- Email: [email protected]
INTRODUCTION TO CRITICAL CARE
the bookshelf SURGERY ON CALL. By LEONARD G. CoMELLA and AuN T. Norwalk, Conn: Appleton & Lange, 1990, 436 pp, t2O.50
LEFOR.
Surprv On CGll was written by On Gomella and Lefor for residents when they are OIl call for the JUlIeI'Y service. It is really a pocket-sized manual designed to be carried in the lab coat of the harried physician when be or she is tryiDg to solve clinical problems. The book itself is broken down into seven diIereot sections; however, most of the space is allotted to on-call problems. which range from very common things. such as CODStipdion, abdommaI pain, aspiration, and Fbley catheter problems, to some of the more
complicated and challenging topics, such as changing neurologic status, syncope, and medical and endOCrine problems. It is interesting that the authors have chosen to organize the book by problem instead of by dJagnosis, with the intention that the information is quicldy and easily found when )lOU need it. However, with this approecb some problems will obviously be left out. With the 70 problems described, they've certainly covered most of the situatioDs that a resident would encounter. Each of the problems is broken down into questions that one should ask, the diB"erential diagnosis of the problem, followed by the data-base plan, including initial management and complications that might develop. Smaller sections of the book deal with Iabontory tests and their interpretation, common procedures that might be required (eg, arterial line placement, central venous catheterizatioo, both needle and surgical cricothyrotom~ nasal ~ and almost any other procedure that might be necessary. There are also several small sections dealing with 8uids and electrolytes, blood component therapy, and ventilator JDaD8IeIDeDt, and the book ends with a fairly significant chapter on commonly used medications. There is even a page devoted to drugs commonly used in resuscitation. The ..thon made this manual very convenient for the resident who is on call and needs valuable, Pertinent information on various problems that might arise. I sincerely believe that they achieved this goal due to orpnization of the material. This manual is full of worthwhile information dealing with almost ~ clinical problem. The manual gives step-by-step management of many clinical problems, but its not just a cookbook of medicme. The procedures section is very nicely done and covers aD the common procedures, with good use of diagrams and a step-by-step way of doing the particular procedure. Also, complications are appropriately mentioned. The section 00 COIIlIDOD1y used medicatioos is certainly up to date, and I did not &nd any errors in aay of the medications, including the drugs used in resuscitation, which are up to standard with the American Heart Association. The manual
itseJf was well refereoced, with a good index and a good appendix. I think the value of this manual is in providing a framework to IIWUIge the patient 01' clinical problem. It oftentimes helps in stabiliziDg the patient, ukiDI the right questions. coming up with a differential diagnosis, and helpiDg in some ddBcuIt situations.. We must recognize it as a manual and not a textbook on surgery, but it surprisingly contains much information that is extremely Pertinent and very helpful. It was designed fOr surgical house olBcen while on call, but it would also be useful for medical residents, moonlighting physicians, and even emergency physicians as a quick reference. lker L. Sf4IomIon, M.D.
Eoaruol&,lndiDu
INTRODUcnON 10 CRITICAL CARE. Edited by J. M. CJVE1TA, R. W TAYLOR, and R. R. Kluy. Philadelphia: JB LippiDcott, 1989, 311 pp,
t29.95
E\'eI')' physician who treats patients in ICUs or emergency rooms (or sends his patients to either) wiD beoeGt from the thoughtful, practical, and phi1oIopbic insights presented in this handy-size, easy-to-read p&Perbeck. In addition to the authors, who are intensive care physicians themselves, 15 other conbibutors-physicians, nurses, lawyers, judges, ethicists, and psychotherapists- guide the reader through the confusing thought processes physicians struggle with concerning patient care in the ICUI on the way to dear, reuooable, and objective conclusions. The very readable and sensible qualities mthis book are illustrated in this quotation &om the section on medicomoral priocipIes: ~ primary prindpies tnditiooally have inbmed the practice of medicine: preserving life and alleviating sutrering. Fbr the most part these two principles can be applied COncurreD~ without con8ict, to guide the physicianS decisioos and actions. However', ID drcumstaDces of aiticaI 01' terminal iDDess, they sometimes come Ioto con8ict only at the expense of the other. Then it becomes possible to apply one principle only at the expense of the other. To continue, willy~ to attempt to preserve life ma~ in fact, in8ict rather than alleviate suI'eriDg. ADd to consciously strive to alleviate sWJering may require abmcIoaiDI the intention to continue to preserve life."
The book is divided into two sections: "Concepts" and ··People:· The "Concepts" section sets out the objectives of ICU care: patient selection. generic goals, bedside examination, and distributive justice, followed by consideration of the what and when of clinical decision-making. Neatly discussed is legal decision-making in irreversible CNS damage, incompetent patients, and minon and infants; the emerging legal consensus regarding these problems is presented, and practical directions for avoiding legal problems are outlined. The "People" section is concerned with the organization of the ICU team and its divided functions. The growing recognition of the need to blend art and science in the supercharged atmosphere of critical care is discussed with the thrust it deserves. Preventive care in the ICU is also recognized and given the emphasis it, too, deserves: skin care. musculoskeletal management. and early recognition of subtle infectious processes. One cannot recommend too highly this thoroughly practical, well-organized, and timely book.
Hobert C. 7J&t, M. D. Eoaraaoille, IndiDfItJ PROBLEMS IN CRI11CAL CARE: PROGNOSTIC SCORING SY~MS IN THE ICU. By J. CHIUSroPHER FABNER. Philadelphia: JB Lippincott, 1989, 698 pp, t30.00 In recent years. there has been ina'easing interest in establishing objective criteria to determine the probability of successful outcome of patients admitted to ICUs. Indeed, a veritable cottage industry bas developed, and many authors have entered the Geld to propose new statistical elaborations of more or less objective information. Interest in this 6eld of study is not likely to subside any time soon. Indeed, the establishment of a universally accepted set of criteria for ICU prognosis is a highly desirable goal, though one quite diflicult to achieve. A clear, well-written, and well-edited book such as this can be a very useful road map for those who are not fully familiar with the many prognostic systems developed over the last 15 years. The book describes "generic" prognostic techniques such as llSS and APACHE. as well as specialized scoring systems for pediabic patients or patients with trauma or speci6c organ dysfunction. Most chapters are authored by the investigators who have done most of the original work on that subject. A proYOCative point/counterpoint conclusion is provided in the 6naI two chapters by Drs Knaus and Civetta, who respectively support and critique the validity of prognostic indicators. In this era of stringent cost control and wroogful-Iife liability suits, this book should be recommended reading for ICU practitioners and trainees alike.
GrtJ%itJno Carlon, M. D.
NewYori
INTRODUCTION TO RESPIRATORY CARE. By MICHAEL LEVI'TLn, JIMMY CAIRO, and STANLEY HALL. Philadelphia: WB Saunders. 1990, 589 pp, ,,".95 Pulmonologists blessed with strong support from respiratory care practitioners may take for granted the education required to b'ansform an entrylevel student into a knowledgeable professional ~ The breadth of material covered in this introductory text underscores the cbaI1eDge facmg students and teachers of respiratory care. The well-organized and clearly written text is divided into three sections, including basic sciences, diagnostic aspects of cardiopdmonary diseases, and therapeutic modalities of respiratory care. Each of the 20 cbapten begins with a useful list of objectives and an outline ofcontents. The clarity of the text and illustrative 6gures reveals the familiarity of the authors with this material and their experience in presenting this to students. Appendices include common terms and symbols, useful nomograms, and normal laboratory values. One might 6nd fault with the rather simplistic discussion of clinical medicine, but this may be appropriate for the anticipated audience. Additional references might be useful for the reader seeking the elusive scientific rationale for many of the techniques of bronchopulmonary hygiene. However, this text is an excellent starting point for the ~ S~
G. ltJtfn, M.D.
Rochat.; MfnnaottJ
Continued on next page
LEFOR.
Surprv On CGll was written by On Gomella and Lefor for residents when they are OIl call for the JUlIeI'Y service. It is really a pocket-sized manual designed to be carried in the lab coat of the harried physician when be or she is tryiDg to solve clinical problems. The book itself is broken down into seven diIereot sections; however, most of the space is allotted to on-call problems. which range from very common things. such as CODStipdion, abdommaI pain, aspiration, and Fbley catheter problems, to some of the more
complicated and challenging topics, such as changing neurologic status, syncope, and medical and endOCrine problems. It is interesting that the authors have chosen to organize the book by problem instead of by dJagnosis, with the intention that the information is quicldy and easily found when )lOU need it. However, with this approecb some problems will obviously be left out. With the 70 problems described, they've certainly covered most of the situatioDs that a resident would encounter. Each of the problems is broken down into questions that one should ask, the diB"erential diagnosis of the problem, followed by the data-base plan, including initial management and complications that might develop. Smaller sections of the book deal with Iabontory tests and their interpretation, common procedures that might be required (eg, arterial line placement, central venous catheterizatioo, both needle and surgical cricothyrotom~ nasal ~ and almost any other procedure that might be necessary. There are also several small sections dealing with 8uids and electrolytes, blood component therapy, and ventilator JDaD8IeIDeDt, and the book ends with a fairly significant chapter on commonly used medications. There is even a page devoted to drugs commonly used in resuscitation. The ..thon made this manual very convenient for the resident who is on call and needs valuable, Pertinent information on various problems that might arise. I sincerely believe that they achieved this goal due to orpnization of the material. This manual is full of worthwhile information dealing with almost ~ clinical problem. The manual gives step-by-step management of many clinical problems, but its not just a cookbook of medicme. The procedures section is very nicely done and covers aD the common procedures, with good use of diagrams and a step-by-step way of doing the particular procedure. Also, complications are appropriately mentioned. The section 00 COIIlIDOD1y used medicatioos is certainly up to date, and I did not &nd any errors in aay of the medications, including the drugs used in resuscitation, which are up to standard with the American Heart Association. The manual
itseJf was well refereoced, with a good index and a good appendix. I think the value of this manual is in providing a framework to IIWUIge the patient 01' clinical problem. It oftentimes helps in stabiliziDg the patient, ukiDI the right questions. coming up with a differential diagnosis, and helpiDg in some ddBcuIt situations.. We must recognize it as a manual and not a textbook on surgery, but it surprisingly contains much information that is extremely Pertinent and very helpful. It was designed fOr surgical house olBcen while on call, but it would also be useful for medical residents, moonlighting physicians, and even emergency physicians as a quick reference. lker L. Sf4IomIon, M.D.
Eoaruol&,lndiDu
INTRODUcnON 10 CRITICAL CARE. Edited by J. M. CJVE1TA, R. W TAYLOR, and R. R. Kluy. Philadelphia: JB LippiDcott, 1989, 311 pp,
t29.95
E\'eI')' physician who treats patients in ICUs or emergency rooms (or sends his patients to either) wiD beoeGt from the thoughtful, practical, and phi1oIopbic insights presented in this handy-size, easy-to-read p&Perbeck. In addition to the authors, who are intensive care physicians themselves, 15 other conbibutors-physicians, nurses, lawyers, judges, ethicists, and psychotherapists- guide the reader through the confusing thought processes physicians struggle with concerning patient care in the ICUI on the way to dear, reuooable, and objective conclusions. The very readable and sensible qualities mthis book are illustrated in this quotation &om the section on medicomoral priocipIes: ~ primary prindpies tnditiooally have inbmed the practice of medicine: preserving life and alleviating sutrering. Fbr the most part these two principles can be applied COncurreD~ without con8ict, to guide the physicianS decisioos and actions. However', ID drcumstaDces of aiticaI 01' terminal iDDess, they sometimes come Ioto con8ict only at the expense of the other. Then it becomes possible to apply one principle only at the expense of the other. To continue, willy~ to attempt to preserve life ma~ in fact, in8ict rather than alleviate suI'eriDg. ADd to consciously strive to alleviate sWJering may require abmcIoaiDI the intention to continue to preserve life."
The book is divided into two sections: "Concepts" and ··People:· The "Concepts" section sets out the objectives of ICU care: patient selection. generic goals, bedside examination, and distributive justice, followed by consideration of the what and when of clinical decision-making. Neatly discussed is legal decision-making in irreversible CNS damage, incompetent patients, and minon and infants; the emerging legal consensus regarding these problems is presented, and practical directions for avoiding legal problems are outlined. The "People" section is concerned with the organization of the ICU team and its divided functions. The growing recognition of the need to blend art and science in the supercharged atmosphere of critical care is discussed with the thrust it deserves. Preventive care in the ICU is also recognized and given the emphasis it, too, deserves: skin care. musculoskeletal management. and early recognition of subtle infectious processes. One cannot recommend too highly this thoroughly practical, well-organized, and timely book.
Hobert C. 7J&t, M. D. Eoaraaoille, IndiDfItJ PROBLEMS IN CRI11CAL CARE: PROGNOSTIC SCORING SY~MS IN THE ICU. By J. CHIUSroPHER FABNER. Philadelphia: JB Lippincott, 1989, 698 pp, t30.00 In recent years. there has been ina'easing interest in establishing objective criteria to determine the probability of successful outcome of patients admitted to ICUs. Indeed, a veritable cottage industry bas developed, and many authors have entered the Geld to propose new statistical elaborations of more or less objective information. Interest in this 6eld of study is not likely to subside any time soon. Indeed, the establishment of a universally accepted set of criteria for ICU prognosis is a highly desirable goal, though one quite diflicult to achieve. A clear, well-written, and well-edited book such as this can be a very useful road map for those who are not fully familiar with the many prognostic systems developed over the last 15 years. The book describes "generic" prognostic techniques such as llSS and APACHE. as well as specialized scoring systems for pediabic patients or patients with trauma or speci6c organ dysfunction. Most chapters are authored by the investigators who have done most of the original work on that subject. A proYOCative point/counterpoint conclusion is provided in the 6naI two chapters by Drs Knaus and Civetta, who respectively support and critique the validity of prognostic indicators. In this era of stringent cost control and wroogful-Iife liability suits, this book should be recommended reading for ICU practitioners and trainees alike.
GrtJ%itJno Carlon, M. D.
NewYori
INTRODUCTION TO RESPIRATORY CARE. By MICHAEL LEVI'TLn, JIMMY CAIRO, and STANLEY HALL. Philadelphia: WB Saunders. 1990, 589 pp, ,,".95 Pulmonologists blessed with strong support from respiratory care practitioners may take for granted the education required to b'ansform an entrylevel student into a knowledgeable professional ~ The breadth of material covered in this introductory text underscores the cbaI1eDge facmg students and teachers of respiratory care. The well-organized and clearly written text is divided into three sections, including basic sciences, diagnostic aspects of cardiopdmonary diseases, and therapeutic modalities of respiratory care. Each of the 20 cbapten begins with a useful list of objectives and an outline ofcontents. The clarity of the text and illustrative 6gures reveals the familiarity of the authors with this material and their experience in presenting this to students. Appendices include common terms and symbols, useful nomograms, and normal laboratory values. One might 6nd fault with the rather simplistic discussion of clinical medicine, but this may be appropriate for the anticipated audience. Additional references might be useful for the reader seeking the elusive scientific rationale for many of the techniques of bronchopulmonary hygiene. However, this text is an excellent starting point for the ~ S~
G. ltJtfn, M.D.
Rochat.; MfnnaottJ
Continued on next page