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Management of wilderness and environmental emergencies
Book Reviews
work, but I’m not sure why. For example the chapters, Signal Transduction in the Cell, Maturation of the Respiratory System, Electrocardiography in Critical Care Medicine, Disaster Management, and Understanding Radiation Poisoning, were well written, but seemed out of place. Reading this text elicited a combination of elation and disappointment. After reading the chapter on accidental hypothermia, I looked forward to the usual companion chapter on heat illness, however, in its place was a chapter on malignant hyperthermia, certainly a necessary topic in critical care, but there was no mention of heat illness. The sections on nursing and organization were informative and contained information important to successfully managing an intensive care unit, and this information is not available in most medical textbooks. Most of the illustrations and tables were helpful, but as in the first edition many were distracting, added nothing to the text, or existed only as filler. Most editors agree that the index is the biggest headache of any textbook. No matter how much effort goes into the text, if that material is not properly indexed it cannot be easily retrieved; this work is no exception. There is an entire chapter on hyperbaric oxygen but nothing in the index. Fever is a common and important problem in critical care; there were two references, one “post FOB” and one “without infection.” Paralyzing agents are commonly used in intensive care units, but were not indexed. With the use of key words for each chapter and for computer indexing, these problems should be avoidable. Overall, this is an outstanding effort on the part of the editors to present a very broad, complicated topic under one cover, and for the most part they have succeeded. Trying to control the output of 223 contributors must be a monumental task. The Textbook of Critical Care is not a perfect textbook. There are no perfect textbooks, nor are there perfect physicians, baseball players, or musicians. There are levels of excellence, however, in any endeavor and this textbook, like Osler, DiMaggio, and Mozart, is near the top. The continued high standards of the editors will keep this book the standard in the field by which all other critical care works are measured for many years. I highly recommend it for inclusion in the library of any physician who cares for critical care patients whether in the emergency department or in the intensive care unit. Edward J. Otten, MD University of Cincinnati School of Medicine
561
•i MANAGEMENT OF WILDERNESS AND ENVIRONMENTAL EMERGENCIES, 2nd ed. Edited by P. S. Auerbach and E. C. Geehr. 1068 pp. St. Louis, C. V. Mosby, 1989, $99.00 The first edition of this work was an innovative idea for bringing together in a single textbook information from many different areas-emergency medicine, search and rescue, survival technology, toxicology, undersea medicine, and high altitude medicine. The idea was well received and the first edition became an often quoted and very popular textbook. One always expects more from a second edition, especially when the first edition was as successful as this one. The editors have the advantage of feedback from their colleagues, and it always seems easier to rewrite a textbook when the framework is already there. Auerbath and Geehr have far surpassed my expectations with this second edition. Where the first was a wellwritten, practical, moderate-sized text, this edition is a very polished, scientific, expanded text with literally something for everyone. There are 61 contributors from many different specialties and professions, including a veterinarian, a dentist, a coast guardsman, a forest ranger, a nutritionist, and assorted doctors of philosophy. Anyone familiar with the literature of emergency medicine will recognize the names Hackett, Halstead, Davis, Callaham, Danzl, Henry, Kizer, Rees, Paris, Stewart, Roberts, Sullivan, Kunkel, Wingert, and Minton. This is not one of your typical “old boy” textbooks, where an editor gets everyone at one’s medical center from the medical students to the professor emeritus to write a chapter. Rather, these authors are the experts in their particular fields, and the chapters reflect their research, experience, and in-depth knowledge. The text is divided into 36 chapters, many of which are new or reorganized into a more logical arrangement. Chapters on burns, radiation injuries, and inhalation injuries, all of which may occur outside of a wilderness setting or are not unique to it, have been deleted. Added chapters include Cold-Water Immersion, Tick-Borne Diseases, Wild and Domestic Animal Attacks, Foreign Travel and Exotic Diseases, Field Water Disinfection, Wilderness Trauma Emergencies, Poisonous Mushrooms, and Emergency Veterinary Medicine. One of my favorite new chapters is Wilderness Equipment and Medical Supplies. Most of my friends and colleagues know that I am an outdoor enthusiast, therefore, whenever they need any information on what supplies and equipment to take backpacking or trekking, they ask me. I usually end
562
up making up lists of suppliers, equipment, and instructions tailored to their trip. This chapter has what is called a “wilderness index” that does all of that and more. Besides new chapters, this edition has added 68 color illustrations that give a nice visual dimension to the work, although I am not certain that the additional cost of color plates is justified by the limited information they contain. Most of the illustrations are well selected and augment the text nicely, however, many of the photographs in the Cold Water Immersion chapters seem to exist as filler. The chapters are extensively referenced; for example, the chapter on Infectious Diarrhea has 408 references, and the index is complete and easy to use. There are a few minor errors, but the textual material is up-to-date, accurate, and complete. If you want to disinfect water, treat an elephant bite, or survive a forest fire, the information is here. Auerbach’s chapters on aquatic hazards are outstanding and the best treatment of this subject in any form. This textbook should be found in every emergency
The Journal of Emergency Medicine
department, medical library, and search and rescue service in the country. Any physician who routinely cares for climbers, divers, hikers, skiers, boaters, and other persons who frequent the outdoors should be familiar with this work. That includes most of the practicing physicians in this country. I highly recommend this text to military physicians. Although the chapter on wilderness trauma is not extensive, this text supplemented by a good surgery textbook would be the basis for a medical library in any theatre of operations. I generally choose one textbook each year that our faculty and residents read and review in depth. I try to choose a classic work that is not only instructive but interesting. This year we will be reading Auerbach and Geehr’s Management of Wilder-
ness and Environmental Emergencies. Edward J Otten, MD Department of Emergency Medicine University of Cincinnati Hospital Cincinnati, Ohio 45267-0769
work, but I’m not sure why. For example the chapters, Signal Transduction in the Cell, Maturation of the Respiratory System, Electrocardiography in Critical Care Medicine, Disaster Management, and Understanding Radiation Poisoning, were well written, but seemed out of place. Reading this text elicited a combination of elation and disappointment. After reading the chapter on accidental hypothermia, I looked forward to the usual companion chapter on heat illness, however, in its place was a chapter on malignant hyperthermia, certainly a necessary topic in critical care, but there was no mention of heat illness. The sections on nursing and organization were informative and contained information important to successfully managing an intensive care unit, and this information is not available in most medical textbooks. Most of the illustrations and tables were helpful, but as in the first edition many were distracting, added nothing to the text, or existed only as filler. Most editors agree that the index is the biggest headache of any textbook. No matter how much effort goes into the text, if that material is not properly indexed it cannot be easily retrieved; this work is no exception. There is an entire chapter on hyperbaric oxygen but nothing in the index. Fever is a common and important problem in critical care; there were two references, one “post FOB” and one “without infection.” Paralyzing agents are commonly used in intensive care units, but were not indexed. With the use of key words for each chapter and for computer indexing, these problems should be avoidable. Overall, this is an outstanding effort on the part of the editors to present a very broad, complicated topic under one cover, and for the most part they have succeeded. Trying to control the output of 223 contributors must be a monumental task. The Textbook of Critical Care is not a perfect textbook. There are no perfect textbooks, nor are there perfect physicians, baseball players, or musicians. There are levels of excellence, however, in any endeavor and this textbook, like Osler, DiMaggio, and Mozart, is near the top. The continued high standards of the editors will keep this book the standard in the field by which all other critical care works are measured for many years. I highly recommend it for inclusion in the library of any physician who cares for critical care patients whether in the emergency department or in the intensive care unit. Edward J. Otten, MD University of Cincinnati School of Medicine
561
•i MANAGEMENT OF WILDERNESS AND ENVIRONMENTAL EMERGENCIES, 2nd ed. Edited by P. S. Auerbach and E. C. Geehr. 1068 pp. St. Louis, C. V. Mosby, 1989, $99.00 The first edition of this work was an innovative idea for bringing together in a single textbook information from many different areas-emergency medicine, search and rescue, survival technology, toxicology, undersea medicine, and high altitude medicine. The idea was well received and the first edition became an often quoted and very popular textbook. One always expects more from a second edition, especially when the first edition was as successful as this one. The editors have the advantage of feedback from their colleagues, and it always seems easier to rewrite a textbook when the framework is already there. Auerbath and Geehr have far surpassed my expectations with this second edition. Where the first was a wellwritten, practical, moderate-sized text, this edition is a very polished, scientific, expanded text with literally something for everyone. There are 61 contributors from many different specialties and professions, including a veterinarian, a dentist, a coast guardsman, a forest ranger, a nutritionist, and assorted doctors of philosophy. Anyone familiar with the literature of emergency medicine will recognize the names Hackett, Halstead, Davis, Callaham, Danzl, Henry, Kizer, Rees, Paris, Stewart, Roberts, Sullivan, Kunkel, Wingert, and Minton. This is not one of your typical “old boy” textbooks, where an editor gets everyone at one’s medical center from the medical students to the professor emeritus to write a chapter. Rather, these authors are the experts in their particular fields, and the chapters reflect their research, experience, and in-depth knowledge. The text is divided into 36 chapters, many of which are new or reorganized into a more logical arrangement. Chapters on burns, radiation injuries, and inhalation injuries, all of which may occur outside of a wilderness setting or are not unique to it, have been deleted. Added chapters include Cold-Water Immersion, Tick-Borne Diseases, Wild and Domestic Animal Attacks, Foreign Travel and Exotic Diseases, Field Water Disinfection, Wilderness Trauma Emergencies, Poisonous Mushrooms, and Emergency Veterinary Medicine. One of my favorite new chapters is Wilderness Equipment and Medical Supplies. Most of my friends and colleagues know that I am an outdoor enthusiast, therefore, whenever they need any information on what supplies and equipment to take backpacking or trekking, they ask me. I usually end
562
up making up lists of suppliers, equipment, and instructions tailored to their trip. This chapter has what is called a “wilderness index” that does all of that and more. Besides new chapters, this edition has added 68 color illustrations that give a nice visual dimension to the work, although I am not certain that the additional cost of color plates is justified by the limited information they contain. Most of the illustrations are well selected and augment the text nicely, however, many of the photographs in the Cold Water Immersion chapters seem to exist as filler. The chapters are extensively referenced; for example, the chapter on Infectious Diarrhea has 408 references, and the index is complete and easy to use. There are a few minor errors, but the textual material is up-to-date, accurate, and complete. If you want to disinfect water, treat an elephant bite, or survive a forest fire, the information is here. Auerbach’s chapters on aquatic hazards are outstanding and the best treatment of this subject in any form. This textbook should be found in every emergency
The Journal of Emergency Medicine
department, medical library, and search and rescue service in the country. Any physician who routinely cares for climbers, divers, hikers, skiers, boaters, and other persons who frequent the outdoors should be familiar with this work. That includes most of the practicing physicians in this country. I highly recommend this text to military physicians. Although the chapter on wilderness trauma is not extensive, this text supplemented by a good surgery textbook would be the basis for a medical library in any theatre of operations. I generally choose one textbook each year that our faculty and residents read and review in depth. I try to choose a classic work that is not only instructive but interesting. This year we will be reading Auerbach and Geehr’s Management of Wilder-
ness and Environmental Emergencies. Edward J Otten, MD Department of Emergency Medicine University of Cincinnati Hospital Cincinnati, Ohio 45267-0769