The Challenges Of On Call Neurosurgery

On-call neurosurgery concerns practice related to urgent and emergency neurosurgical care including outside of 'normal' working hours. Being on-call involves many competing responsibilities and is regarded as one of the most demanding aspects of a neurosurgical career. The on-call work pattern has evolved over the past decade due to changes in demographics, technology and working practices, each of which have brought new and emerging challenges. These challenges aside, the on-call provides a unique and rewarding environment to make a meaningful difference to patients and to learn the science and art of neurosurgery. Success in on-call work requires not only good technical knowledge and application but also a wide variety of non-technical skills. These skills will help deal with some of the difficult situations neurosurgeons in training face when on-call to make the experience more manageable and educational.

On-call neurosurgery concerns practice related to urgent and emergency neurosurgical care including outside of 'normal' working hours. Being on-call involves many competing responsibilities and is regarded as one of the most demanding aspects of a neurosurgical career. The on-call work pattern has evolved over the past decade due to changes in demographics, technology and working practices, each of which have brought new and emerging challenges. These challenges aside, the on-call provides a unique and rewarding environment to make a meaningful difference to patients and to learn the science and art of neurosurgery. Success in on-call work requires not only good technical knowledge and application but also a wide variety of non-technical skills. These skills will help deal with some of the difficult situations neurosurgeons in training face when on-call to make the experience more manageable and educational.

Surviving Neurosurgery: Vignettes of Resilience is a practical guide to the inner workings of the lives of neurosurgeons, healthcare partners, and patients. To this end, this text serves as a first-hand documentary of the unique challenges faced as one progresses through their career. It is a snapshot in time capturing the experiences of both patients and providers. The text is divided into seven parts that run the gamut of a neurosurgeon’s career symbolic of the seven years of neurosurgical training. These narratives include, but are not limited to, residency challenges, surgical nuances, research and funding, embracing humanity, patient experiences, and overcoming hurdles along the journey. Chapters share the wisdom and experiences of over 100 authors consisting of patients, trainees, advanced practice providers, and attending neurosurgeons.

Emergency Neurosurgery is a constantly evolving specialty, resulting in ever increasing challenges posed on the higher specialty trainee. The focus of this Element is to guide the reader on the application of robust and easily applicable management strategies whilst dealing with the most challenging aspects of their professional workload. The authors have categorised the various subgroups of emergency neurosurgical workload, devised a comprehensive management algorithm, included case scenaria related to the most challenging emergency situations and highlighted easily overlooked clinical information. In summary, this Element will provide robust and easily applicable management strategies whilst dealing with the most challenging aspects of the emergency neurosurgical workload.

Seizures are a presenting feature of many neurosurgical disorders, and can arise as a result of neurosurgical treatment or its complications. Recognition and effective management of seizures can be life-saving, and will minimise long term seizure induced morbidity. In this Element the authors describe seizure diagnosis, emergency and ongoing management, and considerations in neurosurgical conditions.

Emergency neurosurgery encompasses serious and high-risk cranial and spinal conditions across all ages. The authors provide an overview of the changes occurring within emergency surgery to meet the challenges provided from unscheduled care. Considering the wider landscape of emergency surgery provides a context for the changes occurring within emergency neurosurgery. The delivery of emergency neurosurgery within the UK, the Republic of Ireland, the Netherlands, and the United States of America (USA) is then described to provide an overview of different models of care.

This book reviews the common clinical scenarios that might trigger emergent consultation for neurosurgical intervention, with attention to key components of the clinical interview and exam, optimal diagnostic evaluation, indications for and the goals of operative intervention, perioperative considerations, and strategies for complication mitigation. This is not a surgical atlas, but rather, a road map for the journey to the operating room door. The intent is to establish a systematic, evidence-based action plan for the patient presenting in neurologic crisis. Each chapter opens with a relevant case vignette and then unfolds through uniform sections to tell the story of how one might approach the disease entity in question, from initial request for consultation to definitive management, highlighting steps of the decision-making process: • What are the highest yield questions to ask during a focused interview? • What are the most pertinent objective exam findings? • What is the proper differential diagnosis? • What is the most appropriate and efficient plan for diagnostic evaluation – with respect to laboratories and imaging? • Does this patient have an indication for emergent or urgent neurosurgical intervention? • If so, what is the goal of that intervention? • What are the most common potential complications of the proposed procedure, and what steps might be taken to mitigate those risks? Each chapter is punctuated by 3-5 teaching pearls, summarizing these key elements. The overall goal is to create a framework for assessment that might be applied in the emergency department, the trauma bay, or the ICU when a neurologic emergency arises. The scope of the text encompasses not only cranial and spinal trauma, but also entities such as shunt failure, stroke, aneurysmal subarachnoid hemorrhage, pituitary apoplexy, cauda equina syndrome, and central nervous system infection that might require time-sensitive intervention. An additional section addresses issues requiring emergent neurosurgical response in the ICU setting, including sudden neurologic worsening, status epilepticus, and abnormal clotting/ coagulopathy. The text will not only serve as a valuable resource for those preparing to take the oral board exam, but will also provide a targeted refresher for clinicians taking general neurosurgical call in the community as well as an educational reference for mid-level practitioners and those in training who are serving as first responders on behalf of a neurosurgical service.