Foreign intravascular object embolization (FIOE) is an important, yet underreported occurrence that has been described in a variety of settings, from penetrating trauma to intravascular procedures. In this chapter, the authors will review the most common types of FIOEs, including bullet or “projectile” embolism (BPE), followed by intravascular catheter or wire embolization (ICWE), and conclude with intravascular noncatheter object (e.g., coil, gelatin, stent, and venous filter) migration (INCOM). In addition to detailed topic-based summaries, tables highlighting selected references and case scenarios are also presented to provide the reader with a resource for future research in this clinical area.
Part of the book: Embolic Diseases
The conceptual differentiation of spinal and neurogenic shock tends to be misunderstood among clinicians. In order to better illustrate the differences in definition, presentation, and development of spinal shock (SS) from neurogenic and other forms of shock, we present herein a clinically relevant summary of typical characteristics of SS. First described in the eighteenth century, the continued investigation into the disease process and the response of neural structures to spinal cord trauma have led to a more complete description and understanding. We will begin in the first part of the chapter describing the etiology of SS, including a working definition, as it pertains to complete spinal cord injuries (SCIs). This is followed by the summary of pathophysiology and clinical presentations associated with each clinical phase of SS. Finally, we explore treatment options and considerations as they relate to incomplete SCI. We hope that by presenting a clear and well-delineated overview of SS, we will allow the clinician to better understand and more accurately predict the evolution of this process. This, in turn, should facilitate the ability to deliver better care for the patient.
Part of the book: Clinical Management of Shock
Starting a new ACGME approved residency program can positively impact patient care, medical education, hospital operations, and the community as whole. This requires a significant amount of commitment, time, and preparation. The initial application and accreditation process should start early and requires a thorough understanding on the ACGME requirements. Building a new residency program involves collaboration among various stakeholders, starting with the teaching hospital, ACGME, and the Center of Medicare and Medicaid services (CMS). It is prudent to also consider the operational and logistical issues such as budget, faculty and administrative staff hire, faculty time for administrative duties, and educational space for faculty and residents. It is vital to recognize how the institution’s strengths and weaknesses match up to these requirements. A robust educational and clinical curriculum in line with ACGME’s core competencies and useful educational collaboration among various programs is critical for effective program. Recruiting and developing the appropriate faculty members is another important aspect for a successful program. The final challenge is recruiting residents that will fit well into the new residency program. Lastly, we discuss the challenges and tips to mitigate the risks of disappointment in the process of starting and creating a flagship residency program.
Part of the book: Contemporary Topics in Graduate Medical Education