Emergency pediatrics

Emergency pediatrics

BOOK REVIEWS points. There is also an entire chapter devoted to the patient who signs out or refuses treatment, a chapter on psychiatric emergencies ...

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points. There is also an entire chapter devoted to the patient who signs out or refuses treatment, a chapter on psychiatric emergencies associated with death, and a chapter about psychiatric emergencies encountered in disasters. A special chapter on psychiatric problems in the elderly reflects the growing importance of geriatrics as a greater percentage of the population becomes elderly, but the chapter itself is disappointing and does not say much that is not already in the book. The following chapter, dealing with the ED “repeater,” points out how dangerous this all-too-frequent visitor can be if the staff assumes he or she is not ill. These last five chapters each have an important point to make, and they do make it. However, the same message could have been communicated more succinctly. The last two chapters, on interpersonal psychiatric therapy and psychiatric therapy: medicinal and electroconvulsive, could altogether have been left out of a book meant to help emergency physicians in their handling of psychiatric emergencies. Fauman and Fauman’s slim volume, Emergency Psychiatry for the House Of$cer, is a gem. Small enough to be easily portable, this book contains a lot of information in a mere 170 pages of 53/4” x 7%“. It is part of the “For the House Offtcer” series published by Williams & Wilkins, is designed to be a reference, and contains in it everything a physician will probably truly need in the ED. It is clear, concise, and eminently readable. This book gives realistic suggestions for conducting relatively speedy and informative interviews without alienating or rushing patients. Superbly organized into four sections, the first dealing with clinical assessment and management, the second with specific psychiatric disorders, the third with psychosocial problems, and the fourth with administrative skills, it makes clear how to actually practice what is written. Reading any of the four books reviewed would leave one better able to deal with psychiatric problems. Rund and Hutzler’s book, for those with a special interest in psychiatric emergencies, could be very satisfying, as it presents more information specifically tailored to emergency medicine than the other books. However, when it comes to ready reference, Fauman and Fauman’s Emergency Psychiatry is preeminent in readability, applicability to practice, and accessibility of information. MAJA JURISIC,MD

St. Joseph’s Hospital Milwaukee, Wisconsin

Testifying in Court, 2nd ed. By Horsley JE, with Carlova J. Oradell, New Jersey, Medical Economics Books, 1983, 142 pages, $21.95. Like some journals, many textbooks on first impression Testifying in Court: A Guide for qualify as “throwaways.” Physicians presents itself in that manner. It is written by a lawyer with the assistance of the West Coast editor of Medical Economics magazine. They have co-authored another book entitled Your Family and the Law. The paper is coarse, the margins narrow, the print large, and the anecdotes long to create a 142-page book, including the index.

Despite its shortcomings, I would strongly recommend the purchase of this book for a hospital or emergency medicine training program library. For, despite all the padding, it has no peer in clearly and effectively communicating the practical aspects of the lawyer-physician relationship. As stated in the first chapter, for many physicians testifying equals terrifying. This book does much to alleviate those fears in an easy reading style. Though the anecdotes are many, they serve to reinforce the points made by the author. This is a book written for easy consumption. The cute titles “Do I Have to Go to Court?” and “Will the Way You Come on ‘Run Them Off?” belie the useful information contained within. Other chapters include “How to Figure a Witness Fee, ” “How to be an Effective Expert Witness,” and “How to Act Toward Judge and Jury.” The chapter “Watch Out for Booby Traps” should be mandatory reading for anyone headed for the courtroom. It is surprisingly rare to find good practical advice about testifying, depositions, legalese, and the like. Despite the breezy style and the ploys to make a book with 25 pages of information last over 130 pages, I came away feeling more comfortable about my role as an expert witness and potential relationship with the courts. The author knows what he is talking about. There is no competition on the market that I could find. Read it, learn, and abate some of the intimidation the legal system uses so well. GLENN C. HAMILTON, MD

Wright State University Dayton, Ohio Editor’s Note: This is the first of a series of book reviews on textbooks pertinent to faculty development in emergency medicine. The relationship of faculty to the legal system is an important concern, particularly in the physician’s capacity as expert witness.

Manual of Emergency Pediatrics. Edited by Reece RM. Philadelphia, WB Saunders Co., 1984. Emergency Pediatrics. Edited by Barkin RM, Rosen I? St. Louis, CV Mosby Co., 1983. When asked to compare these two books, I was delighted, as I wanted to own and read both in any event. My initial enthusiasm continued as I perused the two volumes; each contained a good deal of important information and many useful tips. On superficial examination, I was struck by the similarity of these two texts. The titles, constructions, and lengths are nearly identical. While the dimensions of the Reece manual are smaller, the format of each page is more compact, the end result being a similar amount of information overall. Both of these works are paperback books, available for a reasonable price. Perhaps an important point for a manual, both are too large to tit the pocket of most white coats. Neither of these books attempts to be a text; both give the essentials only to the reader. Barkin and Rosen have chosen an outline format, listing many items numerically.





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The text is well supplemented by tables, and information is readily accessible. The Reece manual sticks with a standard paragraph style and has a fair number of tables. The information has slightly more depth, but the reader may need to search out the highlights. Illustrations and radiographs are sparse, in both books, as is appropriate for a manual. The Barkin manual has an edge in the visual department numerically, particularly in the section on procedures. Inexplicably, for a book of emergencies, the Reece manual concentrates most of its 30 or 40 pictures on parasites. If anyone in the emergency medicine field loves the study of pediatric infectious diseases, I do; however, I seldom do microscopic examination of the stool on an emergent basis. Reece, a pediatrician and director of a family development center, has assembled the third edition of his manual with the assistance of 50 contributors, composed almost exclusively of pediatricians, pediatric subspecialists, and surgeons. On the other hand, Barkin, a pediatrician/emergency physician, and Rosen, an emergency physician, have enlisted the help of 25 colleagues, primarily in emergency medicine, for their first edition. The Reece team hails predominantly from the Boston area, whereas the Barkin authors, for the most part, are from Denver. These facts make for some interesting comparisons, and perhaps rivalries: East versus West; new versus traditional; pediatrics versus emergency medicine. As one reads these two manuals, one cannot escape the conclusion that these factors shaped the final product. Ultimately, as I will discuss, I think the major forces influencing a physician’s preference for one or the other of these manuals will be his or her background and training rather than an across-the-board superiority of either book. Without comparing in depth the coverage of every area in each manual, I have chosen a few representative examples. Let me start with cardiopulmonary resuscitation (CPR) which must be a cornerstone of any treatise on emergencies. The Barkin book devotes 30 pages, the entirety of the second section, to CPR, and it is easily found in the table of contents. On the other hand, CPR is listed less prominently in alphabetical order in the “True Emergencies” section of the Reece manual. The discussion, ten pages long, deals with basic life support (BLS) and advanced cardiac life support (ACLS) but sometimes does not do justice to the latter. For instance, mouth-to-mouth ventilation is covered, but the reader is warned not to rush to intubation too hastily; endotracheal intubation is not discussed further. On the other hand, the Barkin test starts with ACLS and covers intubation in detai1, providing a table of tube sizes by age. Reece does not broach the subject of cannulation, a vital aspect of many resuscitations, other than to admonish the reader not to worry about cutdowns until help arrives. More in line with the practice in most pediatric and general emergency departments, Barkin discusses both peripheral and central venous access, with specific reference to the procedures in the appendix. As with resuscitation, the management of multiple trauma and other true emergencies receives more attention in the Barkin manual. While less emergent than cardiopulmonary arrest, an illness such as glomerulonephritis usually requires intricate medical management by the pediatrician or pediatric nephrologist but may also be the cause of a life-threatening 470


hypertensive crisis. Both manuals provide thorough coverage of this disease. More background information appears in the section in the Reece book, but the essentials are present in each of the two. Finally, we come to illnesses such as leukemia and juvenile rheumatoid arthritis. While the mention of these diseases does not immediately conjure up the image of an emergency, they each have numerous life-threatening complications, and patients with these afflictions are seen with regularity in the emergency department of a children’s hospital. As expected, the Reece manual deals extensively with both topics. Each is covered in four or five pages, equally in terms of background information and emergent aspects. On the other hand, each is merely listed on a single line of a table in the book by Barkin and Rosen. What’s my recommendation? If an emergency physician wants to know specifically how to handle life-threatening emergencies in children, he or she should purchase Barkin and Rosen. If a pediatrician wants coverage of the spectrum of serious disorders seen in pediatrics, he or she should choose Reece. If one wants everything in a single manual, glue these two books together. GARY

R. FLEISHER, MD The Children’s Hospital of Philadelphia Philadelphia, Pennsylvania

The Society of Critical Care Medicine: Textbook of Critical Care. Edited by Shoemaker WC, Thompson WL, Holbrook PR. Philadelphia, W. B. Saunders Co., 1984, 1,063 pages, $75.00. NOW with over 220 members, the Society of Critical Care Medicine, which began in 1970 with only 26 members, has published its first compendium on the current practice of critical care. To enhance appreciation of the efforts that went into creating this text, some historical background on the Society of Critical Care is in order. In early 1980, Shoemaker and Thompson published 18 lectures from the Ninth Annual Meeting of the Society of Critical Care as the first issue of a yearly State of the Art Symposium. Three such symposia were published between 1980 and 1982, comprising key reviews by respected researchers and practitioners of critical care. During this time, the American Board of Medical Specialties approved critical care medicine as a multidisciplinary subspecialty with plans for establishing a certification examination. Members of the Society of Critical Care felt a comprehensive text was needed to define the knowledge base for this new subspecialty. The Textbook of Critical Care emerged from the framework laid down by the yearly symposia of the Society of Critical Care as its “benchmark” text.

Content The 123 chapters are subdivided into 12 sections: Resuscitation, Monitoring, Ventilation, Cardiovascular, Infections, Visceral Dysfunction, Hematology-Immunology-Oncology, Therapeutics, Trauma, Central Nervous System, Psychosocial Crises, and Organization. One third of the