- Email: [email protected]
Practical procedures andaccident and emergency medicine
The Journal of Emergency Medone, Vol 5, pp 441-443. 1987
Printed in Ihe USA
Cl PRACTICAL PROCEDURES IN ACCIDENT AND EMERGENCY MEDICINE. By David G. Ferguson and Stuart M. Lord. 237 pp. London, Butterworths 8, Co Ltd, 1986, $29.95.
The textbook is small enough to fit in a white coat or leather bag. The cost is reasonable for its size and detail. The text is unlikely to hold up to heavy use for more than a year, although beyond a year’s use the student should be ready for a more comprehensive text. The illustrations are helpful and the discussions complementary, although many of the techniques can not be learned by review of the manual alone. Discussions of common complications and advice for avoiding pitfalls are quite limited in the text. Several common procedures such as lumbar puncture, tonometry, Seldinger (introducer wire) catheter placement, and passage of a naso- or orogastric tube are not discussed. The indications for procedures are rather sketchy and occasionally complemented by contraindications. There are a number of cultural differences in this text from Great Britain when compared with procedures texts written in the United States. Cricothyrotomy seems to be emphasized over intubation. Both cricothyrotomy and endotracheal intubation stress extending the patient’s neck without cautioning about associated neck injuries. Tube thoracostomy is only described for the anterior second intercostal position. The defibrillation section does not mention the asynchronous mode and cardioversion is not discussed. These issues aside, the book has value for the student who desires a quick over-
The performance of clinical procedures represents an important component of the practice of emergency medicine. The emergency physician must know the indications for, the techniques of, the alternatives to, and the complications of procedures that overlap a variety of other specialty areas. Texts describing clinical procedures have self-triaged themselves into two categories: the large, comprehensive, and more costly authoritative texts and the smaller, less expensive texts of limited breadth and depth. The subject of this review fits the latter category nicely. The text is directed toward “senior medical students and newly qualified doctors.” Such a procedures text can provide the student with a means to rapidly preview a procedure before undertaking clinical instruction from a more senior physician. In general, such a text should have the following characteristics: small size yet containing procedures of common use, durability (if to be carried by the student), many procedurally helpful illustrations, concise descriptions of aspects not clarified by illustrations, low cost, and brief discussions of common complications with advice on how to avoid pitfalls.
~
Copyright F‘1987 Pergamon Journals Ltd
??
Book Reviews, which keeps readers informed of important publications in the emergency medicine field, is coordinated by Edward J Otten, MD, Associate Professor and Director of Prehospital Care, Department of Emergency Medicine, University of Cincinnati College of Medicine.
0736-4679/87 $3 .OO + .OO 441
The Journal of Emergency
442
view of procedures that will be performed or observed during the junior and senior years of medical school. The specialist in emergency medicine or the advanced resident in emergency medicine, however, will want a more comprehensive text. Jerris R. Hedges, MD, MS University of Cincinnati Medical Center
? ?SPINAL INJURIES (ed 2). By David Yashon. 546 pp. Norwalk, Conn, Appleton-Century-Crofts, 1986, $69.95
The author is a neurosurgeon at Ohio State University. He sets out to write “an encyclopedia of all aspects of spinal cord and vertebral injury” (which includes a comprehensive bibliography) for physicians, medical students, and “associated professionals who care in some way for patients with a spinal injury.” He falls short of this lofty goal. The book is a highly referenced compilation of topics related to spinal injury. What is gained by an excessively referenced broad scope is lost by the lack of depth and organization. The result is an array of topics presented in an awkward and difficult-toread fashion. The book contains 31 chapters that are arranged by topics. The topics selected seem all encompassing and include such enticing titles as “Birth Injury” and “Catecholamines in Spinal Injury,” However, the organization of the book does not seem to follow a logical process. For example, Chapter 3 is titled “Anatomy and Physiology” and Chapter 26 is titled “Biomechanics.” Some chapters are anatomically organized, eg, “Lower Cervical, Thoracic, and Lumbar Spinal Cord Injuries,” whereas others are based on mechanism of injury, eg, “Stab Wounds of the Spinal Cord.” The chapters vary in comprehensiveness. Some sections such as “Regeneration in the Central Nervous System” are in
Medicine
great depth yet others such as the section on “Emergency Management” are very cursory. There are instances of redundancy and fragmentary presentations. For example, the Queckenstedt test is mentioned in three places but never described. A logical organization of the subjects within the individual chapters is also lacking. Paragraphs consist of brief literature reviews of discrete topics. Subheadings are rarely used to define and delineate the different topics. One of the aims of the author was to provide a comprehensive bibliography. He does accomplish this by providing a long list of references with each chapter. Unfortunately, the readability of most of the chapters suffers from this goal. The pervasive style of presentation is in the form of a literature review with innumerable article references and authors’ names intertwined among their data, results, and conclusions. The author seldomly offers his impressions for guidance or clarification. The referencing may have been to excess, with inclusion of many case reports and articles from nonrefereed journals. The quality of illustrations and photographs is poor to fair. The black and white photographs of gross and microscopic pathology are illegible. Radiographs can be interpreted only if gross abnormalities are present; few had accompanying line illustrations. Some radiographs are included without references in the text. The illustrations of anatomy and surgical techniques are sparse; definitive texts would be more useful for this purpose. The index is above average. Although a few gaps exist (eg, anterior cord syndrome), most key words were included. Most terms had multiple pages listed but italics are not used to denote priority page numbers. The usefulness of this text to emergency physicians seems very limited. The text does offer a pathway to a literature search and presents some of the pertinent and recent research in the field. However, the poor organization, fragmented presenta-
Printed in Ihe USA
Cl PRACTICAL PROCEDURES IN ACCIDENT AND EMERGENCY MEDICINE. By David G. Ferguson and Stuart M. Lord. 237 pp. London, Butterworths 8, Co Ltd, 1986, $29.95.
The textbook is small enough to fit in a white coat or leather bag. The cost is reasonable for its size and detail. The text is unlikely to hold up to heavy use for more than a year, although beyond a year’s use the student should be ready for a more comprehensive text. The illustrations are helpful and the discussions complementary, although many of the techniques can not be learned by review of the manual alone. Discussions of common complications and advice for avoiding pitfalls are quite limited in the text. Several common procedures such as lumbar puncture, tonometry, Seldinger (introducer wire) catheter placement, and passage of a naso- or orogastric tube are not discussed. The indications for procedures are rather sketchy and occasionally complemented by contraindications. There are a number of cultural differences in this text from Great Britain when compared with procedures texts written in the United States. Cricothyrotomy seems to be emphasized over intubation. Both cricothyrotomy and endotracheal intubation stress extending the patient’s neck without cautioning about associated neck injuries. Tube thoracostomy is only described for the anterior second intercostal position. The defibrillation section does not mention the asynchronous mode and cardioversion is not discussed. These issues aside, the book has value for the student who desires a quick over-
The performance of clinical procedures represents an important component of the practice of emergency medicine. The emergency physician must know the indications for, the techniques of, the alternatives to, and the complications of procedures that overlap a variety of other specialty areas. Texts describing clinical procedures have self-triaged themselves into two categories: the large, comprehensive, and more costly authoritative texts and the smaller, less expensive texts of limited breadth and depth. The subject of this review fits the latter category nicely. The text is directed toward “senior medical students and newly qualified doctors.” Such a procedures text can provide the student with a means to rapidly preview a procedure before undertaking clinical instruction from a more senior physician. In general, such a text should have the following characteristics: small size yet containing procedures of common use, durability (if to be carried by the student), many procedurally helpful illustrations, concise descriptions of aspects not clarified by illustrations, low cost, and brief discussions of common complications with advice on how to avoid pitfalls.
~
Copyright F‘1987 Pergamon Journals Ltd
??
Book Reviews, which keeps readers informed of important publications in the emergency medicine field, is coordinated by Edward J Otten, MD, Associate Professor and Director of Prehospital Care, Department of Emergency Medicine, University of Cincinnati College of Medicine.
0736-4679/87 $3 .OO + .OO 441
The Journal of Emergency
442
view of procedures that will be performed or observed during the junior and senior years of medical school. The specialist in emergency medicine or the advanced resident in emergency medicine, however, will want a more comprehensive text. Jerris R. Hedges, MD, MS University of Cincinnati Medical Center
? ?SPINAL INJURIES (ed 2). By David Yashon. 546 pp. Norwalk, Conn, Appleton-Century-Crofts, 1986, $69.95
The author is a neurosurgeon at Ohio State University. He sets out to write “an encyclopedia of all aspects of spinal cord and vertebral injury” (which includes a comprehensive bibliography) for physicians, medical students, and “associated professionals who care in some way for patients with a spinal injury.” He falls short of this lofty goal. The book is a highly referenced compilation of topics related to spinal injury. What is gained by an excessively referenced broad scope is lost by the lack of depth and organization. The result is an array of topics presented in an awkward and difficult-toread fashion. The book contains 31 chapters that are arranged by topics. The topics selected seem all encompassing and include such enticing titles as “Birth Injury” and “Catecholamines in Spinal Injury,” However, the organization of the book does not seem to follow a logical process. For example, Chapter 3 is titled “Anatomy and Physiology” and Chapter 26 is titled “Biomechanics.” Some chapters are anatomically organized, eg, “Lower Cervical, Thoracic, and Lumbar Spinal Cord Injuries,” whereas others are based on mechanism of injury, eg, “Stab Wounds of the Spinal Cord.” The chapters vary in comprehensiveness. Some sections such as “Regeneration in the Central Nervous System” are in
Medicine
great depth yet others such as the section on “Emergency Management” are very cursory. There are instances of redundancy and fragmentary presentations. For example, the Queckenstedt test is mentioned in three places but never described. A logical organization of the subjects within the individual chapters is also lacking. Paragraphs consist of brief literature reviews of discrete topics. Subheadings are rarely used to define and delineate the different topics. One of the aims of the author was to provide a comprehensive bibliography. He does accomplish this by providing a long list of references with each chapter. Unfortunately, the readability of most of the chapters suffers from this goal. The pervasive style of presentation is in the form of a literature review with innumerable article references and authors’ names intertwined among their data, results, and conclusions. The author seldomly offers his impressions for guidance or clarification. The referencing may have been to excess, with inclusion of many case reports and articles from nonrefereed journals. The quality of illustrations and photographs is poor to fair. The black and white photographs of gross and microscopic pathology are illegible. Radiographs can be interpreted only if gross abnormalities are present; few had accompanying line illustrations. Some radiographs are included without references in the text. The illustrations of anatomy and surgical techniques are sparse; definitive texts would be more useful for this purpose. The index is above average. Although a few gaps exist (eg, anterior cord syndrome), most key words were included. Most terms had multiple pages listed but italics are not used to denote priority page numbers. The usefulness of this text to emergency physicians seems very limited. The text does offer a pathway to a literature search and presents some of the pertinent and recent research in the field. However, the poor organization, fragmented presenta-