8waLf1-vVvadivHuy81JoPk&hl=en&sa=X&ei=ja-UfjsAZPI9QS8pIGgCA&ved=0CDUQ6AEwAA#v=onepage&q=collateral%20circulation%20motor%20evoked%20potentials&f=false

http://www.sciencedirect.com/science/article/pii/S0741521499703496

MEP loss

http://neuroanesthesia.ucsf.edu/residents/respdf/MacDonaldMEPreview.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072898/

MEP with Anes

http://www.spectrummedicalgroup.com/ps/library/libdocs/evokedpotentialsB.pdf

 

EMG

http://cdn.intechopen.com/pdfs/25866/InTech-Emg_and_evoked_potentials_in_the_operating_room_during_spinal_surgery.pdf

http://unpa.pro/Resources/Documents/Downloads/United%20Neurodiagnostic%20Professionals%20of%20America%20-%20EMG%20and%20Evoked%20Potentials%20in%20the%20Operating%20Room%20During%20Spinal%20Surgery.pdf

Diagnostic EMG potentials https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CC0QFjAA&url=http%3A%2F%2Fpmr.stanford.edu%2Fresources%2FEMGsummary.doc&ei=_ycOUpKsDKWe2gW22YCoAw&usg=AFQjCNEmEXSeo72-fcjfSOfboifTF2fGCA&sig2=GNbdZX5_3pDbrNab10vlgg

 

EEG

Intro

 

BAER

High frequency hearing loss

http://www.ncbi.nlm.nih.gov/pubmed/2242186

http://www.ncbi.nlm.nih.gov/pubmed/4057976

Interpeak latency for BAER

What is an ABR?

Interpeak interval of BAER

http://books.google.com/books?id=yFo8gzZdUwMC&pg=PA28&lpg=PA28&dq=interpeak+interval+changes+sensitive+in+retrocochlear+lesions&source=bl&ots=asj2LxT9Np&sig=3GiCkZUX_44z7D5hat5pMX9JsQQ&hl=en&sa=X&ei=Eb-HUZ3oLoz68QSM5oCICg&ved=0CDAQ6AEwAA#v=onepage&q=interpeak%20interval%20changes%20sensitive%20in%20retrocochlear%20lesions&f=false

 

VEP

http://www.gcu.ac.uk/media/gcalwebv2/theuniversity/academicschools/sls/psytimetables/SLS%20-%20VEP_Standard_2010.pdf

 

Phase reversal

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737735/pdf/v072p00221.pdf

 

H-reflex

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080401/

http://www.medicine.tcd.ie/physiology/assets/docs/lecturenotes/AW/JS/H_Reflex.pdf

 

F-wave

http://webcache.googleusercontent.com/search?q=cache:P5Ul26OM_1kJ:downloads.hindawi.com/journals/tswj/2007/690647.pdf+&cd=1&hl=en&ct=clnk&gl=us

https://www.aaet.info/files/documents/F-waves.pdf

 

D wave

http://books.google.com/books?id=Gxz22SdPwa4C&pg=PA131&lpg=PA131&dq=spinal+D-wave+amplitude&source=bl&ots=am17KgN3Rv&sig=jFionZL7t4UKHAe-uRvDL1-3qt4&hl=en&sa=X&ei=QriHUbaHDIzW9ATpsID4Bg&ved=0CE0Q6AEwAw#v=onepage&q=spinal%20D-wave%20amplitude&f=false

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072896/

http://www.technion.ac.il/eplab/clin302/week14/Spinal%20SEPmonitoring.pdf

http://www.technion.ac.il/eplab/clin302/week14/Spinal%20SEPmonitoring.pdf

http://www.spineneurosurgery.com/about_us/n_perin/curriculum_vitae/images/SpinalCord_NeuroPhysiology.pdf

 

Cerebral oximetry

http://www.anesthesiologynews.com/download/CerebralOximetry_AN0412_WM.pdf

 

TCD

http://www.researchgate.net/publication/6203789_Transcranial_Doppler_and_anesthetics/file/9fcfd50aebc2c3f158.pdf

http://radiographics.rsna.org/content/15/1/179.full.pdf

 

Surgeries

Scoliosis

iii. http://www.youtube.com/watch?v=1kvScXxV8xA

CEA

ACDF

Posterior cervical fusion

TLIF

XLIF

MVD

iii. http://www.mayfieldclinic.com/PE-MVD.htm

 

Thyroidectomy

Parathyroidectomy

Craniectomy

iii. http://www.youtube.com/watch?v=98yXvWC5U9c

Deep brain stim

T – AAA

AVM

 

Disorders

Wallenberg’s syndrome AKA Lat medullary syndrome

Broca’s aphasia

Easy way to remember brainstem disorders

http://lessons4medicos.blogspot.com/2009/07/brainstem-rules-of-4.html

Charcot-Marie-Tooth

http://www.youtube.com/watch?v=BFvSmdkDxBM

DM

Spinal cord compression

http://www.youtube.com/watch?v=5mOFY1_gM1w

Guillain-Barre

http://www.youtube.com/watch?v=FKFpmxUpsJw

MS

http://www.youtube.com/watch?v=YIg_5umVYiQ

Anterior spinal infarct

http://www.youtube.com/watch?v=W0w3nsVnMDM

Horner’s

Syringomyelia

http://www.youtube.com/watch?v=Y2QahQmHMas

Shingle’s

Muscular dystrophy

Subacute combined degeneration

http://www.youtube.com/watch?v=AnOrzqLNlQg

Myasthenia gravis

http://www.youtube.com/watch?v=B5YmSJLKQ0o

Compartment Syndrome

Spinal instability

Dementia

http://www.youtube.com/watch?v=J29PY3zZXcE

Cervical injury

iii. http://www.youtube.com/watch?v=XyLWQ0ccL8c

Hyperkyphosis (Scheuermann’s Kyphosis)

http://www.srs.org/professionals/conditions_and_treatment/kyphosis_in_the_adolescent_and_young_adult/Scheuermanns_kyphosis_disease.htm

Scoliosis

http://www.srs.org/patient_and_family/scoliosis/

Ankylosing spondylitis

http://www.webmd.com/back-pain/guide/ankylosing-spondylitis

Spondylolisthesis

Spondylolysis

http://www.youtube.com/watch?v=xS3bED3tB6M

Spina bifida

http://www.youtube.com/watch?v=ouMi5z1vwbE

Transverse myelitis

http://newzealand.myelitis.org/New%20Zealand%20TM%20Support%20Group.htm

Anterior cord syndrome

Posterior cord syndrome

http://accessphysiotherapy.mhmedical.com/data/Multimedia/grandRounds/somatosensorypathways/media/somatosensorypathways_print.html along with a lot of other nervous system lesions

Brown Séquard syndrome

http://www.youtube.com/watch?v=fBVAHFNzy6g

Friedreich ataxia

http://www.curefa.org/whatis.html

Arnold Chiari malformation

ALS

http://www.youtube.com/watch?v=H-tAtHQyhug

Parkinson’s

http://www.youtube.com/watch?v=rarcd1CVly0

Hyperkinesia

http://en.wikipedia.org/wiki/Hyperkinesia

Essential tremor

http://www.youtube.com/watch?v=KiMsKsd_MYQ

Tic Douloureux

Restless leg syndrome

http://www.youtube.com/watch?v=AwzjEggsTBE

Huntington’s

http://www.youtube.com/watch?v=Ia7l0j1fYC8

Hemiballism

http://en.wikipedia.org/wiki/Hemiballismus

Catatonia

http://en.wikipedia.org/wiki/Catatonic

Cerebral palsy

Epilepsy

http://www.youtube.com/watch?v=PmiHnQ_IkS8

Vertigo

http://www.youtube.com/watch?v=oBMq5C4KJrQ

Pseudo Tumor Cerebri

http://www.youtube.com/watch?v=IgDMpb5WCyk

Myelopathy in cervical spine

Cervical HNP

Spinal cord injury

Lumbar stenosis

Central cord syndrome

Sacral sparing

Brachial plexus

iii. http://www.youtube.com/watch?v=XAwTj9ke4J8

Pudendal palsy

aaa. Foot drop

bbb. Wrist drop

ccc. Wing of scapula

ddd. Nerve injuries

 

Examinations

Spinal cord exam

iii. http://www.youtube.com/watch?v=gXucXj65ZIY

Sensory exam

Hoffmann’s Sign Test

Babinski Sign Test

Clonus

Joe Hartman DC, DACNB, DABNM

Joe Hartman DC, DACNB, DABNM

Vice President Of Clinical Services - Sentient Medical

Joe came into the neuromonitoring field as a board-certified chiropractic neurologist with an interest in neurodiagnostics. After earning a diplomate from the American Board of Neurophysiologic Monitoring, he started IntraoperativeNeuromonitoring.com as a resource for other surgical neurophysiologist looking to learn and discuss all things neuromonitoring. Once he started work at Sentient Medical in 2016, the website was relaunched and expanded to include webinars, polls, practice test and a forum. He spends more time tinkering on this website in his spare time than he cares to admit.

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