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Clinical procedures in emergency medicine
The Journai of Emergency Medcme, Vol 3. pp 427-429,
1985
PrInted r the USA
Copyright E 1985 Pergamon Press Ltd
??
few photomicrographs in the microbiological procedures section are also black and white reproductions. Techniques relating to the “ABC’s” are emphasized as one would expect. The opening chapter on emergency airway management procedures exemplifies the complete treatment chapter topics receive. A discussion on chin-lift and jaw thrust maneuvers proceeds a discussion of airway suctioning methods. Oropharyngeal, nasopharyngeal, and esophageal airways and techniques of insertion are described. An overview of tracheal intubations describes special considerations of cervical spine injury, hypertonus, and time constraints. Direct laryngoscopy is discussed with orotracheal intubation techniques. A table of tracheal tube sizes for patients of different ages is included. Pharmacological adjuncts are detailed, including topical and systemic lidocaine, succinylcholine, and pancuronium bromide. Nasotracheal intubation methods described include blind placement, placement under direct vision, and fiberoptic-assisted insertion. Retrograde orotracheal intubation is discussed. Transcricothyroid catheter ventilation is described. Algorithms summarize the management decisions. Emergency cricothyroidotomy is discussed in a separate chapter. Chapters on inhalation techniques, mechanical ventilation, transtracheal aspiration, thoracentesis, tube thoracostomy, and tracheotomy care complete the respiratory procedures section. More recent developments in emergency care are discussed including transcutaneous cardiac pacing, endotracheal drug administration, and interosseous fluid adminis-
11 CLINICAL PROCEDURES IN EMERGENCY MEDICINE. Edited by James R. Roberts and Jerris FL Hedges. 1,105 pp. Philadelphia, W. B. Saunders Company, 1985, $85.00. This ambitious work has the stated purpose of being more than a “cookbook” of procedures by discussing clinical rationale, alternatives, and complications of a variety of techniques. The size and cost of this book place it in a different category than other procedure books. There are 83 chapter contributors; information gleaned from the introduction show slightly more than half to be emergency medicine physicians. Anesthesiologists, otolaryngologists, urologists, dentists, and surgeons are among the other physician contributors, with smaller sections written by a paramedic, a nurse, a pharmacist, and microbiologist. The procedures are grouped mainly into subspecialty-oriented sections; “respiratory procedures” are followed by “cardiology” through “dentistry,” and “microbiology.” A special procedures section includes a discussion on the amytal interview, rewarming techniques, and compartmental syndromes. An appendix of commonly used infusion rates for various drugs completes the book. An introduction and historical background relating to the procedure starts most sections. Discussions of indications, contraindications, needed equipment, complications, and the technique of the procedure follow. The reference listings are extensive. Illustrations are abundant and well executed. Many sections feature black and white photographs of good quality. The -___ -~
Book Reviews, coordinated by Edward J. Otten, MD, University of Cincinnati College of Medicine, keeps readers informed of important publications in the emergency med-
=
icine field.
0736-4679/85 427
$3.00
+ .OO
428
The Journal of Emergency
tration. The varied nature of emergency medicine is reflected in chapters on emergency childbirth, examination of the rape victim, and emergency dental procedures. More minor but still important techniques of ring and fishhook removal are described. Prehospital splinting is illustrated. Some chapters describe methods controversial in their inclusion in an emergency medicine procedures book. Many might consider the techniques of trigger point therapy, skin grafting, and amytal interview not in the realm of the emergency physician. This book is useful in many ways. I have found it very helpful in reviewing procedures prior to performance both in emergency and intensive care units. The chapters are so complete that they would also serve as excellent reference sources for teaching. The scope is very wide; several times I have thought of a topic that surely would be omitted from the book only to locate the discussion through the index. When looking for clinical information on any procedure from arthrocentesis to zipper removal, start with this definitive work.
J. Stephen Huff, MD Department of Emergency Medicine University of Cincinnati Cincinnati. OH
Cl EPILEPSY: 100 ELEMENTARY PRINCIPLES. Major Problems in Neurology, Volume 12. By Roger J. Porter. 162 pp. Philadelphia, W. B. Saunders Company, 1984, $21.95. The other monographs in the Major Problems in Neurology Series have been of interest primarily to neurologists. This most recent volume is targeted at the wider audience of primary care physicians who commonly deal with epilepsy. Dr. Porter is chief of the Epilepsy Branch of the National Institute of Neurological and Communicative Disorders and Stroke of the National In-
Medione
stitutes of Health. Nevertheless, the book presents not dry “ivory tower” axioms that one might expect from a lofty academician, but rather more “common sense” discussions that have immediate application to patient care. The structure is deceptively simple. After opening statements, well-organized and referenced discussions follow evolving from often self-evident appearing principles to complex but clear summaries of the current neurologic literature. This organization into free-standing items allows the reader with small blocks of time to easily assimilate the material. The first chapter describes an approach to the seizure patient. The following six chapters address different diagnostic considerations of epilepsy and seizures. The current classification of seizures and the importance of accurate seizure diagnosis are clearly discussed. Psychogenic seizures and their differentiation from epileptic seizures receive attention. The relationship of violence to epilepsy is reviewed. Eight chapters-roughly one-half the text-are devoted to therapy. The discussions are delightful in their clear presentation of often painful to read pharmacologic principles. Important clinical points abound. The final two chapters deal with psychosocial aspects of epilepsy and future directions of research. The illustrations complement the text and add to readability. More than 200 articles are referenced. An index is included. The only criticism is minor; the brief word on febrile seizures should have included a more complete discussion of diagnostic steps. Dr. Porter has written a marvelous book that has something to offer every physician who deals with epilepsy regardless of his level of training. Only a handful of the 100 principles could be construed as irrelevant to emergency medicine. He has succeeded in communicating the most clinically useful thoughts of the academic specialist to the clinician. Read the book-something in it will change the way you deal with the seizure patient. Communication with neuro-
1985
PrInted r the USA
Copyright E 1985 Pergamon Press Ltd
??
few photomicrographs in the microbiological procedures section are also black and white reproductions. Techniques relating to the “ABC’s” are emphasized as one would expect. The opening chapter on emergency airway management procedures exemplifies the complete treatment chapter topics receive. A discussion on chin-lift and jaw thrust maneuvers proceeds a discussion of airway suctioning methods. Oropharyngeal, nasopharyngeal, and esophageal airways and techniques of insertion are described. An overview of tracheal intubations describes special considerations of cervical spine injury, hypertonus, and time constraints. Direct laryngoscopy is discussed with orotracheal intubation techniques. A table of tracheal tube sizes for patients of different ages is included. Pharmacological adjuncts are detailed, including topical and systemic lidocaine, succinylcholine, and pancuronium bromide. Nasotracheal intubation methods described include blind placement, placement under direct vision, and fiberoptic-assisted insertion. Retrograde orotracheal intubation is discussed. Transcricothyroid catheter ventilation is described. Algorithms summarize the management decisions. Emergency cricothyroidotomy is discussed in a separate chapter. Chapters on inhalation techniques, mechanical ventilation, transtracheal aspiration, thoracentesis, tube thoracostomy, and tracheotomy care complete the respiratory procedures section. More recent developments in emergency care are discussed including transcutaneous cardiac pacing, endotracheal drug administration, and interosseous fluid adminis-
11 CLINICAL PROCEDURES IN EMERGENCY MEDICINE. Edited by James R. Roberts and Jerris FL Hedges. 1,105 pp. Philadelphia, W. B. Saunders Company, 1985, $85.00. This ambitious work has the stated purpose of being more than a “cookbook” of procedures by discussing clinical rationale, alternatives, and complications of a variety of techniques. The size and cost of this book place it in a different category than other procedure books. There are 83 chapter contributors; information gleaned from the introduction show slightly more than half to be emergency medicine physicians. Anesthesiologists, otolaryngologists, urologists, dentists, and surgeons are among the other physician contributors, with smaller sections written by a paramedic, a nurse, a pharmacist, and microbiologist. The procedures are grouped mainly into subspecialty-oriented sections; “respiratory procedures” are followed by “cardiology” through “dentistry,” and “microbiology.” A special procedures section includes a discussion on the amytal interview, rewarming techniques, and compartmental syndromes. An appendix of commonly used infusion rates for various drugs completes the book. An introduction and historical background relating to the procedure starts most sections. Discussions of indications, contraindications, needed equipment, complications, and the technique of the procedure follow. The reference listings are extensive. Illustrations are abundant and well executed. Many sections feature black and white photographs of good quality. The -___ -~
Book Reviews, coordinated by Edward J. Otten, MD, University of Cincinnati College of Medicine, keeps readers informed of important publications in the emergency med-
=
icine field.
0736-4679/85 427
$3.00
+ .OO
428
The Journal of Emergency
tration. The varied nature of emergency medicine is reflected in chapters on emergency childbirth, examination of the rape victim, and emergency dental procedures. More minor but still important techniques of ring and fishhook removal are described. Prehospital splinting is illustrated. Some chapters describe methods controversial in their inclusion in an emergency medicine procedures book. Many might consider the techniques of trigger point therapy, skin grafting, and amytal interview not in the realm of the emergency physician. This book is useful in many ways. I have found it very helpful in reviewing procedures prior to performance both in emergency and intensive care units. The chapters are so complete that they would also serve as excellent reference sources for teaching. The scope is very wide; several times I have thought of a topic that surely would be omitted from the book only to locate the discussion through the index. When looking for clinical information on any procedure from arthrocentesis to zipper removal, start with this definitive work.
J. Stephen Huff, MD Department of Emergency Medicine University of Cincinnati Cincinnati. OH
Cl EPILEPSY: 100 ELEMENTARY PRINCIPLES. Major Problems in Neurology, Volume 12. By Roger J. Porter. 162 pp. Philadelphia, W. B. Saunders Company, 1984, $21.95. The other monographs in the Major Problems in Neurology Series have been of interest primarily to neurologists. This most recent volume is targeted at the wider audience of primary care physicians who commonly deal with epilepsy. Dr. Porter is chief of the Epilepsy Branch of the National Institute of Neurological and Communicative Disorders and Stroke of the National In-
Medione
stitutes of Health. Nevertheless, the book presents not dry “ivory tower” axioms that one might expect from a lofty academician, but rather more “common sense” discussions that have immediate application to patient care. The structure is deceptively simple. After opening statements, well-organized and referenced discussions follow evolving from often self-evident appearing principles to complex but clear summaries of the current neurologic literature. This organization into free-standing items allows the reader with small blocks of time to easily assimilate the material. The first chapter describes an approach to the seizure patient. The following six chapters address different diagnostic considerations of epilepsy and seizures. The current classification of seizures and the importance of accurate seizure diagnosis are clearly discussed. Psychogenic seizures and their differentiation from epileptic seizures receive attention. The relationship of violence to epilepsy is reviewed. Eight chapters-roughly one-half the text-are devoted to therapy. The discussions are delightful in their clear presentation of often painful to read pharmacologic principles. Important clinical points abound. The final two chapters deal with psychosocial aspects of epilepsy and future directions of research. The illustrations complement the text and add to readability. More than 200 articles are referenced. An index is included. The only criticism is minor; the brief word on febrile seizures should have included a more complete discussion of diagnostic steps. Dr. Porter has written a marvelous book that has something to offer every physician who deals with epilepsy regardless of his level of training. Only a handful of the 100 principles could be construed as irrelevant to emergency medicine. He has succeeded in communicating the most clinically useful thoughts of the academic specialist to the clinician. Read the book-something in it will change the way you deal with the seizure patient. Communication with neuro-