An Introduction to Clinical Emergency Medicine: Guide for Practitioners in the Emergency Department

BOOK REVIEWS An Introduction to Clinical Emergency Medicine: Guide for Practitioners in the Emergency Department Mahadevan SV, Garmel GM, eds. New York: Cambridge University Press; 2005, 798 pp, $75.00. Emergency department patients seldom present with a diagnosis. They present, instead, with a complaint or, as is often the case, multiple complaints. Many emergency medicine texts, though, present the field of emergency medicine in discrete chapters addressing specific conditions, such as pulmonary embolism or pericarditis. In this text, Mahadevan and Garmel attempt to present the knowledge base of emergency medicine in such a way as to complement the manner in which emergency physicians approach the care of emergency department patients. Chapters are primarily divided into specific complaints such as dyspnea and chest pain, rather than diagnoses. Although not without its shortcomings, this approach is a very effective means of teaching emergency medicine and the authors use it well. This text has 4 sections: (1) principles of emergency medicine (airway management, shock, pain management, etc), (2) primary complaints, (3) unique issues in emergency medicine (domestic violence, environmental emergencies, etc.), and (4) appendices. The appendices include descriptions of common emergency department procedures, including bedside sonography for trauma, and discussions of the interpretation of many common emergency department laboratory tests. The largest section of this text, comprising nearly two thirds of its pages, is the second section dealing with primary complaints in emergency medicine. Each chapter in this section reviews the approach to a specific complaint in a standard format that discusses the following topics: scope of the problem, anatomy or pathophysiology, history, physical examination, differential diagnosis, diagnostic testing, treatment principles, special patients, disposition, and pearls, pitfalls, and myths. At the end of each chapter is a reference list. The chapters are generally well written, succinct, and extremely practical. Discussions on pathophysiology are limited to that which is necessary for the clinician to understand a particular condition. The text is replete with useful tables that provide quick synopses of pertinent findings, mnemonics, differential diagnoses, and treatments. Recommended treatment regimens are current and specific, providing indications, contraindications, and dosages. Although there is an inescapable lag between primary clinical research and the incorporation of research results into texts, the authors have done an excellent job at keeping recommendations up to date. One of the most striking characteristics of this text is the quality of the graphics presented. This text is printed on excellent stock, and all tables are printed in color to enhance their readability. There are 195 tables and 320 figures in this text. Where appropriate, diagrams are used. Most figures are clinical 102

images that rival those found in any atlas. Likewise, the radiographic images are excellent. The extremity trauma chapter is particularly well illustrated with 35 radiographs, with complete labeling of both normal and abnormal findings. The focused abdominal sonography for trauma section also has excellent images. This text is clearly one of the most visually impressive texts to come along in years. One shortcoming of this text is a result of its problem-oriented approach to emergency medicine. This text is not well suited for an in-depth review of a single condition. The chapter on abdominal pain, for example, covers all of the major causes of abdominal pain but looks at those conditions as it reviews the history, physical examination, diagnostic tests, and so on, for patients with abdominal pain. There is no single section that reviews conditions such as appendicitis individually. One other aspect that should be noted is that given its length of fewer than 800 pages, this text is not meant to provide a thorough review of all the topics it covers. Other texts will need to fill that niche. Notwithstanding these limitations, An Introduction to Clinical Emergency Medicine is an excellent introduction to clinical emergency medicine for practitioners in this field. The superb graphics of this text make it a pleasure to read. It is an extremely readable, up-to-date text that has something to teach medical students, residents, and attending physicians. SCOTT W. MELANSON, MD Associate Program Director Emergency Medicine Residency St. Luke’s Hospital Bethlehem, Pennsylvania

EDITOR’S NOTE You may wonder why I have selected this book for review because it seems to be aimed at emergency medicine physicians. When reading the book, it becomes apparent that the text would be quite helpful for an attending physician or resident of any discipline who is called to the emergency department to see and treat a patient. The editors’ methodology in discussing various patient complaints proceeds in a logical manner from basic science through history and physical examination and differential diagnosis and then through treatment. The authors also discuss pearls, pitfalls, and myths dealing with a specific complaint. I believe this book will be very helpful for any physician, whether an attending or resident, who is called to the emergency room to see a patient. JOEL C. ROSENFELD, MD, MEd Book Review Editor, Current Surgery Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania

CURRENT SURGERY • © 2006 by the Association of Program Directors in Surgery Published by Elsevier Inc.

doi:10.1016/j.cursur.2005.09.021 0149-7944/06/$30.00