BOOK REVIEWS

tomography of the brain. One can imagine the consequences of following these guidelines in US medical practice. Another such example is one author's recommendation that "Factor VIII concentrate must not be used without consult- ing with a hemophilia specialist" in the chapter on bleeding disorders and blood transfusion.

This book has several limitations. For exam- ple, the author of the chapter on respiratory emergencies fails to mention rapid-sequence intubation, so important in emergency situa- tions. The discussion of relevant physiologic considerations is too brief in the chapter on emergency surgery in children. The titles of caapters 44 and 45 are misleading because these do not comprise medical and nongastro- intestinal emergencies. The chapters should be labeled more appropriately to indicate dis- cJssion of gastrointestinal emergencies in the newborn and the older child, respectively. In the chapter on cardiac emergencies, most of ttle contents have received cursory mention, and algorithms in figures 6.6 and 6.7 are in- correct. The chapter dedicated to primary care of the injured has no reference to brain resus- ctation or the use of alcohol and illegal drugs as a factor in trauma injuries. The chapter on tile spine would benefit from extensive revision and inclusion of evaluation of stability in cervi- cal spine injuries and spinal cord injury syn- dromes. Lack of citations of current trends in tile management of various emergencies is the most striking deficiency of this book.

Some chapters lack sufficient information. Most troubling to me are the frequency with which an opinion is presented as fact and the paucity of discussion to indicate the contro- w~rsial nature of a topic. None of the chapters is referenced; inclusion of references would definitely improve the standard of the book. Finally, much of the information in the book is not particularly relevant to the emergency medicine specialist. The prime examples are rrajor surgical techniques, parenteral nutrition, preoperative assessment, and postoperative care.

Although differences in spelling and termi- nology (eg, "appendicectomy," "operating theatre," "hospital resident staph" [instead of "nosocomial infection"], "pethidine" [instead o1: "Demerol"], "lignocaine" [instead of "lido- caine"]) are interesting, other information such a,'; the description of intraspinal and IM admin- istration of benzyl penicillin for meningitis, in

the chapter on intracranial compression and sepsis, raise some concern.

Because this book does not meet the high standards of US emergency medicine, I cannot recommend it for US emergency medicine pro- fessionals. However, this book may suit British medical students and surgical house officers rotating through the ED during their training and may serve as a secondary reference for the amateur surgeons in the United Kingdom.

Prom C Shukla, MS, MD Department of Emergency Medicine Henry Ford Cottage Hospital Grosse Pointe Farms, Michigan

Emergency Medicine Pearls: A Practical Guide for the Efficient Resident Singer, Burstein & Schiavone (eds)

FA Davis, 1996 284 pages, $19.95

This text is a pocket-sized handbook written for junior emergency medicine residents and rotating medical students, interns, and resi- dents from other departments. The book com- prises 18 chapters that cover most acute problems seen by emergency physicians. Two appendixes, one containing the Advanced Cardiac Life Support algorithms, the other the effects of specific toxins on various organ sys- tems, round out the book.

The book is well-written, concise, easy to read, and organized by presenting symptoms and organ system for quick reference. The first chapter, "Welcome to the Emergency Department," is particularly well done and contains several important clinical pearls {ie, look at the vital signs and address and explain abnormalities, read all nursing and paramedic notes) that all physicians new to the emergency department should learn. The book also pre- sents good, brief approaches to some of the more common problems we face in emergency medicine such as abdominal or chest pain. Chapters on dealing with the difficult patient and a chapter on social and legal issues in the ED, including a section on how to inform the family of a loved one's death, are additional practical components. The book is filled with figures and tables (a highlight), most of which are quite well done and useful. A few, such as

the drawing of the WBCs and bacteria seen in urinary-tract infections, in the chapter on com- mon infections, are of questionable utility.

The authors state that the book is not in- tended to replace more comprehensive texts. This is something of an understatement. Topics, for the most part, are covered very superficially. Important information is generally conveyed, but if the student or resident doesn't already have a reasonable understanding of the prob- lem, he or she will have trouble grasping the important concepts. For example, some un- common entities such as scaphoid lunate dis- location and peri{unate/lunate dislocation are presented in this "practical guide" with no description or explanation of these problems. A single sentence containing a clinical pearl is all that is attributed to each of these prob- lems. Absent from the guide are sections on otolaryngologic, dental, urologic, metabolic {eg, diabetic ketoacidosis) and endocrine prob- lems. Also omitted are information on fluid and electrolyte disorders and emergency medi- cal services. Admittedly, attempting to distill a body of knowledge as vast as that of emer- gency medicine into a reasonably comprehen- sive handbook is a difficult task, rarely accom- plished. The authors correctly state that some recommendations in the text are controversial. For example, with regard to anaphylaxis the authors state that ICU admission is mandatory for any patient in whom hypotension develops at any point. Other controversial statements include, "All patients with pancreatitis should be admitted . . . . , and, "Gynecologic consul- tation should be obtained in all cases of abor- tion, whether threatened, incomplete, or complete." It will be important for those who use the book to supplement their education about the practice of emergency medicine and to understand that these "all-or-none" state- ments are usually not appropriate, Other state- ments in the book such as, "All chest pain is serious until evaluated fully," and, "In general, order an electrocardiogram for any patient with chest pain in whom you cannot absolutely ex- clude cardiac disease," are somewhat vague and give the student little guidance. There also are a few errors including calling cephalexin a second- rather than a first-generation cepha- Iosporin in the section on urinary tract infection. Recommending the use of Augmentin (amoxi- cillin-clavulanate potassium) for the treatment of cat bite infections is appropriate, but giving

FEBRUARY 1997 29:2 ANNALS OF EMERGENCY MEDICINE 3 8 9

BOOK REVIEWS

the option of using a first-generation cephalo- sporin alone, however, would not be appro- priate because it does not adequately cover Pasteurella multocifla on its own. Finally, rec- ommending the determination of electrolyte, glucose, blood urea nitrogen, and creatinine concentrations in patients with pelvic pain is unfounded and ill advised, particularly in light of the cost-conscious era in which we practice.

This text is unique in its focus, and no cur- rently available book is directly comparable. However, "minitexts" such as Emergency Medicine Secrets (Hanley & Belfus, $37.95) are formatted in question-and-answer form. Secrets is more geared, however, for examina- tion review or preparation for conference dis- cussions. Pearls is also much less complete than the Manual of Emergency Medicine (Little, Brown; $34.95). Neither of these mini- texts is nearly as concise and readable as Pearls, however. There also is the Emergency Medicine Handbook(Plymouth Press, $10.95}, which provides convenient access to frequently used but rarely memorized information. It is more a true handbook and is not meant to be an introductory guide to emergency medicine.

Despite its shortcomings, Emergency Medicine Pearls does a reasonable job of dis- tilling broad subject matter into a concise and readable handbook, and certainly the price is right as an introductory guide and quick refer- ence to emergency medicine. I believe it is a reasonable choice for rotating residents from other services and would be useful initial read- ing for medical students and emergency medi- cine residents.

Mark T Steele, MD Department of Emergency Medicine University of Missouri-Kansas City School of Medicine Kansas City, Missouri

CORRECTIONS

In the December 1996 NHTSA Notes [1996; 28:711-712] there was an error in the first paragraph regarding the total cost of motor vehicle crashes. The total cost of these crashes in 1994 was $150.5 billion, as correctly stated elsewhere in the article.

In the December issue a typographic error was made in a reply by Dr Gary Vilke to a letter by Dr Tracy Weiner [1996;28:731]. We apologize to the authors for this error. The correct first sentence of the reply follows: "We express our deepest sympathy to you and your family for this tragic outcome of a cervical spine epidural abscess."

An inadvertent error was introduced into Table 9-1, page 52, of the article "An Evaluation of Technologies for Identifying Acute Cardiac Ischemia in the Emergency Department: Report From a National Heart Attack Alert Program Working Group," January 1997;29:13-87. The corrected table is shown below, with the correction in boldface.

Table 9-1. Diagnostic performance, AMI and physicians.

Parameters Physicians (%) Protocol (%) P

Sensitivity* 88 88 Specificity t 71 75 Positive predictive value* 29 32 Overall accuracy 73 76

*Percentage of patients with AMI admitted to CGU. CPercentage of patients without AMI not admitted to CCU. *Percentage of patients with AMI among the total admitted to CCU,

NS <.00001

.10 <.00001

3 1 0 ANNALS OF EMERGENCY MEDICINE 29:2 FEBRUARY 1997