- Email: [email protected]
Ultrasound in emergency medicine
Book Reviews
authors, which is continuous infusion with simultaneous pressure recording. A 22 gauge intravenous catheter is inserted into the compartment and 0.7 cc saline is infused per day. Great emphasis is put on clinical symptoms and signs, and the author makes it quite clear that most compartmental syndromes can be diagnosed by careful clinical examination and evaluation of existing symptoms. Like many other clinical diagnoses, it is important to maintain a high index of suspicion. Interstitial pressure recordings are seldom necessary or decisive in the choice of treatment. In differentiating between arterial insufficiency, nerve lesions and compartmental syndromes, however, continuous pressure recording may be of great value. I was pleased to find that the post-ischaemic course is satisfactorily described. Indications for operation are thoroughly covered, as well as the operative techniques. The chapter entitled ‘Recurrent Compartmental Syndromes due to Intensive Use of Muscles’, by V. G. Veith, is especially valuable to doctors dealing with sportsmen. A number of case reports end the book, but their value is not up to the standards ofthe rest ofthe book. All in all, this is an outstanding book, with appropriate emphasis on pathophysiology, clinical symptoms and signs and practical details. It should be available in every accident department. M. ROMANUS Ultrasound in Emergency Medicine. Edited by K. J. W. Taylor and G. N. Viscomi. 236 x 160 mm. Pp. 208. 1981. Edinburgh.Churchill Livingstone. fl2.95. Ultrasonagraphic technology is advancing so rapidly that many of those not immediately involved are unaware of the remarkable development of the newest equipment or the diagnostic accuracy achievable by experts. Before dipping into any text on the subject. the tyro should know that the initial impression made by many ultrasonic images is of confusion: he should be aware that the operator has the advantage of multiple views of the relevant area in a variety of projections; and that interpretation is dependent on the skill of the operator. This book, one of a well-known series. describes the use of ultrasound in emergency medicine. The accident surgeon will be most interested in the chapters on the abdomen and particularly in the brief descriptions of the investigation of injuries of the spleen, liver, kidney and pancreas. Fluid collections such as haematomas, abscesses, urine collections or peritoneal free fluid as well as organ lacerations are examples of the types of lesion demonstrated. The book also covers a variety of other clinical emergencies where the ultrasonic techniaue is likelv to be of value. Thev include obstetrjcs, renal ‘failure, testicular swelling and examination of the neonatal skull; the cardiac chapter draws attention to the value of this type of examination in cases where there is haemopericardium and shows how the position of foreign bodies like bullets and shrapnel can be accurately determined within the heart. Echoencephalography for adults is included.
535 though in most places the accuracy of CAT scanning or angiography are now preferred. The text makes no mention of ultrasound of the limbs as this is an as yet unexplored field; but since, for example, it is not difficult to demonstrate the normal upper leg arteries as far as the popliteal trifurcation, there seems to be a place for evaluation of vascular injuries and there is little doubt that other applications will follow. This short book has a place in the Accident and Emergency Department as a guide to the value of ultrasound in a variety of situations. Surgeons concerned with trauma should know of its potential, even if the technique is not yet part of their regular investigative practice. J. C. MCLARNON Practical Wound Management. By John M. Finley. 254 x 204 mm. Pp. 226. Index. 1981. Year Book Publishers, London. f23.75. This book is in two parts, of which the first and smaller deals with the general background of the management of wounds and the second with techniques of dressing different parts of the body and different wounds and other breaches of the surface. The title, Practical Wound Management, might suggest that the reader will find details of surgical management but this is not the case, except in the most general terms. The author describes the book as being ‘for every concerned health care professional’. The people who are most likely to find it of practical value are nurses in training, casualty and industrial nurses and also medical students and junior medical staff. It has the merit ofsimplicity in that for each purpose a method of treatment or dressing is described and the author avoids going into detail about the choice of method and the factors influencing the choice. There is much valuable information clearly set out and profusely illustrated. It is a pity to find that the word stoma is not used and that ostomy. which is an operation, is used in its place. If the author is allowed his particular methods perhaps the same may be allowed to a reviewer. particularly one who has seen unfortunate results from the use of tubegauze. Properly applied this is very valuable but even with the best will in the world things can go wrong. Constrictions can form and fingers become badly swollen and stiffen as a result of its use. It can also cover up a great deal more of the finger than is necessary. P. s. LONDON
Guide to Orthopaedics 1. Trauma. By K. L. G. Mills. 246 x 186 mm. -Pp. 308. 198 I. Edinburgh, Churchill Livingstone. fl0.00. The aims of this book are clearly stated in the preface. It is intended for the orthopaedic trainee and with a speciality examination in mind. This may well refer to the future possibility of an examination at the end of
authors, which is continuous infusion with simultaneous pressure recording. A 22 gauge intravenous catheter is inserted into the compartment and 0.7 cc saline is infused per day. Great emphasis is put on clinical symptoms and signs, and the author makes it quite clear that most compartmental syndromes can be diagnosed by careful clinical examination and evaluation of existing symptoms. Like many other clinical diagnoses, it is important to maintain a high index of suspicion. Interstitial pressure recordings are seldom necessary or decisive in the choice of treatment. In differentiating between arterial insufficiency, nerve lesions and compartmental syndromes, however, continuous pressure recording may be of great value. I was pleased to find that the post-ischaemic course is satisfactorily described. Indications for operation are thoroughly covered, as well as the operative techniques. The chapter entitled ‘Recurrent Compartmental Syndromes due to Intensive Use of Muscles’, by V. G. Veith, is especially valuable to doctors dealing with sportsmen. A number of case reports end the book, but their value is not up to the standards ofthe rest ofthe book. All in all, this is an outstanding book, with appropriate emphasis on pathophysiology, clinical symptoms and signs and practical details. It should be available in every accident department. M. ROMANUS Ultrasound in Emergency Medicine. Edited by K. J. W. Taylor and G. N. Viscomi. 236 x 160 mm. Pp. 208. 1981. Edinburgh.Churchill Livingstone. fl2.95. Ultrasonagraphic technology is advancing so rapidly that many of those not immediately involved are unaware of the remarkable development of the newest equipment or the diagnostic accuracy achievable by experts. Before dipping into any text on the subject. the tyro should know that the initial impression made by many ultrasonic images is of confusion: he should be aware that the operator has the advantage of multiple views of the relevant area in a variety of projections; and that interpretation is dependent on the skill of the operator. This book, one of a well-known series. describes the use of ultrasound in emergency medicine. The accident surgeon will be most interested in the chapters on the abdomen and particularly in the brief descriptions of the investigation of injuries of the spleen, liver, kidney and pancreas. Fluid collections such as haematomas, abscesses, urine collections or peritoneal free fluid as well as organ lacerations are examples of the types of lesion demonstrated. The book also covers a variety of other clinical emergencies where the ultrasonic techniaue is likelv to be of value. Thev include obstetrjcs, renal ‘failure, testicular swelling and examination of the neonatal skull; the cardiac chapter draws attention to the value of this type of examination in cases where there is haemopericardium and shows how the position of foreign bodies like bullets and shrapnel can be accurately determined within the heart. Echoencephalography for adults is included.
535 though in most places the accuracy of CAT scanning or angiography are now preferred. The text makes no mention of ultrasound of the limbs as this is an as yet unexplored field; but since, for example, it is not difficult to demonstrate the normal upper leg arteries as far as the popliteal trifurcation, there seems to be a place for evaluation of vascular injuries and there is little doubt that other applications will follow. This short book has a place in the Accident and Emergency Department as a guide to the value of ultrasound in a variety of situations. Surgeons concerned with trauma should know of its potential, even if the technique is not yet part of their regular investigative practice. J. C. MCLARNON Practical Wound Management. By John M. Finley. 254 x 204 mm. Pp. 226. Index. 1981. Year Book Publishers, London. f23.75. This book is in two parts, of which the first and smaller deals with the general background of the management of wounds and the second with techniques of dressing different parts of the body and different wounds and other breaches of the surface. The title, Practical Wound Management, might suggest that the reader will find details of surgical management but this is not the case, except in the most general terms. The author describes the book as being ‘for every concerned health care professional’. The people who are most likely to find it of practical value are nurses in training, casualty and industrial nurses and also medical students and junior medical staff. It has the merit ofsimplicity in that for each purpose a method of treatment or dressing is described and the author avoids going into detail about the choice of method and the factors influencing the choice. There is much valuable information clearly set out and profusely illustrated. It is a pity to find that the word stoma is not used and that ostomy. which is an operation, is used in its place. If the author is allowed his particular methods perhaps the same may be allowed to a reviewer. particularly one who has seen unfortunate results from the use of tubegauze. Properly applied this is very valuable but even with the best will in the world things can go wrong. Constrictions can form and fingers become badly swollen and stiffen as a result of its use. It can also cover up a great deal more of the finger than is necessary. P. s. LONDON
Guide to Orthopaedics 1. Trauma. By K. L. G. Mills. 246 x 186 mm. -Pp. 308. 198 I. Edinburgh, Churchill Livingstone. fl0.00. The aims of this book are clearly stated in the preface. It is intended for the orthopaedic trainee and with a speciality examination in mind. This may well refer to the future possibility of an examination at the end of