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Pediatric emergency medicine
Book Reviews Pediatric Emergency Medicine. By Ehrlich FE, Heldrich FJ, Tepas JJ III. Rockville, Maryland, Aspen Publications, 1987, 556 pages. ISBN 892987, $88.00. The most recent contribution in the area of pediatric emergency medicine, this textbook is written primarily for the generalist who sees infants and children in the emergency department setting, and secondarily for the pediatrician who works occasionally in the emergency department (as a reference text oriented toward emergencies in pediatrics). The book is organized into three sections. Part I (17 pages) addresses cardiac and trauma resuscitation in children, and Part II (26 pages) common pediatric emergencies. Part III (513 pages) comprises the bulk of the text and addresses disease presentations by organ systems. For most systems, matching chapters have been written with noninvasive/invasive orientations. Thus, a chapter on central nervous system disorders is followed by chapters on central nervous system injuries and craniofacial injuries. The chapters themselves are generally well organized and always start with a one- or two-page review of the appropriate approach to the database acquisition for patients with problems referable to the organ system, which I found appealing. The writing style is generally easy to read; however, the content is uneven, both within chapters and from chapter to chapter, even for commonly encountered pediatric emergencies. For example, good extensive sections on diabetic ketoacidosis, child abuse, and sexual abuse are encountered, but other important topics, such as HenochSchdnlein purpura and emergent management of hemophilia, are treated cursorily. Infrequently, a proficient review of the clinical approach to a particular problem in a longer section is followed by an abbreviated summary of differential diagnosis and/or treatment options. For example, the chapter on initial care of the injured child beautifully reviews the sequential approach to the primary and secondary survey, but it does not assess resuscitation phase therapies, problems relating to age in airway and vascular accesses, physiologic measurements, and temperature control. A third type of unevenness is encountered in treatment recommendations. In some sections, they are too perfunctory and general in nature to be helpful; in others, therapeutic recommendations deal largely with inpatient management, with little regard for what practical therapy can be initiated in the emergency department (for example, for diabetic ketoacidosis) . The reproductions (illustrations, tables, radiographs, photographs, etc.) are generally good in quality but sparingly used. For example, no pictures or illustrations are used in
Book or software for review in this column shoufd be sent to the American Journal of Emergency Medicine: 3800 Reservoir Road NW, Washington, DC 20007.
the dermatology section. Accessibility to information, through the table of contents and index, is generally good. In summary, this book contains many excellent sections and chapters, and the juxtaposition of surgical/medical approaches makes it useful as a reference text in the department library or for topical reading. However, its unevenness makes it disappointing as a comprehensive review of pediatric emergency medicine. The book will have utility for the emergency physician (i.e., house officer or “infrequent” nonspecialist) for whom it was written; however, those who practice pediatric emergency medicine daily and those who wish for a definitive pediatric emergency medicine text may find it disappointing and likely will need to supplement this book with sections from another standard pediatric text. LOUIS S. BINER,MD Texas Tech University El Paso, Texas The field of pediatric emergency medicine is a relatively new subspecialty, with formalized training being available for only 6 to 7 years. The first major textbook in this field, Textbook of Pediatric Emergency Medicine, edited by Drs. Fleisher and Ludwig, was published only 3 years ago. The field of pediatric emergency medicine, however, is enlarging rapidly, and the number of subspecialists in it is growing. Therefore, it is only appropriate that a second major textbook is now available that can be used as a resource both in clinical situations and in the instruction of residents and fellows. The contributing authors all herald from major teaching institutions and have impressive academic credentials, which is reflected in the particular subspecialty area of pediatrics they address in the book. One subspecialty area that is underrepresented in this book’s authorship is that of pediatric emergency medicine; the only pediatric emergency specialist listed as a contributing author is Dr. Ehrlich himself. The contents is clearly organized into anatomic regions, i.e., respiratory disorders, disorders of the central nervous system, etc. Each of these areas is subdivided into more specific anatomic areas, and these areas, in turn, are subdivided again into specific disease entities and injuries. This structure, coupled with the 1Zpage index, makes locating a desired disease entity by name or symptoms relatively easy. The written information in the book is clearly stated and presented in a precise and succinct manner. One of the book’s highlights is the several tables and algorithms that supplement and outline the written material. This textbook contains fewer illustrations, radiographs, and pictures of clinical material than does the Fleisher-Ludwig book, but this is a mild shortcoming. A comparison between this book and the Fleisher-Ludwig textbook is inevitable. The Fleisher-Ludwig textbook contains a slightly broader scope of information pertaining to pediatric emergency medicine. For instance, it contains a section on the administration of the emergency department 73
AMERICAN JOURNAL OF EMERGENCY MEDICINE H Volume 6, Number 1 W January 1988
and another on procedures performed in that department. Sections on these topics are lacking in Ehrlich et al.‘s book. Although both books contain clear and accurate information on drug dosing, the Fleisher/Ludwig textbook seems, in many areas, to contain more information and more details. For example, just nine pages in Ehrlich et al.‘s textbook are devoted to cardiopulmonary resuscitation. The current textbook, however, utilizes information tables more effectively to summarize and emphasize important points, and several sections are outstanding, which contribute to its usefulness as a basic textbook. Two of the better sections in the book are on child abuse and respiratory disorders. If the Fleisher-Ludwig book is already in your library, the addition of this textbook will not significantly increase your resource information. The cost, though, is slightly less than that of the Fleisher-Ludwig book. All factors considered, I believe Ehrlich et al.‘s textbook is good and could prove helpful in any emergency department. MICHAEL ALTIERI, MD Fairfax Hospital Falls Church, Virginia
A Clinical Manual of Emergency Pediatrics. By Crain EF, Gershel JC. Norwalk, Connecticut, Appleton-centuryCrofts, 1986, 524 pages. ISBN O-8385-1126-0, $24.95 (paperback). Physicians who manage pediatric emergencies, either in the hospital or office setting, are the intended audience for this book. Its pocket-size makes it easily portable and accessible. The contents of the text are organized according to disease category (i.e., hematologic emergencies, infectious disease emergencies, resuscitation, etc.). Within each section, specific disorders are discussed individually, in the following format: introduction, clinical presentation, diagnosis, emergency department management, and indications for admission. Tables and diagrams are occasionally interspersed, and pertinent references are listed at the end of each section. The authors do a good job of addressing both common and less-common pediatric emergency topics. Sections on dental and gynecologic emergencies have (thankfully) been included. The toxicology section is nicely arranged and includes some particularly helpful tables describing toxidromes, odors, nontoxic ingestions, and physical findings. In general, the text is well organized and comprehensive, yet concise. The only shortcoming of the book is that which plagues all texts-that is, the constant infusion of new information into the medical literature. Even since the recent release of this manual, several antibiotic and technical advances have come about that are influencing pediatric emergency care significantly. For example, the recent emergence of betalactamase-producing strains of gonococci have mandated the use of ceftriaxone for the treatment of pelvic inflammatory disease in many institutions. Similarly, intraosseous infusion and venous access by Seldinger technique have replaced surgical cutdown as the procedure(s) of choice for difficult cases of venous access during resuscitation. Other examples apply in other chapters. However, given the limits 74
of reference texts, this manual does a very good job of presenting “current” information. For physicians who encounter pediatric emergencies, particularly those who do not manage pediatric patients on a regular basis, this manual is a valuable reference. I have noted a number of pediatric interns and residents who have purchased and carry the book throughout their emergency department rotations. I recommend the book as a good quick reference for pediatric emergency management, especially for those in training or with limited pediatric experience. M. DOUGLASBAKER, MD University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
Emergency Medicine: Self-Assessment and Review. By Thomas HA Jr, Koehler J, O’Connor RE. St. Louis, C.V. Mosby Co., 1985, 132 pages. $36.00. This emergency medicine review book, consisting of questions and answers, was designed to accompany the two-volume textbook Emergency Medicine: Concepts and Clinical Practice, by Rosen et al. Dr. Thomas, the primary author of this book, met Peter Rosen while completing his emergency medicine training in Denver. He and two resident coauthors compiled multiple questions from each chapter that were later critiqued by the editorial review board. This review board comprised all five authors from the parent text. The review book follows the exact format of the parent text, including corresponding chapters and answers with the page number from which the explanation was derived. Although in the preface the author states this book is not intended as a board review course, the proportion of questions on each topic is the same as that used on the written board examination, and the format is very similar. The questions are multiple choice and matching and include radiographs and electrocardiograms for interpretation. In general, the questions from each chapter are fairly representative of the major points to be learned and retained from the parent text. This is especially true of the sections on trauma (chapters 5, 13 to 26), orthopedic injuries (chapters 35 to 45), and toxicology (chapters 93- 101). The orthopedic chapter is the most complete, well-written section and includes all major fracture/dislocations with their associated neurovascular injuries. The explanations for the answers are very thorough, yet succinct. The section on spinal injury is also superb and includes easy-to-interpret diagrams of various cervical spine fractures for identilication and determination of stability. The chapters on toxicology are fairly complete and include such topics as alcohol-related disease, tricyclic antidepressants, tranquilizers, sedative-hypnotics, narcotics, salicylates and acetaminophen, hallucinogens, stimulants, corrosives, and hydrocarbons. The chapter on headaches covers the differential diagnoses quite well and includes migraines, subarachnoid bleeding, cluster headache, and temporal arteritis.
Book or software for review in this column shoufd be sent to the American Journal of Emergency Medicine: 3800 Reservoir Road NW, Washington, DC 20007.
the dermatology section. Accessibility to information, through the table of contents and index, is generally good. In summary, this book contains many excellent sections and chapters, and the juxtaposition of surgical/medical approaches makes it useful as a reference text in the department library or for topical reading. However, its unevenness makes it disappointing as a comprehensive review of pediatric emergency medicine. The book will have utility for the emergency physician (i.e., house officer or “infrequent” nonspecialist) for whom it was written; however, those who practice pediatric emergency medicine daily and those who wish for a definitive pediatric emergency medicine text may find it disappointing and likely will need to supplement this book with sections from another standard pediatric text. LOUIS S. BINER,MD Texas Tech University El Paso, Texas The field of pediatric emergency medicine is a relatively new subspecialty, with formalized training being available for only 6 to 7 years. The first major textbook in this field, Textbook of Pediatric Emergency Medicine, edited by Drs. Fleisher and Ludwig, was published only 3 years ago. The field of pediatric emergency medicine, however, is enlarging rapidly, and the number of subspecialists in it is growing. Therefore, it is only appropriate that a second major textbook is now available that can be used as a resource both in clinical situations and in the instruction of residents and fellows. The contributing authors all herald from major teaching institutions and have impressive academic credentials, which is reflected in the particular subspecialty area of pediatrics they address in the book. One subspecialty area that is underrepresented in this book’s authorship is that of pediatric emergency medicine; the only pediatric emergency specialist listed as a contributing author is Dr. Ehrlich himself. The contents is clearly organized into anatomic regions, i.e., respiratory disorders, disorders of the central nervous system, etc. Each of these areas is subdivided into more specific anatomic areas, and these areas, in turn, are subdivided again into specific disease entities and injuries. This structure, coupled with the 1Zpage index, makes locating a desired disease entity by name or symptoms relatively easy. The written information in the book is clearly stated and presented in a precise and succinct manner. One of the book’s highlights is the several tables and algorithms that supplement and outline the written material. This textbook contains fewer illustrations, radiographs, and pictures of clinical material than does the Fleisher-Ludwig book, but this is a mild shortcoming. A comparison between this book and the Fleisher-Ludwig textbook is inevitable. The Fleisher-Ludwig textbook contains a slightly broader scope of information pertaining to pediatric emergency medicine. For instance, it contains a section on the administration of the emergency department 73
AMERICAN JOURNAL OF EMERGENCY MEDICINE H Volume 6, Number 1 W January 1988
and another on procedures performed in that department. Sections on these topics are lacking in Ehrlich et al.‘s book. Although both books contain clear and accurate information on drug dosing, the Fleisher/Ludwig textbook seems, in many areas, to contain more information and more details. For example, just nine pages in Ehrlich et al.‘s textbook are devoted to cardiopulmonary resuscitation. The current textbook, however, utilizes information tables more effectively to summarize and emphasize important points, and several sections are outstanding, which contribute to its usefulness as a basic textbook. Two of the better sections in the book are on child abuse and respiratory disorders. If the Fleisher-Ludwig book is already in your library, the addition of this textbook will not significantly increase your resource information. The cost, though, is slightly less than that of the Fleisher-Ludwig book. All factors considered, I believe Ehrlich et al.‘s textbook is good and could prove helpful in any emergency department. MICHAEL ALTIERI, MD Fairfax Hospital Falls Church, Virginia
A Clinical Manual of Emergency Pediatrics. By Crain EF, Gershel JC. Norwalk, Connecticut, Appleton-centuryCrofts, 1986, 524 pages. ISBN O-8385-1126-0, $24.95 (paperback). Physicians who manage pediatric emergencies, either in the hospital or office setting, are the intended audience for this book. Its pocket-size makes it easily portable and accessible. The contents of the text are organized according to disease category (i.e., hematologic emergencies, infectious disease emergencies, resuscitation, etc.). Within each section, specific disorders are discussed individually, in the following format: introduction, clinical presentation, diagnosis, emergency department management, and indications for admission. Tables and diagrams are occasionally interspersed, and pertinent references are listed at the end of each section. The authors do a good job of addressing both common and less-common pediatric emergency topics. Sections on dental and gynecologic emergencies have (thankfully) been included. The toxicology section is nicely arranged and includes some particularly helpful tables describing toxidromes, odors, nontoxic ingestions, and physical findings. In general, the text is well organized and comprehensive, yet concise. The only shortcoming of the book is that which plagues all texts-that is, the constant infusion of new information into the medical literature. Even since the recent release of this manual, several antibiotic and technical advances have come about that are influencing pediatric emergency care significantly. For example, the recent emergence of betalactamase-producing strains of gonococci have mandated the use of ceftriaxone for the treatment of pelvic inflammatory disease in many institutions. Similarly, intraosseous infusion and venous access by Seldinger technique have replaced surgical cutdown as the procedure(s) of choice for difficult cases of venous access during resuscitation. Other examples apply in other chapters. However, given the limits 74
of reference texts, this manual does a very good job of presenting “current” information. For physicians who encounter pediatric emergencies, particularly those who do not manage pediatric patients on a regular basis, this manual is a valuable reference. I have noted a number of pediatric interns and residents who have purchased and carry the book throughout their emergency department rotations. I recommend the book as a good quick reference for pediatric emergency management, especially for those in training or with limited pediatric experience. M. DOUGLASBAKER, MD University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
Emergency Medicine: Self-Assessment and Review. By Thomas HA Jr, Koehler J, O’Connor RE. St. Louis, C.V. Mosby Co., 1985, 132 pages. $36.00. This emergency medicine review book, consisting of questions and answers, was designed to accompany the two-volume textbook Emergency Medicine: Concepts and Clinical Practice, by Rosen et al. Dr. Thomas, the primary author of this book, met Peter Rosen while completing his emergency medicine training in Denver. He and two resident coauthors compiled multiple questions from each chapter that were later critiqued by the editorial review board. This review board comprised all five authors from the parent text. The review book follows the exact format of the parent text, including corresponding chapters and answers with the page number from which the explanation was derived. Although in the preface the author states this book is not intended as a board review course, the proportion of questions on each topic is the same as that used on the written board examination, and the format is very similar. The questions are multiple choice and matching and include radiographs and electrocardiograms for interpretation. In general, the questions from each chapter are fairly representative of the major points to be learned and retained from the parent text. This is especially true of the sections on trauma (chapters 5, 13 to 26), orthopedic injuries (chapters 35 to 45), and toxicology (chapters 93- 101). The orthopedic chapter is the most complete, well-written section and includes all major fracture/dislocations with their associated neurovascular injuries. The explanations for the answers are very thorough, yet succinct. The section on spinal injury is also superb and includes easy-to-interpret diagrams of various cervical spine fractures for identilication and determination of stability. The chapters on toxicology are fairly complete and include such topics as alcohol-related disease, tricyclic antidepressants, tranquilizers, sedative-hypnotics, narcotics, salicylates and acetaminophen, hallucinogens, stimulants, corrosives, and hydrocarbons. The chapter on headaches covers the differential diagnoses quite well and includes migraines, subarachnoid bleeding, cluster headache, and temporal arteritis.