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Neurosurgical emergencies, volumes I and II
BOOK/SOFTWARE REVIEWS
Neurosurgical Emergencies, Volumes I and II. Christopher Loftus, MD, editor. American Association of Neurological Surgeons, 1994,
Authorship: Thirty two of the thirty-six contributors are neurosurgeons. There are no emergency physician contributors. Overview: This book is divided into two volumes and, according to the editor, is intended for a wide audience including neurosurgeons, residents, and physicians outside of neurosurgery who treat neurosurgical patients. Volume I, devoted to emergencies involving the head, contains 13 chapters and is 233 pages. Volume II, concerned with emergencies involving the spine, is divided into 9 chapters covered in 110 pages. Volume II also includes 63 pages of continuing medical education questions, with answers, covering both volumes but without explanations of the answers or page references to the appropriate text. The chapters cover the major topics expected in a book of neurosurgical emergencies. With few exceptions, such as the "Perinatal Management of the Child Born with a Myelomeningocele," the chapters should be interesting to emergency physicians. The chapters tend to be clearly written and well organized. This is little overlap between the information in each chapter, with conformity in recommendations. Most of the chapters have an acceptable number and quality of neuroimaging studies. Each chapter is well referenced, with recent articles from peer-reviewed journals, except for one chapter, "Acute Shunt Malfunction," which has no references at all. Table of Contents and Index: The table of contents and index are a little unusual in this two-volume set; Volume I does not list the chapters or contributors--or index the materials--in Volume II, while Volume II provides a cumulative list of chapters and an index for both volumes. The index has inaccuracies that interfere with the book's value as an easily accessible reference. For example, methylprednisolone in spinal injury is referenced to page 257, 258, but in actuality the discussion is on page 253, and there is no mention of posttraumatic seizures, even though it is discussed on page 65. Strong Points: The book's broad scope covers the majority of topics that an emergency physician would want to read about. Most chapters have relevance to the practice of emergency medicine and provide at least an overview of the topic. Chapters that were particularly good were on intracranial pressure monitoring, hydrocephalus, herniation syndromes, intracerebral hematoma, surgery for stroke, spinal disc disease, intraspinal hemorrhage, and spinal infections. These chapters provide good insight into how a neurosurgeon approaches these entities and generally do a good job of presenting controversies surrounding various management strategies. For example, the chapter on spinal trauma discusses the rationale of surgical intervention for compressive lesions of the spinal cord and clarifies the variation that is observed in the management of these cases. Neurosurgical topics that are not presented in this book but that might have been appropriate for discussion include the management of minor head trauma and brain death. Weaknesses: There are several significant weaknesses with this book. Most of the chapters fail to provide emphasis on clinical presentation and differential diagnosis. Because this book's audience is intended to include other clinicians besides neurosurgeons, there should have been more of an attempt to establish the basics. For example, the chapter on "Acute Shunt Malfunction" begins by stating that the author assumes that the reader is familiar with shunting systems; the chapter on " A c u t e Management of Subarachnoid Hemorrhage" offers very little discussion on the wide variety of clinical symptoms and presentations, an area that is of great interest to most emergency physicians. The chapter on '~The Acute/ Emergent Management of Vertebral Column Fracture-Dislocation Injuries" provides no discussion of the various cord syndromes. The chapter on "Cerebral Infectious Processes" offers no discussion on the management of viral meningitis.
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Several of the chapters recommend management strategies that are controversial at best. In the chapter on "Status Epilepticus," Table 4 implies that a lumbar puncture (LP) should be performed before computed tomography (CT) if meningitis is suspected, but does not emphasize the importance of instituting treatment for bacterial meningitis as soon as the diagnosis is suspected. Along the same lines, the chapter on "Cerebral Infectious Processes" (page 168) recommends cultures before antibiotics are started, although in actual practice time factors dictate that clinicians begin antibiotics before CT and LP. Almost every chapter would have benefited from the inclusion of more tables, especially tables that clearly provide management guidelines. This absence of management tables limits the book's value in emergent situations. For example, the chapter on "Acute Management of Subarachnoid Hemorrhage" presents management recommendations over five pages. The chapter on "Status Epilepticus" has a management table (Table 4); however, phenytoin, which is included in the table, is not mentioned at all in the text! Other surprises in the chapter on "Status Epilepticns" include the recommendation to give a hyperosmolar load of dextrose to patients in status instead of simply checking a dextrostix, and failure to discuss other pharmacological interventions that are available in managing status when pentobarbital is not available. General Recommendations: I looked forward to reading this book, based on its comprehensive table of contents, and anticipated a good general reference book addressing the difficult decisions in managing neurosurgical patients. Overall, the book does an adequate job discussing the topics, but orientation and presentation limit the value for an emergency medicine library. This is particularly true in respect to the high price of $90.00 for each volume. Sixty-five pages of CME questions is of little value in a reference book, and I think that the book would have been better served had it been published as a one-volume, 343-page book, with the option of purchasing the CME questions separately. ANDY JAGODA, MD
Division of Emergency Medicine University of Florida Jacksonville, FL The Airway: Emergency Management. Robert H. Dailey, Barry Simon, Garry P. Young, Ronald D. Stewart. Mosby Yearbook, 1992.
Authorship: The editors and a vast majority of the authors of this textbook are practicing emergency physicians. Many of them are involved with Emergency Medicine training programs and a large number of them are involved with some aspect of airway management research. Of the non-emergency medicine contributors, most are pulmonologists, anesthesiologists, or intensivists who are obviously involved with airway management. The editors and contributing authors have credibility and substantial experience in the area of airway management. Overview: Of all the skills required for the practice of Emergency Medicine, none is as important or livesaving as airway assessment and intervention for the patient with respiratory embarrassment. Undoubtedly, the hallmark of the emergency physician is decisiveness about the approaches to securing the airway of a critically ill or injured patient. Finally, here is a textbook that brings together all of the essential airway management information necessary to heighten the skills of practicing emergency physicians. Drs Dailey, Simon, Young, and Stewart are the editors of an excellent textbook. This textbook is ideal for the practicing emergency physician, the emergency physician in training, or any clinician faced with the need to urgently manage a patient's airway. It is a complete treatise on the topic of airway management and is essential reading for emergency physicians who may find that their current armamentarium of airway techniques is deficient.
Neurosurgical Emergencies, Volumes I and II. Christopher Loftus, MD, editor. American Association of Neurological Surgeons, 1994,
Authorship: Thirty two of the thirty-six contributors are neurosurgeons. There are no emergency physician contributors. Overview: This book is divided into two volumes and, according to the editor, is intended for a wide audience including neurosurgeons, residents, and physicians outside of neurosurgery who treat neurosurgical patients. Volume I, devoted to emergencies involving the head, contains 13 chapters and is 233 pages. Volume II, concerned with emergencies involving the spine, is divided into 9 chapters covered in 110 pages. Volume II also includes 63 pages of continuing medical education questions, with answers, covering both volumes but without explanations of the answers or page references to the appropriate text. The chapters cover the major topics expected in a book of neurosurgical emergencies. With few exceptions, such as the "Perinatal Management of the Child Born with a Myelomeningocele," the chapters should be interesting to emergency physicians. The chapters tend to be clearly written and well organized. This is little overlap between the information in each chapter, with conformity in recommendations. Most of the chapters have an acceptable number and quality of neuroimaging studies. Each chapter is well referenced, with recent articles from peer-reviewed journals, except for one chapter, "Acute Shunt Malfunction," which has no references at all. Table of Contents and Index: The table of contents and index are a little unusual in this two-volume set; Volume I does not list the chapters or contributors--or index the materials--in Volume II, while Volume II provides a cumulative list of chapters and an index for both volumes. The index has inaccuracies that interfere with the book's value as an easily accessible reference. For example, methylprednisolone in spinal injury is referenced to page 257, 258, but in actuality the discussion is on page 253, and there is no mention of posttraumatic seizures, even though it is discussed on page 65. Strong Points: The book's broad scope covers the majority of topics that an emergency physician would want to read about. Most chapters have relevance to the practice of emergency medicine and provide at least an overview of the topic. Chapters that were particularly good were on intracranial pressure monitoring, hydrocephalus, herniation syndromes, intracerebral hematoma, surgery for stroke, spinal disc disease, intraspinal hemorrhage, and spinal infections. These chapters provide good insight into how a neurosurgeon approaches these entities and generally do a good job of presenting controversies surrounding various management strategies. For example, the chapter on spinal trauma discusses the rationale of surgical intervention for compressive lesions of the spinal cord and clarifies the variation that is observed in the management of these cases. Neurosurgical topics that are not presented in this book but that might have been appropriate for discussion include the management of minor head trauma and brain death. Weaknesses: There are several significant weaknesses with this book. Most of the chapters fail to provide emphasis on clinical presentation and differential diagnosis. Because this book's audience is intended to include other clinicians besides neurosurgeons, there should have been more of an attempt to establish the basics. For example, the chapter on "Acute Shunt Malfunction" begins by stating that the author assumes that the reader is familiar with shunting systems; the chapter on " A c u t e Management of Subarachnoid Hemorrhage" offers very little discussion on the wide variety of clinical symptoms and presentations, an area that is of great interest to most emergency physicians. The chapter on '~The Acute/ Emergent Management of Vertebral Column Fracture-Dislocation Injuries" provides no discussion of the various cord syndromes. The chapter on "Cerebral Infectious Processes" offers no discussion on the management of viral meningitis.
239
Several of the chapters recommend management strategies that are controversial at best. In the chapter on "Status Epilepticus," Table 4 implies that a lumbar puncture (LP) should be performed before computed tomography (CT) if meningitis is suspected, but does not emphasize the importance of instituting treatment for bacterial meningitis as soon as the diagnosis is suspected. Along the same lines, the chapter on "Cerebral Infectious Processes" (page 168) recommends cultures before antibiotics are started, although in actual practice time factors dictate that clinicians begin antibiotics before CT and LP. Almost every chapter would have benefited from the inclusion of more tables, especially tables that clearly provide management guidelines. This absence of management tables limits the book's value in emergent situations. For example, the chapter on "Acute Management of Subarachnoid Hemorrhage" presents management recommendations over five pages. The chapter on "Status Epilepticus" has a management table (Table 4); however, phenytoin, which is included in the table, is not mentioned at all in the text! Other surprises in the chapter on "Status Epilepticns" include the recommendation to give a hyperosmolar load of dextrose to patients in status instead of simply checking a dextrostix, and failure to discuss other pharmacological interventions that are available in managing status when pentobarbital is not available. General Recommendations: I looked forward to reading this book, based on its comprehensive table of contents, and anticipated a good general reference book addressing the difficult decisions in managing neurosurgical patients. Overall, the book does an adequate job discussing the topics, but orientation and presentation limit the value for an emergency medicine library. This is particularly true in respect to the high price of $90.00 for each volume. Sixty-five pages of CME questions is of little value in a reference book, and I think that the book would have been better served had it been published as a one-volume, 343-page book, with the option of purchasing the CME questions separately. ANDY JAGODA, MD
Division of Emergency Medicine University of Florida Jacksonville, FL The Airway: Emergency Management. Robert H. Dailey, Barry Simon, Garry P. Young, Ronald D. Stewart. Mosby Yearbook, 1992.
Authorship: The editors and a vast majority of the authors of this textbook are practicing emergency physicians. Many of them are involved with Emergency Medicine training programs and a large number of them are involved with some aspect of airway management research. Of the non-emergency medicine contributors, most are pulmonologists, anesthesiologists, or intensivists who are obviously involved with airway management. The editors and contributing authors have credibility and substantial experience in the area of airway management. Overview: Of all the skills required for the practice of Emergency Medicine, none is as important or livesaving as airway assessment and intervention for the patient with respiratory embarrassment. Undoubtedly, the hallmark of the emergency physician is decisiveness about the approaches to securing the airway of a critically ill or injured patient. Finally, here is a textbook that brings together all of the essential airway management information necessary to heighten the skills of practicing emergency physicians. Drs Dailey, Simon, Young, and Stewart are the editors of an excellent textbook. This textbook is ideal for the practicing emergency physician, the emergency physician in training, or any clinician faced with the need to urgently manage a patient's airway. It is a complete treatise on the topic of airway management and is essential reading for emergency physicians who may find that their current armamentarium of airway techniques is deficient.