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Paramedic Emergency Care, ed 2
Book Reviews Paramedic Emergency Care, ed 2 Vincent N Mosesso, Jv, MD, FACEP Donald M Yealy, MD, FACEP
Advances in Trauma and
Paramedic Emergency Care, ed 2 Bledsoe, Porter, and Shade 1994, BradyJPrentice-Hall, Inc 1.058 pages
Critical Care, v o l 8 Wm John Zehner, Jv, MD, FACEP
Copy right 0by the American College of Emergency Phys~cians.
Textbooks for paramedic training have become much more sophisticated since the first edition of Nancy Caroline's Emergency Care in the Streets was published in 1980. Brady's Paramedic Emergency Care (ed 2)by Bledsoe, Porter, and Shade further advances the quality of educational material available for paramedic training. This 1,058-page, hardbound volume presents up-to-date information in a well-designed and easy-to-read package. The authors have organized the contents according to the Department of Transportation's 1985 national standard curriculum and divided the text into six parts: Prehospital Environment, Preparatory Information, Trauma Emergencies, Medical Emergencies, Obstetrical/Gynecological Emergencies, and Psychiatric Emergencies. The medical and educational expertise of the authors and the array of qualified reviewers have produced an impressive text that is properly focused for its intended audience. Each chapter begins with objectives and a case study, which serve well to direct the student to key concepts and to stimulate interest in the material. Chapters related to specific medical problems follow the
format of relevant anatomy and physiology, pathophysiology, patient assessment, and management. The reading list at the end of each chapter is good in concept but should be more extensive. The overall content of the material is quite good. In particular, w e were impressed with the clarity and accuracy of the arrhythmia section, which included the recently disseminated advanced cardiac life support revisions. The section on trauma includes an excellent description of trauma kinetics (both blunt and penetrating) and thorough, well-written discussions of the most important and commonly encountered injuries. A close review of the chapter on asthma reveals it to be quite up to date, with appropriate emphasis on objective measurement of airflow, pulse oximetry, and treatment with oxygen, P-agonists, and steroids. Other sections that should be complimented are the opening discussion on bloodborne pathogens and infectious diseases and the attention given to stress management and the Critical Incident Stress Debriefing system. Perhaps the most impressive feature in this textbook is the large number of full-color photographs and illustrations. The anatomy and physiology chapter is particularly notable for its color plates of every body system. These will serve as a valuable reference not only for the course itself but for years to come. The plates are in an appropriate level of detail to be complete without being obfuscated by irrelevant
details. The illustrations and photographs throughout each chapter are of exceptional quality and serve to enhance and clarify the text quite successfully. In an endeavor of this magnitude, one would expect to find some shortcomings. In some areas, the content of the material could be expanded. An example is the chapter "Medico-legal Considerations." The text states that the medic may accept a refusal "if [the patient] still remains alert and oriented" (p 47). Missing is a discussion of the concept of competency-what it is, the need to determine and document its presence, and how to do this. Another example is the failure to indicate the need to correlate pulse recognition by the pulse oximeter with the patient's actual pulse to assure accuracy. The discussion on carbon dioxide detection for evaluation of endotracheal tube placement also should be expanded to include circumstances that lead to confusing readings. Key concepts could be highlighted more prominently, especially to assist the student i n culling these from the otherwise well-written text. For instance, although the section on asthma includes appropriate discussion on the P-agonists, the main role of these agents and the importance of using them aggressively do not stand out as critical facts on which the student should focus. Similarly, w e would like to see greater emphasis on the urgency of external pacing for patients with severely symptomatic bradycardia. Another exam/
A N N A L S O F EMERGENCY MEDICINE
25.4
APRIL 1995
BOOK REVIEWS
ple is that although information on the contraindications to verapamil (wide QRS complex and hypotension) is present, it is not clearly delineated. Overall, Bledsoe, Porter, and Shade have produced an excellent textbook that will be of great value to both the student and the experienced paramedic. The illustrations and photographs are superior and can be used for a variety of educational purposes; they are well worth the cost of the text itself. The coverage is comprehensive, the content accurate and generally thorough, the readability excellent. For these reasons, this text could also serve those emergency medical services and emergency physicians who would like a reference for paramedic-level training and knowledge. Vincent N Mosesso, Jr, MD, FACEP Division of Emergency Medicine University of Pittsburgh Affiliated Residency in Emergency Medicine Donald M Yealy, MD, FACEP Division of Emergency Medicine University of Pittsburgh
Advances in Trauma and Critical Care, vol 8 KI Maull, HC Cleveland, DV Feliciano, et al 1993, CV Mosby Co 298 pages Keeping up with advances in trauma and critical care can be a daunting task, but it is one made easier by Advances in Trauma and Critical Care. The reader has the ability to choose a subject of particular interest or question and review the latest literature and recommendations regarding that topic. Volume 8 is one of a series dealing with recent changes in the treatment of the acutely traumatized individual. The textbook includes 11 chapters that contain topics ranging from penetrating torso trauma to ethical considerations in the ICU. Each chapter appears to be designed to
A P R I L 1995
25 4
stand separately from the others. Most chapters are 20 to 30 pages long, well referenced, and well written. The book is clearly directed toward surgeons caring for the acutely traumatized patient. The references to emergency physicians are few and far between. However, almost every chapter has utility for the emergency physician. I found a marked difference in quality from chapter to chapter. The individual authors appear to do a better job with specific injuries, such as in the chapter on blunt traumatic rupture of the thoracic aorta, as opposed to those chapters dealing with more general topics such as penetrating torso trauma. The reader should be wary of accepting certain treatment and management guidelines at face value. Some recommendations appear to be based on the authors' practice model, with little supporting evidence for its use. For example, the chapter on penetrating torso trauma suggests an algorithm for management of penetrating abdominal stab wounds. This management algorithm calls for patients who have received stab wounds to the abdomen and who exhibit shock or unstable vital signs to receive 1,500 mL of lactated Ringer's solution. If they "stabilize" and have no abdominal signs, they are admitted and observed without further diagnostic studies or laparotomy. This is based on the authors' practice in the hospital, with few supporting references. One of the articles referenced to justify this treatment algorithm actually advocates hemodynamic instability as an indication for immediate laparotomy.' I recommend that the reader review the references for any management guidelines. Chapters that I thought were particularly well written and useful were "Blunt Traumatic Rupture of the Thoracic Aorta," "Head Injury From the General Surgeon's Perspective" (which could have been titled "Head Injury From the Emergency Physician's Perspective"), and "Current Management of Hand Injuries." The chapter on blunt trau-
ANNALS O F EMERGENCY MEDICINE
matic rupture of the thoracic aorta gives an excellent discussion, with ample references, on the diagnostic modalities used in diagnosing this injury. This discussion includes the use and sensitivity of chest radiography, the selected use of dynamic chest computed tomography, the latest use of transesophageal echocardiography, and the old gold standard of arteriography. Most chapters discuss the specific surgical management of various injuries, such as the Pringle maneuver used in hepatotomy for operative repair in liver trauma. These obviously have no use in the practice of emergency medicine. However, all the chapters have a good beginning discussion on the management, stabilization, and diagnostic modalities used in the treatment of various injuries. The individual chapters vary in their usefulness to emergency physicians and in their accuracy and style, but are generally well written and instructional. I believe volume 8 in Advances in Trauma and Critical Care, including previous and subsequent volumes, would be useful to the emergency physician routinely involved in the care of the acutely traumatized patient. Wm John Zehner, Jr, MD, FACEP State University of New York Health Science Center Svracuse 1. Zubowsk~R, Naliathambi M, lvatury R, et al. Selective consewatism in abdominal stab wounds- The eflicacy o/serial physical examination J Trauma 1988;28:16651668.
Advances in Trauma and
Paramedic Emergency Care, ed 2 Bledsoe, Porter, and Shade 1994, BradyJPrentice-Hall, Inc 1.058 pages
Critical Care, v o l 8 Wm John Zehner, Jv, MD, FACEP
Copy right 0by the American College of Emergency Phys~cians.
Textbooks for paramedic training have become much more sophisticated since the first edition of Nancy Caroline's Emergency Care in the Streets was published in 1980. Brady's Paramedic Emergency Care (ed 2)by Bledsoe, Porter, and Shade further advances the quality of educational material available for paramedic training. This 1,058-page, hardbound volume presents up-to-date information in a well-designed and easy-to-read package. The authors have organized the contents according to the Department of Transportation's 1985 national standard curriculum and divided the text into six parts: Prehospital Environment, Preparatory Information, Trauma Emergencies, Medical Emergencies, Obstetrical/Gynecological Emergencies, and Psychiatric Emergencies. The medical and educational expertise of the authors and the array of qualified reviewers have produced an impressive text that is properly focused for its intended audience. Each chapter begins with objectives and a case study, which serve well to direct the student to key concepts and to stimulate interest in the material. Chapters related to specific medical problems follow the
format of relevant anatomy and physiology, pathophysiology, patient assessment, and management. The reading list at the end of each chapter is good in concept but should be more extensive. The overall content of the material is quite good. In particular, w e were impressed with the clarity and accuracy of the arrhythmia section, which included the recently disseminated advanced cardiac life support revisions. The section on trauma includes an excellent description of trauma kinetics (both blunt and penetrating) and thorough, well-written discussions of the most important and commonly encountered injuries. A close review of the chapter on asthma reveals it to be quite up to date, with appropriate emphasis on objective measurement of airflow, pulse oximetry, and treatment with oxygen, P-agonists, and steroids. Other sections that should be complimented are the opening discussion on bloodborne pathogens and infectious diseases and the attention given to stress management and the Critical Incident Stress Debriefing system. Perhaps the most impressive feature in this textbook is the large number of full-color photographs and illustrations. The anatomy and physiology chapter is particularly notable for its color plates of every body system. These will serve as a valuable reference not only for the course itself but for years to come. The plates are in an appropriate level of detail to be complete without being obfuscated by irrelevant
details. The illustrations and photographs throughout each chapter are of exceptional quality and serve to enhance and clarify the text quite successfully. In an endeavor of this magnitude, one would expect to find some shortcomings. In some areas, the content of the material could be expanded. An example is the chapter "Medico-legal Considerations." The text states that the medic may accept a refusal "if [the patient] still remains alert and oriented" (p 47). Missing is a discussion of the concept of competency-what it is, the need to determine and document its presence, and how to do this. Another example is the failure to indicate the need to correlate pulse recognition by the pulse oximeter with the patient's actual pulse to assure accuracy. The discussion on carbon dioxide detection for evaluation of endotracheal tube placement also should be expanded to include circumstances that lead to confusing readings. Key concepts could be highlighted more prominently, especially to assist the student i n culling these from the otherwise well-written text. For instance, although the section on asthma includes appropriate discussion on the P-agonists, the main role of these agents and the importance of using them aggressively do not stand out as critical facts on which the student should focus. Similarly, w e would like to see greater emphasis on the urgency of external pacing for patients with severely symptomatic bradycardia. Another exam/
A N N A L S O F EMERGENCY MEDICINE
25.4
APRIL 1995
BOOK REVIEWS
ple is that although information on the contraindications to verapamil (wide QRS complex and hypotension) is present, it is not clearly delineated. Overall, Bledsoe, Porter, and Shade have produced an excellent textbook that will be of great value to both the student and the experienced paramedic. The illustrations and photographs are superior and can be used for a variety of educational purposes; they are well worth the cost of the text itself. The coverage is comprehensive, the content accurate and generally thorough, the readability excellent. For these reasons, this text could also serve those emergency medical services and emergency physicians who would like a reference for paramedic-level training and knowledge. Vincent N Mosesso, Jr, MD, FACEP Division of Emergency Medicine University of Pittsburgh Affiliated Residency in Emergency Medicine Donald M Yealy, MD, FACEP Division of Emergency Medicine University of Pittsburgh
Advances in Trauma and Critical Care, vol 8 KI Maull, HC Cleveland, DV Feliciano, et al 1993, CV Mosby Co 298 pages Keeping up with advances in trauma and critical care can be a daunting task, but it is one made easier by Advances in Trauma and Critical Care. The reader has the ability to choose a subject of particular interest or question and review the latest literature and recommendations regarding that topic. Volume 8 is one of a series dealing with recent changes in the treatment of the acutely traumatized individual. The textbook includes 11 chapters that contain topics ranging from penetrating torso trauma to ethical considerations in the ICU. Each chapter appears to be designed to
A P R I L 1995
25 4
stand separately from the others. Most chapters are 20 to 30 pages long, well referenced, and well written. The book is clearly directed toward surgeons caring for the acutely traumatized patient. The references to emergency physicians are few and far between. However, almost every chapter has utility for the emergency physician. I found a marked difference in quality from chapter to chapter. The individual authors appear to do a better job with specific injuries, such as in the chapter on blunt traumatic rupture of the thoracic aorta, as opposed to those chapters dealing with more general topics such as penetrating torso trauma. The reader should be wary of accepting certain treatment and management guidelines at face value. Some recommendations appear to be based on the authors' practice model, with little supporting evidence for its use. For example, the chapter on penetrating torso trauma suggests an algorithm for management of penetrating abdominal stab wounds. This management algorithm calls for patients who have received stab wounds to the abdomen and who exhibit shock or unstable vital signs to receive 1,500 mL of lactated Ringer's solution. If they "stabilize" and have no abdominal signs, they are admitted and observed without further diagnostic studies or laparotomy. This is based on the authors' practice in the hospital, with few supporting references. One of the articles referenced to justify this treatment algorithm actually advocates hemodynamic instability as an indication for immediate laparotomy.' I recommend that the reader review the references for any management guidelines. Chapters that I thought were particularly well written and useful were "Blunt Traumatic Rupture of the Thoracic Aorta," "Head Injury From the General Surgeon's Perspective" (which could have been titled "Head Injury From the Emergency Physician's Perspective"), and "Current Management of Hand Injuries." The chapter on blunt trau-
ANNALS O F EMERGENCY MEDICINE
matic rupture of the thoracic aorta gives an excellent discussion, with ample references, on the diagnostic modalities used in diagnosing this injury. This discussion includes the use and sensitivity of chest radiography, the selected use of dynamic chest computed tomography, the latest use of transesophageal echocardiography, and the old gold standard of arteriography. Most chapters discuss the specific surgical management of various injuries, such as the Pringle maneuver used in hepatotomy for operative repair in liver trauma. These obviously have no use in the practice of emergency medicine. However, all the chapters have a good beginning discussion on the management, stabilization, and diagnostic modalities used in the treatment of various injuries. The individual chapters vary in their usefulness to emergency physicians and in their accuracy and style, but are generally well written and instructional. I believe volume 8 in Advances in Trauma and Critical Care, including previous and subsequent volumes, would be useful to the emergency physician routinely involved in the care of the acutely traumatized patient. Wm John Zehner, Jr, MD, FACEP State University of New York Health Science Center Svracuse 1. Zubowsk~R, Naliathambi M, lvatury R, et al. Selective consewatism in abdominal stab wounds- The eflicacy o/serial physical examination J Trauma 1988;28:16651668.