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Emergency medicine: The essential update
The Journal
of Emergency Medicine, Vol
0 COMPUTER Plus
PROGRAM
8, pp. 229-232,
REVIEW:
Prlnted in the USA
1990
. Copyrtght
0 1990 Pergamon Press plc
0 EMERGENCY MEDICINE:THE ESSENTIAL UPDATE. Edited by G. R. Schwartz et al. 336 pp.
TOMES
Philadelphia, W. B. Saunders Co., 1989, $49.95. TOMES plus (TM) is a computerized medical information system containing material regarding toxicology, occupational medicine, and environmental hazards. It is produced by MICROMEDEX of Denver, Colorado, who also publish Poisindex and Emergindex. The system is available on 5 l/j” floppy discs and on a compact optical disc. An IBM compatible AT or XT computer with a hard disk and a CD-ROM player are the minimum requisite hardware. The cost of the program is $4,100 for an annual subscription, less if purchased in conjunction with an Emergindex system. The system is updated quarterly. We reviewed volume 1, expiring July 3 1, 1989. The Tomes section includes medical and hazard management standards and Department of Transportation response guidelines. The latter consist of site management recommendations (with respect to potential physical hazards such as fire, explosion, and health risks) and first aid. Tomes is organized much like the more familiar Poisindex, except that it references chemical toxins. A comprehensive range of toxins is included. The material is presented in an organized manner in which the user may select from a menu of subject headings, such as clinical effects, case reports, range of toxicity, kinetics, and treatment. Subject access is rapid, and the system is easy to use. Timeliness of the information and the rapidity with which it can be recalled are major strengths of the system. We found the search function to be a useful feature. This allows the user to find a chemical listing by inserting a phonetic or approximate spelling. The system has great utility. Obviously, however, it is not one that will find continuous use in every emergency department. We recommend it for institutions likely to deal with a high volume of industrial and other toxic exposure.
Emergency Medicine: The Essential Update is an interesting and informative book that was designed to provide a “cutting edge” supplement to existing major reference textbooks. The book is relatively short, consisting of a total of 21 chapters in 7 sections. Authors are primarily practicing emergency physicians and medical subspecialists. There is a suggestion in the introduction that this book might be useful as a reference source in the emergency department. However, I doubt that this would be a practical use for this book, as the vast majority of problems encountered in the emergency department are not covered. Nevertheless, this book contains excellent up-to-date material that is formatted for easy reading. Most of the chapters are written assuming that the reader already has some knowledge of the subject matter. For example, the chapter on CPR does not repeat well-known BCLS and ACLS protocols. Instead the author utilizes short summaries describing recent advances and controversies pertinent to the field of resuscitation. primarily
In this and other from
chapters
the references
are
1987 and 1988.
The book as a whole is oriented towards medical emergencies, with only one chapter devoted solely to trauma care. One-third of the chapters concern infectious diseases as they relate to the emergency department, including good chapters on sexually transmitted diseases, meningitis, and the use of newer antibiotics. A useful and unusual chapter concerning the appropriate use of the hepatitis B vaccination is also included in this section. Chapters on calcium-channel blocking agents, immunizations, emergent conditions of pregnancy, and a detailed discussion of pacemaker use are all good. These are subjects that usually are not adequately covered in conventional textbooks. The chapter dealing with the management of the poisoned patient is particularly good, as it contains up-to-date material in an easy to read
George L. Sternbach, MD Michael D. Laufer, MD
Book Reviews, which keep readers informed of important publications in the emergency medicine field, is coordinated by Edward J. Otten, MD, Associate Professor and Director of Prehospital Care, Department of Emergency Medicine, ZXZXZYZ University of Cincinnati College of Medicine. 0736-4679190 229
$3.00
+ .OO
230
The Journal of Emergency Medicine
format. This chapter first discusses general management and then covers a few specific poisonings such as digitalis, acetaminophen, ibuprofen, and calcium-channel blockers. Problems with the book are mostly minor. The chapter on acute care imaging is good, but too much information was crammed into too little space. The chapter on sexually transmitted diseases ignored altemative antibiotic therapies such as quinolones and trimethoprim-sulfamethoxazole and instead merely presented the standard CDC treatment guidelines for the various diseases. Obvious errors are also few, but at least two are potentially serious. The use of midazolam is appropriately recommended for sedation for lumbar puncture when necessary. However, the suggested dose of 0.15 to 0.35 mgikg IV (10.5 to 24.5 mg for a 70 kg person) is excessive and is likely to pose a significant risk of hypotension and respiratory depression. For conscious sedation an initial dose of 1.0 to 2.5 mg with slow titration to the desired effect would be more appropriate. Also, this same table suggests the use of phenytoin at a dose of 10 mg/kg for seizure control. A more effective dose for status epilepticus would be 15 to 18 mg/kg. In summary, this book is not likely to be of much use as a reference text, but should provide interesting reading for almost any emergency physician. Less emphasis on medical emergencies would have been welcome, but the topics that were included were all well done. However, potential purchasers are likely to be put off by the high price for such a small book. Seth W. Wright, MD Vanderbilt University Nashville, Tennessee 37212
grams and illustrations and a paucity of tables. Overall, most common emergency problems likely to be encountered are covered, however most areas are mentioned briefly in two paragraphs entitled “recognition” and “management.” For a general pediatrician, family practitioner, or emergency physician practicing emergency pediatrics, more emphasis on management needs be included. There are also omissions. For instance, there is no discussion on pelvic inflammatory disease or gynecologic problems; there is an excellent discussion of intraperitoneal rehydration, whereas intraosseous infusion is not even mentioned. This book has an excellent overview of pathology encountered in developing countries, but application of these topics to the United States is limited. Also, there are many recommendations considered obsolete or controversial in the United States. Some examples: the recommendation of calcium for cardiac arrest does not conform with the accepted Pediatric Advanced Life Support guidelines; the recommendation of doxapram for respiratory depression; the use of nikethamide for respiratory arrest; no mention of CT scanning in the evaluation of blunt abdominal trauma; statements suggesting that a carboxyhemoglobin concentration “less than 20% is unimportant”; recommendation of methionine as first line treatment of acetaminophen poisoning; no mention of Foley catheter removal of esophageal foreign bodies. In summary, this is a very extensive but superficial review of emergencies. The book may find good use by physicians practicing in tropical areas or developing countries. This book’s contribution is further limited in the U.S.A. because of the availability of many journals and several more relevant emergency texts. Javier Gonzalez de1 Rey , MD Fellow
0 PAEDIATRIC EMERGENCIES, 2nd ed. Edited by J. A. Black. 940 pp. London: Butterworths, 1987, $80.00. This is a sturdy, beautifully bound, attractive textbook mat should withstand frequent handling. It has 61 contributors, mostly from England and other parts of the British Commonwealth, and is edited by J. A. Black, “Late Consultant Paediatrician” at the Children’s Hospital in Sheffield, England. The book has 16 “Parts” ranging from Trauma to Tropical disorders, a Practical Procedures section that describes the usual invasive procedures as well as some practical tips such as preparation of oral rehydration solutions, and an Appendix that has subjects like anthropometric measurements and a drug formulary . One of the book’s shortcomings is the lack of dia-
Suman Wason, MD Attending Staff Emergency Department Children’s Hospital Medical Center Cincinnati, Ohio 45229
0 EMERGENCY MANAGEMENTOFMETABOLIC AND ENDOCRINE DISORDERS. Edited by Steven R. Silverstein, and Associate Editor David Frommer. 235 pp. Rockville, MD, Aspen Publishers, Inc. 1988, $38.00 Discussions of metabolic and endocrine disorders are often met with groans, rolled eyes, and the dread of overly dry material. I was certainly pleasantly surprised
of Emergency Medicine, Vol
0 COMPUTER Plus
PROGRAM
8, pp. 229-232,
REVIEW:
Prlnted in the USA
1990
. Copyrtght
0 1990 Pergamon Press plc
0 EMERGENCY MEDICINE:THE ESSENTIAL UPDATE. Edited by G. R. Schwartz et al. 336 pp.
TOMES
Philadelphia, W. B. Saunders Co., 1989, $49.95. TOMES plus (TM) is a computerized medical information system containing material regarding toxicology, occupational medicine, and environmental hazards. It is produced by MICROMEDEX of Denver, Colorado, who also publish Poisindex and Emergindex. The system is available on 5 l/j” floppy discs and on a compact optical disc. An IBM compatible AT or XT computer with a hard disk and a CD-ROM player are the minimum requisite hardware. The cost of the program is $4,100 for an annual subscription, less if purchased in conjunction with an Emergindex system. The system is updated quarterly. We reviewed volume 1, expiring July 3 1, 1989. The Tomes section includes medical and hazard management standards and Department of Transportation response guidelines. The latter consist of site management recommendations (with respect to potential physical hazards such as fire, explosion, and health risks) and first aid. Tomes is organized much like the more familiar Poisindex, except that it references chemical toxins. A comprehensive range of toxins is included. The material is presented in an organized manner in which the user may select from a menu of subject headings, such as clinical effects, case reports, range of toxicity, kinetics, and treatment. Subject access is rapid, and the system is easy to use. Timeliness of the information and the rapidity with which it can be recalled are major strengths of the system. We found the search function to be a useful feature. This allows the user to find a chemical listing by inserting a phonetic or approximate spelling. The system has great utility. Obviously, however, it is not one that will find continuous use in every emergency department. We recommend it for institutions likely to deal with a high volume of industrial and other toxic exposure.
Emergency Medicine: The Essential Update is an interesting and informative book that was designed to provide a “cutting edge” supplement to existing major reference textbooks. The book is relatively short, consisting of a total of 21 chapters in 7 sections. Authors are primarily practicing emergency physicians and medical subspecialists. There is a suggestion in the introduction that this book might be useful as a reference source in the emergency department. However, I doubt that this would be a practical use for this book, as the vast majority of problems encountered in the emergency department are not covered. Nevertheless, this book contains excellent up-to-date material that is formatted for easy reading. Most of the chapters are written assuming that the reader already has some knowledge of the subject matter. For example, the chapter on CPR does not repeat well-known BCLS and ACLS protocols. Instead the author utilizes short summaries describing recent advances and controversies pertinent to the field of resuscitation. primarily
In this and other from
chapters
the references
are
1987 and 1988.
The book as a whole is oriented towards medical emergencies, with only one chapter devoted solely to trauma care. One-third of the chapters concern infectious diseases as they relate to the emergency department, including good chapters on sexually transmitted diseases, meningitis, and the use of newer antibiotics. A useful and unusual chapter concerning the appropriate use of the hepatitis B vaccination is also included in this section. Chapters on calcium-channel blocking agents, immunizations, emergent conditions of pregnancy, and a detailed discussion of pacemaker use are all good. These are subjects that usually are not adequately covered in conventional textbooks. The chapter dealing with the management of the poisoned patient is particularly good, as it contains up-to-date material in an easy to read
George L. Sternbach, MD Michael D. Laufer, MD
Book Reviews, which keep readers informed of important publications in the emergency medicine field, is coordinated by Edward J. Otten, MD, Associate Professor and Director of Prehospital Care, Department of Emergency Medicine, ZXZXZYZ University of Cincinnati College of Medicine. 0736-4679190 229
$3.00
+ .OO
230
The Journal of Emergency Medicine
format. This chapter first discusses general management and then covers a few specific poisonings such as digitalis, acetaminophen, ibuprofen, and calcium-channel blockers. Problems with the book are mostly minor. The chapter on acute care imaging is good, but too much information was crammed into too little space. The chapter on sexually transmitted diseases ignored altemative antibiotic therapies such as quinolones and trimethoprim-sulfamethoxazole and instead merely presented the standard CDC treatment guidelines for the various diseases. Obvious errors are also few, but at least two are potentially serious. The use of midazolam is appropriately recommended for sedation for lumbar puncture when necessary. However, the suggested dose of 0.15 to 0.35 mgikg IV (10.5 to 24.5 mg for a 70 kg person) is excessive and is likely to pose a significant risk of hypotension and respiratory depression. For conscious sedation an initial dose of 1.0 to 2.5 mg with slow titration to the desired effect would be more appropriate. Also, this same table suggests the use of phenytoin at a dose of 10 mg/kg for seizure control. A more effective dose for status epilepticus would be 15 to 18 mg/kg. In summary, this book is not likely to be of much use as a reference text, but should provide interesting reading for almost any emergency physician. Less emphasis on medical emergencies would have been welcome, but the topics that were included were all well done. However, potential purchasers are likely to be put off by the high price for such a small book. Seth W. Wright, MD Vanderbilt University Nashville, Tennessee 37212
grams and illustrations and a paucity of tables. Overall, most common emergency problems likely to be encountered are covered, however most areas are mentioned briefly in two paragraphs entitled “recognition” and “management.” For a general pediatrician, family practitioner, or emergency physician practicing emergency pediatrics, more emphasis on management needs be included. There are also omissions. For instance, there is no discussion on pelvic inflammatory disease or gynecologic problems; there is an excellent discussion of intraperitoneal rehydration, whereas intraosseous infusion is not even mentioned. This book has an excellent overview of pathology encountered in developing countries, but application of these topics to the United States is limited. Also, there are many recommendations considered obsolete or controversial in the United States. Some examples: the recommendation of calcium for cardiac arrest does not conform with the accepted Pediatric Advanced Life Support guidelines; the recommendation of doxapram for respiratory depression; the use of nikethamide for respiratory arrest; no mention of CT scanning in the evaluation of blunt abdominal trauma; statements suggesting that a carboxyhemoglobin concentration “less than 20% is unimportant”; recommendation of methionine as first line treatment of acetaminophen poisoning; no mention of Foley catheter removal of esophageal foreign bodies. In summary, this is a very extensive but superficial review of emergencies. The book may find good use by physicians practicing in tropical areas or developing countries. This book’s contribution is further limited in the U.S.A. because of the availability of many journals and several more relevant emergency texts. Javier Gonzalez de1 Rey , MD Fellow
0 PAEDIATRIC EMERGENCIES, 2nd ed. Edited by J. A. Black. 940 pp. London: Butterworths, 1987, $80.00. This is a sturdy, beautifully bound, attractive textbook mat should withstand frequent handling. It has 61 contributors, mostly from England and other parts of the British Commonwealth, and is edited by J. A. Black, “Late Consultant Paediatrician” at the Children’s Hospital in Sheffield, England. The book has 16 “Parts” ranging from Trauma to Tropical disorders, a Practical Procedures section that describes the usual invasive procedures as well as some practical tips such as preparation of oral rehydration solutions, and an Appendix that has subjects like anthropometric measurements and a drug formulary . One of the book’s shortcomings is the lack of dia-
Suman Wason, MD Attending Staff Emergency Department Children’s Hospital Medical Center Cincinnati, Ohio 45229
0 EMERGENCY MANAGEMENTOFMETABOLIC AND ENDOCRINE DISORDERS. Edited by Steven R. Silverstein, and Associate Editor David Frommer. 235 pp. Rockville, MD, Aspen Publishers, Inc. 1988, $38.00 Discussions of metabolic and endocrine disorders are often met with groans, rolled eyes, and the dread of overly dry material. I was certainly pleasantly surprised