AMERICAN JOURNAL OF EMERGENCY MEDICINE n Volume 7, Number 2 W March 1989

Tranbaugh and Lewis in Surgical Clinics of North America but does not refer to the identical topic reviewed within their own book.

All of this may be construed as petty commentary, but underscores the central role of the editor(s) in a multiauthor publication and the need to identify and address complex areas of controversy or contradiction between one author and another, or even within a single chapter.

In summary, the authors were well chosen and the book is reasonably well written, but this is neither a comprehensive basic textbook on trauma management nor a thoughtful, lu- cid update on trauma controversies and developments. With more careful topic selection, conscientious editing, and more emphasis on controversies and new developments in trauma care, future volumes could make a major contribution to the trauma literature.

RON M. WALLS, MD JUDITH A. VESTRUP, MD Vancouver General Hospital University of British Columbia Vancouver, British Columbia

Mastering Dysrhythmias: A Problem-Solving Guide. By Brown RR, Jacobson S. Philadelphia, F.A. Davis Com- pany, 1987, 295 pages. ISBN o-8036-1251-6, $18.95.

As the authors remark in their preface to this book, there are already a healthy number of publications available on the subject of dysrhythmia recognition. Their book will be of significant benefit, however, to providers of emergency medical care because it is designed as a workbook for mas- tering the interpretation of cardiac rhythm strips. The book should be welcomed both by beginning students as a practi- cal adjunct for exercising skills taught in a formal course, and by veteran practitioners as a refresher tool or a source of teaching strips.

The path that Mr Brown and Dr Jacobson have chosen to take deemphasizes explanations of dysrhythmias and cau- tions the readers that they will have to rely on another text or a classroom situation for detailed presentations on the definitions and mechanisms of these problems. The expla- nations provided in this text are brief, and are intended to be used as reminders. The dysrhythmias are presented in a way that encourages a systematic approach to the evaluation of each rhythm strip, so that a disciplined analysis can be done. Additionally, the authors have maximized the readers’ op- portunity to test their knowledge by providing 200 separate tracings in the form of self-assessment exercises and their interpretations.

The book begins with an introductory chapter which em- phasizes the development of a “Systems Approach to Dys- rhythmia Analysis. ” While this chapter provides a very strong and appropriate beginning, it presupposes significant knowledge on the part of the reader inasmuch as it discusses methods for analyzing certain rhythms before they are re- viewed. Therefore, readers not already familiar with the ba- sic types of dysrhythmias may find this chapter confusing.

The main portion of the book is divided into two parts. The fist section intermixes brief presentations of didactic material with practice exercises directly related to that ma- terial. This includes chapters on supraventricular dysrhyth-

246

mias, atrioventricular heart blocks, ventricular dysrhyth- mias, and artificial pacemakers. (The last chapter also con- tains brief discussions on monitor artifacts and rhythms encountered during resuscitations.) The second portion of the book, consisting of four chapters, is devoted entirely to self-assessment exercises. Finally, there is a glossary, a list of abbreviations, an extra self-assessment form (to allow readers to reproduce their own supply), and an index. Al- though the index is concise and easy to use, it does not list references to pages where electrolyte imbalances or hypo- thermia and other useful clinical variances are discussed.

Although the book does point out the need to evaluate any dysrhythmia in the context of the patient’s clinical status at the end of the first chapter, the remainder of the text offers clinical correlations irregularly and incompletely. For exam- ple, the discussion of the clinical significance of sinus tachy- cardia fails to mention that it is frequently seen in hypo- volemic states and that fluid replacement is vital in these instances.

The treatments included for specific dysrhythmias are generally consistent with the most recent American Heart Association’s advanced cardiac life support guidelines. However, the therapy offered for complete heart block im- plies that isoproterenol should be used before atropine is administered; indeed, the authors fail to mention at any point in the text that isoproterenol must be used with caution in patients with diseased hearts.

All in all, the book presents a very useful adjunct for the teaching or learning of rhythm strip interpretation. It is es- pecially useful, as the authors point out, in supplying a large variety of clearly reproduced rhythm strips which others may photocopy out of the book for their own use. (The pub- lishers include a caution, though, that such photocopying is only to be done in coordination with the Copyright Clear- ance Center.)

In summary, persons who teach dysrhythmia recognition frequently will find this a resourceful book, either for their own use or to recommend to their classes for purchase. Ex- perienced personnel, whether they are physicians, nurses, or prehospital providers, will enjoy the book for its large num- ber of practice exercises.

NICHOLAS BENSON, MD East Carolina University School of Medicine Greenville, North Carolina

The Chief Resident as Manager. By Neal Whitman, Elaine Weiss, Lawrence Lutz. Salt Lake City, University of Utah School of Medicine, 1988. $16.00.

Hundreds of books cross our editorial desk each year on their way out for review. It is indeed unusual for a book to grab my attention and to be sufficiently well written, pro- duced, edited, educational, appropriate, and humorous to encourage me to read it in its entirety and actually serve as a reviewer. This is such a unique book. It is easy to method- ically analyze the success of this tome. The topic is clearly an important and neglected one. The scope of the book is consistent with the importance of the topic and the amount of material available on the subject. The authors and editors achieve an excellent distillation and balance between the literature and personal anecdotes for illustration, The price/