- Email: [email protected]
Handbook of Intensive Care. Edited by Bain W. H. and Taylor K. M. Published by Wright PSG. Pp. 564; indexed; illustrated. Price£35.00.
1062
BRITISH JOURNAL OF ANAESTHESIA
Altogether this volume consists of well-balanced and concise reviews covering topics of current interest to ranriirlan-n for both pharmacology and clinical waminatinna In addition,ttinrrmost of the drugs are available in the U.K., it may be said that all anaesthetists wanting to keep abreast of developments would find it useful. Its price may discourage individuals from buying it but it is attractively produced in terms of binding, layout and size, making it acceptable as a book to take home and read in the evening.
R.S.J. Clark*
lilhres and grams for milligrams—this last refers to the daily dosage of gentamicin (by, the time the nurse has obtained 3500 vials from the pharmacy, hopefully someone will have twigged). All this is irritating and does a considerable dis-service to the authors. It should be appreciated that most of the contributors are from the Balanced Salt Solution school and most views expressed are polarized accordingly. The subject matter is introduced by Professor M. T. Jenkins, who gives a fascinating insight into pioneering medical history. A discussion on sodium balance is followed by a lengthy chapter on Balanced Salt Solution in Massive Trauma. Unfortunately, of 42referencesgiven only seven are less than 5 and three less than 3 years old. This criticism can be levelled at most of the text, which reaches its nadir in the chapter on Balanced Salt Solutions in Renal Prophylaxis where, apart from one reference described as "In Press", no other is more recent than 1973. Other chapters on this theme include fluid therapy in paediatrics and two comprehensive and informative accounts of the evidence for crystalloids in Post Traumatic Respiratory Failure and the role of Colloid Osmotic Pressure in Shock and Resuscitation. The last two chapters concern blood transfusion and its associated physical problems. Doctors Steinbronn and Huestis present a concise and lucid account of the rationale for component therapy—a view with which most British haematologists would concur. One's overall impression of this book is that it was assembled hastily and, while most of the contributors present cogent arguments for their views, to be of value to the trainee more than the "salt solution" needs to be "balanced". W.E.I. Fmlay
Handbook of Intensive Care. Edited by W. H. Bain and K. M. Taylor. Published by Wright PSG. Pp. 564; indexed; illustrated. Price £35.00.
This book is edited by two cardiac surgeons from Glasgow who have drawn heavily on the local expertise in it authorship. It does Fluid and Blood Therapy in Anesthesia (Contemporary Anesthesia not claim to cover all aspects of intensive therapy paractice, but certainly encompasses the majority of the field, albeit with a Practice Series). Edited by Bumell R. Brown, jr. Published predominantly surgical bias. Considering that it is a multi-author by F. A. Davis C , Philadelphia. Pp. 189; indexed; illusbook, the style is surprisingly uniform and easy to read. trated. The opening chapters discuss the concept of intensive care and This volume is No. 6 in the series Contemporary Anesthesia the basic structure of an intensive care unit. They reveal the Practice and purports to discuss the problems associated with planning involved in setting one up, an aspect often not consiintra-operative fluid therapy which, as the Editor says (twice!) dered by mf^iml or nursing staff joining an established unit, but "generates more heat than light on the firing line of the operation which would be of particular interest to anyone starting a new room". Sadly, however, it evoked a considerable degree of unit. There is much useful information, but I was disappointed to thermogenesis in the reviewer—uoquenched by the ensuing find the quoted level for nurse staffing is derived from a 1976 crystalloid tide. publication, and so is below today's norm. The book consists of nine chapters by different contributors The majority of the chapter on Haemodynamic Monitoring and suffera from the all too common malaise of varying standards, revises the anaesthetists' study for the Faculty examinations, but repetition and inconsistency. Every chapter is preceeded by a would be very useful reading for those not exposed to Cliniral homily from the Editor and, while it might be unfair to criticize Measurement in their training! It does not really contain enough his folksy style and Americanese, he must accept the responsibili- information on the use of ballon flotation catheters, although a ty for the interminable reiteration. The worst example of this little more appears elsewhere in the book. concerns the theme of lung fluid mechanics which is introduced Good chapters on aspects of electrolyte, gluid and acid—base in Chapter 3, expounded at length in Chapter 5 and repeated with balance follow, with guidance on feeding and an interesting variations in Chapter 6. In addition, the text is sprinkled liberally discussion on the sick-cell concept. These physiologically orienwith careless errors which should have been corrected in tated chapters provide much core material so relevant to many of proof—spelling, omission of HTTTTIQI points, milligram* for mil- our problems: they should not be omitted by those in a rush to get
Downloaded from http://bja.oxfordjournals.org/ at RMIT University Library on July 12, 2015
most workers were "uncertain of it» place as an intravenous anaesthetic". However, Walter Nimmo and Marion Miller present a balanced summary of its properties as an induction agent and it remains to be seen whether it will prove acceptable in the U.S.A. or whether the muscle movements, sickness and venous irritation will consign it to neglect as in the U. K. This volume was produced before the report in the Lancet of June 4, 1983 of increased mortality following its infusion in intensive care units, so that the review has been overtaken by its withdrawal from this field of use. The review of the beta-adrenergic antagonists is partly related to the responses of patients already receiving these agents for ischaemic heart &*****• and partly to their use by anaesthetists during and after surgery. The beta agonists dopamine and dobutamine are also compared. Calcium-channel blocking drugs are probably less familiar to the anaesthetist and receive a separate chapter which coven the electrophysiology of their action as well as the rlini^fli implications. Finally, there are reviews of both lorazepam and midazolam. The value of lorazepam would seem to reside in its nmnwif action, although its prolonged action does limit its uses. Midazolam emerges as a much more versatile drug in all the fields in which we at present use diazepam, plus others related to its rapid onset and shorter duration of action. The authors do not suggest that it is an ideal i.v. induction agent, but stress rather its value in the poor-risk patient and for sedation to cover local
BOOK REVIEWS
Airborru Cart ofthtlll and Injured. By E. L. McNeil. Published • (ring-bound paper-back) (1983) by Springer-Verlag, Berlin, Heidelberg, New York. Pp. 208; illustrated. Price approx. US$6.10. This little book originates from the St Agnes Hospital, Whiteplains, New York, where the author, Edward L. McNeil, is Director of the Department of Emergency Services. It i» intended, in the words of th&preface, to "prepare Medical Technicians, Nurses and Physicians in adapting their present skills and knowledge to the aviation environment and in giving some guidance on the conduct necessary to adjust to the circumstances found in other countries." The foreword reminds us that the aviation environment presents many challenges to persons attending patients who are in conditions especially susceptible to its vagaries. The basic underlying problems responsible for these rhallrngm have not generally been recognized or adequately addressed. This book identifies those problems and provides sensible advice that should ensure safe and effective transfer by air that will not aggravate patients illness or injury. There are four sections: The Attendant and His Environment; Regulations and Operations; Aeromedical Care; Appendices (including the transfer of patients by scheduled commercial airlines). The first section gives general advice about the duties and requirements for a medical flight attendant whether that person be a physician, a nurse or a paramedic, and it goes on to describe some aspects of the aviation environment as it relates to the transport of the ill and injured. The second section, on regulations and operations, begins with advice on choosing and equipping an aircraft suitable for aeromedical transfers, and these aspects are followed by a most useful chapter on the recommended contents of the medical flight bag, together with associated equipment such as suction apparatus and defibrillators. Compatibility with the aircraft's systems is also discussed and there are two lengthy lists of equipment which is suitable for aeromedical use and that which is not. Documentation is dealt with at some length followed by a chapter rm loading nnH nnlrorling into and mit of thr ypry fnnfinwl BpflCTB
of small ambalance aircraft and helipopten. In considering the position of the patients in the aircraft, the author concludes that the majority of patients should be transported with the head forward in the 'plane if transverse orientation is not possible. The third section deals with aeromedical care, and is a comprehensive review of the management of the wide variety of practical problems and medical emergencies which may have to be dealt with during the course of the average aeromedical flight. It begins with the effect of ambient pressure changes on gas in the various body cavities as well as on arterial pressure cuffs, endotracheal tube cuffs, and orthopaedic air splints. There follows some 25 pages on the general topic of oxygenation. The relationship between hypoxia and altitude is followed by several tables and graphs showing the effects of altitude on alveolar oxygen tension, the expected PaO 2 of healthy adults at various altitudes, and the percentage of oxygen required to maintain PaOj of 100 mm Hg at varying altitudes. Apparatus for administering oxygen in aircraft is reviewed and suitable ventilators arc considered. The management of i.v. therapy in aircraft is followed by chapters on the care of the trauma patient and of the cardiac patient, followed by notes on the management of such diverse conditions as diabetes, alcoholism, psychiatric and obstetric conditions, and air sickness, as well as neonatal care and the special problems of children. This book originates from the United States, but physiology is international and anyone with the need to accompany a patient in an aircraft, whether on a scheduled flight or in an air ambulance, should be familiar with the relevant chapters of this book before take-off. The section on oxygenation is particularly valuable and if one were to pick out a particular fact for readers of this brief review, it would be to remind them that the average commercial jet liner cruising at around 35000 feet has a cabin altitude equivalent to about 6000 feet. At that altitude a normal healthy adult would have an arterial oxygen tension of approximately 64 mm Hg and he would require an inspired oxygen percentage of 27% to bring this back to lOOmmHg. Conversely, patients requiring 80% oxygen at sea level to maintain PaOj of 100 mm Hg will require 100% oxygen at an equivalent altutude of 6000 feet and at higher altitudes positive pressure will be required. In the unpressurized aircraft flying at 6000 feet, similar considerations would apply. Altogether this is a fascinating book, containing a wealth of useful information and it should be available to any doctor of whatever background who finds himself having to accompany a patient being transported by air. A. B. M. Telfer
Blood Lost and Rtplactmtm. By Merlin Marshall and Thomas Bird. Published (1983) by Arnold. Pp. 142; indexed; illustrated . Price £ 13.50 The combination of an anaesthetist and haematologist as authors has served to produce an excellent and very readable little book which contains much information useful to all rHniriann regularly involved with the transfusion of blood, its products, and blood substitutes. The contribution by the haematologist should enable anaesthetists and surgeons to be more diplomatic and well informed about their requests to the blood transfusion laboratory. The chapter on blood groups, grouping and cross-matching is succinct. Elsewhere, up to date information on platelet and white
Downloaded from http://bja.oxfordjournals.org/ at RMIT University Library on July 12, 2015
to the later dink-al chapter*. Infection and septic thock are well treated, but it seems unnecessary to '"rin'V a photograph of a nurse applying antiseptic hand lotion to remind us of the need for cleanliness. Radiology is discussed with the help of many useful reproductions of films and extends far beyond theradiologyof the chest. Specific systems of the body are then covered with, in general, a good result. However, the otherwise excellent chapter on the Nervous System consists of only head-injury management, with no mention of ""•Hj'tii neurological problems. Other topics not covered include diabetes, and chest injuries. The book arrived when I was discussing steroids in lung trauma with a colleague, so we turned to it; the index however did not help, and after looking for steroids, lung trauma, ARDS, etc., unsuccessfully, we found a brief discussion by "running one of the chapters. A more detailed index would make the book more useful, but as it stands it is valuable, and should find a place in many units, particularly if the majority of their work is surgical in origin, while the price helps to make it areasonablepersonal buy for the individual interested in Intensive Care. J.S.Gibson
1063
BRITISH JOURNAL OF ANAESTHESIA
Altogether this volume consists of well-balanced and concise reviews covering topics of current interest to ranriirlan-n for both pharmacology and clinical waminatinna In addition,ttinrrmost of the drugs are available in the U.K., it may be said that all anaesthetists wanting to keep abreast of developments would find it useful. Its price may discourage individuals from buying it but it is attractively produced in terms of binding, layout and size, making it acceptable as a book to take home and read in the evening.
R.S.J. Clark*
lilhres and grams for milligrams—this last refers to the daily dosage of gentamicin (by, the time the nurse has obtained 3500 vials from the pharmacy, hopefully someone will have twigged). All this is irritating and does a considerable dis-service to the authors. It should be appreciated that most of the contributors are from the Balanced Salt Solution school and most views expressed are polarized accordingly. The subject matter is introduced by Professor M. T. Jenkins, who gives a fascinating insight into pioneering medical history. A discussion on sodium balance is followed by a lengthy chapter on Balanced Salt Solution in Massive Trauma. Unfortunately, of 42referencesgiven only seven are less than 5 and three less than 3 years old. This criticism can be levelled at most of the text, which reaches its nadir in the chapter on Balanced Salt Solutions in Renal Prophylaxis where, apart from one reference described as "In Press", no other is more recent than 1973. Other chapters on this theme include fluid therapy in paediatrics and two comprehensive and informative accounts of the evidence for crystalloids in Post Traumatic Respiratory Failure and the role of Colloid Osmotic Pressure in Shock and Resuscitation. The last two chapters concern blood transfusion and its associated physical problems. Doctors Steinbronn and Huestis present a concise and lucid account of the rationale for component therapy—a view with which most British haematologists would concur. One's overall impression of this book is that it was assembled hastily and, while most of the contributors present cogent arguments for their views, to be of value to the trainee more than the "salt solution" needs to be "balanced". W.E.I. Fmlay
Handbook of Intensive Care. Edited by W. H. Bain and K. M. Taylor. Published by Wright PSG. Pp. 564; indexed; illustrated. Price £35.00.
This book is edited by two cardiac surgeons from Glasgow who have drawn heavily on the local expertise in it authorship. It does Fluid and Blood Therapy in Anesthesia (Contemporary Anesthesia not claim to cover all aspects of intensive therapy paractice, but certainly encompasses the majority of the field, albeit with a Practice Series). Edited by Bumell R. Brown, jr. Published predominantly surgical bias. Considering that it is a multi-author by F. A. Davis C , Philadelphia. Pp. 189; indexed; illusbook, the style is surprisingly uniform and easy to read. trated. The opening chapters discuss the concept of intensive care and This volume is No. 6 in the series Contemporary Anesthesia the basic structure of an intensive care unit. They reveal the Practice and purports to discuss the problems associated with planning involved in setting one up, an aspect often not consiintra-operative fluid therapy which, as the Editor says (twice!) dered by mf^iml or nursing staff joining an established unit, but "generates more heat than light on the firing line of the operation which would be of particular interest to anyone starting a new room". Sadly, however, it evoked a considerable degree of unit. There is much useful information, but I was disappointed to thermogenesis in the reviewer—uoquenched by the ensuing find the quoted level for nurse staffing is derived from a 1976 crystalloid tide. publication, and so is below today's norm. The book consists of nine chapters by different contributors The majority of the chapter on Haemodynamic Monitoring and suffera from the all too common malaise of varying standards, revises the anaesthetists' study for the Faculty examinations, but repetition and inconsistency. Every chapter is preceeded by a would be very useful reading for those not exposed to Cliniral homily from the Editor and, while it might be unfair to criticize Measurement in their training! It does not really contain enough his folksy style and Americanese, he must accept the responsibili- information on the use of ballon flotation catheters, although a ty for the interminable reiteration. The worst example of this little more appears elsewhere in the book. concerns the theme of lung fluid mechanics which is introduced Good chapters on aspects of electrolyte, gluid and acid—base in Chapter 3, expounded at length in Chapter 5 and repeated with balance follow, with guidance on feeding and an interesting variations in Chapter 6. In addition, the text is sprinkled liberally discussion on the sick-cell concept. These physiologically orienwith careless errors which should have been corrected in tated chapters provide much core material so relevant to many of proof—spelling, omission of HTTTTIQI points, milligram* for mil- our problems: they should not be omitted by those in a rush to get
Downloaded from http://bja.oxfordjournals.org/ at RMIT University Library on July 12, 2015
most workers were "uncertain of it» place as an intravenous anaesthetic". However, Walter Nimmo and Marion Miller present a balanced summary of its properties as an induction agent and it remains to be seen whether it will prove acceptable in the U.S.A. or whether the muscle movements, sickness and venous irritation will consign it to neglect as in the U. K. This volume was produced before the report in the Lancet of June 4, 1983 of increased mortality following its infusion in intensive care units, so that the review has been overtaken by its withdrawal from this field of use. The review of the beta-adrenergic antagonists is partly related to the responses of patients already receiving these agents for ischaemic heart &*****• and partly to their use by anaesthetists during and after surgery. The beta agonists dopamine and dobutamine are also compared. Calcium-channel blocking drugs are probably less familiar to the anaesthetist and receive a separate chapter which coven the electrophysiology of their action as well as the rlini^fli implications. Finally, there are reviews of both lorazepam and midazolam. The value of lorazepam would seem to reside in its nmnwif action, although its prolonged action does limit its uses. Midazolam emerges as a much more versatile drug in all the fields in which we at present use diazepam, plus others related to its rapid onset and shorter duration of action. The authors do not suggest that it is an ideal i.v. induction agent, but stress rather its value in the poor-risk patient and for sedation to cover local
BOOK REVIEWS
Airborru Cart ofthtlll and Injured. By E. L. McNeil. Published • (ring-bound paper-back) (1983) by Springer-Verlag, Berlin, Heidelberg, New York. Pp. 208; illustrated. Price approx. US$6.10. This little book originates from the St Agnes Hospital, Whiteplains, New York, where the author, Edward L. McNeil, is Director of the Department of Emergency Services. It i» intended, in the words of th&preface, to "prepare Medical Technicians, Nurses and Physicians in adapting their present skills and knowledge to the aviation environment and in giving some guidance on the conduct necessary to adjust to the circumstances found in other countries." The foreword reminds us that the aviation environment presents many challenges to persons attending patients who are in conditions especially susceptible to its vagaries. The basic underlying problems responsible for these rhallrngm have not generally been recognized or adequately addressed. This book identifies those problems and provides sensible advice that should ensure safe and effective transfer by air that will not aggravate patients illness or injury. There are four sections: The Attendant and His Environment; Regulations and Operations; Aeromedical Care; Appendices (including the transfer of patients by scheduled commercial airlines). The first section gives general advice about the duties and requirements for a medical flight attendant whether that person be a physician, a nurse or a paramedic, and it goes on to describe some aspects of the aviation environment as it relates to the transport of the ill and injured. The second section, on regulations and operations, begins with advice on choosing and equipping an aircraft suitable for aeromedical transfers, and these aspects are followed by a most useful chapter on the recommended contents of the medical flight bag, together with associated equipment such as suction apparatus and defibrillators. Compatibility with the aircraft's systems is also discussed and there are two lengthy lists of equipment which is suitable for aeromedical use and that which is not. Documentation is dealt with at some length followed by a chapter rm loading nnH nnlrorling into and mit of thr ypry fnnfinwl BpflCTB
of small ambalance aircraft and helipopten. In considering the position of the patients in the aircraft, the author concludes that the majority of patients should be transported with the head forward in the 'plane if transverse orientation is not possible. The third section deals with aeromedical care, and is a comprehensive review of the management of the wide variety of practical problems and medical emergencies which may have to be dealt with during the course of the average aeromedical flight. It begins with the effect of ambient pressure changes on gas in the various body cavities as well as on arterial pressure cuffs, endotracheal tube cuffs, and orthopaedic air splints. There follows some 25 pages on the general topic of oxygenation. The relationship between hypoxia and altitude is followed by several tables and graphs showing the effects of altitude on alveolar oxygen tension, the expected PaO 2 of healthy adults at various altitudes, and the percentage of oxygen required to maintain PaOj of 100 mm Hg at varying altitudes. Apparatus for administering oxygen in aircraft is reviewed and suitable ventilators arc considered. The management of i.v. therapy in aircraft is followed by chapters on the care of the trauma patient and of the cardiac patient, followed by notes on the management of such diverse conditions as diabetes, alcoholism, psychiatric and obstetric conditions, and air sickness, as well as neonatal care and the special problems of children. This book originates from the United States, but physiology is international and anyone with the need to accompany a patient in an aircraft, whether on a scheduled flight or in an air ambulance, should be familiar with the relevant chapters of this book before take-off. The section on oxygenation is particularly valuable and if one were to pick out a particular fact for readers of this brief review, it would be to remind them that the average commercial jet liner cruising at around 35000 feet has a cabin altitude equivalent to about 6000 feet. At that altitude a normal healthy adult would have an arterial oxygen tension of approximately 64 mm Hg and he would require an inspired oxygen percentage of 27% to bring this back to lOOmmHg. Conversely, patients requiring 80% oxygen at sea level to maintain PaOj of 100 mm Hg will require 100% oxygen at an equivalent altutude of 6000 feet and at higher altitudes positive pressure will be required. In the unpressurized aircraft flying at 6000 feet, similar considerations would apply. Altogether this is a fascinating book, containing a wealth of useful information and it should be available to any doctor of whatever background who finds himself having to accompany a patient being transported by air. A. B. M. Telfer
Blood Lost and Rtplactmtm. By Merlin Marshall and Thomas Bird. Published (1983) by Arnold. Pp. 142; indexed; illustrated . Price £ 13.50 The combination of an anaesthetist and haematologist as authors has served to produce an excellent and very readable little book which contains much information useful to all rHniriann regularly involved with the transfusion of blood, its products, and blood substitutes. The contribution by the haematologist should enable anaesthetists and surgeons to be more diplomatic and well informed about their requests to the blood transfusion laboratory. The chapter on blood groups, grouping and cross-matching is succinct. Elsewhere, up to date information on platelet and white
Downloaded from http://bja.oxfordjournals.org/ at RMIT University Library on July 12, 2015
to the later dink-al chapter*. Infection and septic thock are well treated, but it seems unnecessary to '"rin'V a photograph of a nurse applying antiseptic hand lotion to remind us of the need for cleanliness. Radiology is discussed with the help of many useful reproductions of films and extends far beyond theradiologyof the chest. Specific systems of the body are then covered with, in general, a good result. However, the otherwise excellent chapter on the Nervous System consists of only head-injury management, with no mention of ""•Hj'tii neurological problems. Other topics not covered include diabetes, and chest injuries. The book arrived when I was discussing steroids in lung trauma with a colleague, so we turned to it; the index however did not help, and after looking for steroids, lung trauma, ARDS, etc., unsuccessfully, we found a brief discussion by "running one of the chapters. A more detailed index would make the book more useful, but as it stands it is valuable, and should find a place in many units, particularly if the majority of their work is surgical in origin, while the price helps to make it areasonablepersonal buy for the individual interested in Intensive Care. J.S.Gibson
1063