key: cord-321740-5reldbrb
authors: Werdehoff, Steven
title: Emergency Medicine Manual, Sixth Edition
date: 2004-09-21
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2004.03.048
sha: 
doc_id: 321740
cord_uid: 5reldbrb

Unknown

The On Call series consists of handbooks designed to assist physicians with the initial evaluation and management of patients by using a problem-oriented approach. Emergency Medicine On Call is a notable addition to this series, the goal of its editor being ''to provide the house officer and student with a valuable tool to initiate effective evaluation and care of the emergency patient.'' One hundred twenty-five presenting complaints spanning pediatrics, adult medicine, geriatrics, trauma, and toxicology are presented in an easy-to-follow format. Each chapter starts with a sample case that transitions into immediate questions, differential diagnosis, key physical and laboratory findings, and management plans. Common International Classification of Diseases, 9th Revision (ICD-9) diagnoses for each problem are also listed. For the medical student, teaching questions and answers are included at the end of each chapter to highlight an important point. Finally, 2 to 4 articles are referenced per chapter, providing the reader with an excellent starting point for research.

There are several exceptional features in this book that make it unique among handbooks. A 40-page laboratory diagnosis section includes the reference ranges for more than 100 laboratory tests. Short explanations of each test are provided, along with conditions in which one would see values out of the reference range. The procedures section is concise, yet thorough. Helpful diagrams and step-by-step instructions can be quickly reviewed before performing common emergency department (ED) procedures such as lumbar punctures, central lines, wound care, and abscess drainage. Furthermore, a bedside ultrasonography portion provides instructions, figures, and diagrams for basic ED imaging. Although this segment certainly does not substitute for an ultrasonography course, it does provide fundamental information on imaging commonly performed in the ED. Lastly, the appendices contain an assortment of useful information such as PDA Web sites, medication tables, and temperature and weight conversion charts.

After reviewing this book, I would offer 2 suggestions. There are 140 pages devoted to commonly used medications with information on indications for use, dosage, and additional notes. This material is widely available on PDA programs that most physicians and medical students reference daily, and this section is less helpful than the other sections of the handbook. Also, a blood component therapy section could be improved by including suggestions on the amount of blood or plasma component therapy one should anticipate transfusing in various clinical situations.

In summary, Emergency Medicine On Call is an outstanding tool for medical students and residents working in the busy ED. The text clearly meets its editor's goals, and I strongly recommend it to anyone seeking a comprehensive emergency medicine handbook. (4) increase coordination between authors of complementary chapters. The new edition does very well on the first aspect. There is a new chapter on bioterrorism, a new subsection dedicated to severe acute respiratory syndrome (SARS) (amazing, considering the SARS epidemic was only last year), and new toxicologic chapters on theophylline toxicity and hypoglycemic agents. Also new are 12 color plates of dermatologic conditions, which are rather superfluous because most of these entities, including varicella and fifth disease, should be readily familiar to the practicing emergency physician.

On keeping the content up to date, the new edition is hit or miss. On some subjects, such as indications for a computed tomographic scan before lumbar puncture and the benefit of dexamethasone in meningitis for adults, the latest recommendations from robust clinical trials are deftly interwoven into the text. 1, 2 However, in the chapter on head injury, the text suggests computed tomography for isolated loss of consciousness despite a major clinical trial and an American College of Emergency Physicians clinical policy recommending more restrictive indications. 3, 4 The authors have succeeded in increasing the utility and accessibility of knowledge in this edition. A constant threat with books of this size that are meant to be all encompassing is a cookbook mentality without the appropriate clinical context. Adding nuance and clinical reasoning into a book of this breadth without doubling its size is certainly a challenge. Improvement in this area gives confidence that the respective authors have thoroughly overhauled their subjects, making them more available to the reader. An example includes a discussion of the proper use of D-dimer with its various assays in ruling out pulmonary embolism, which is helpful when explaining to colleagues of other services why testing for D-dimer is not supported in patients with at least a moderate pretest probability. This is opposed to the previous edition, which simply stated the sensitivity of D-dimer and its high rate of false positives.

As in all texts with multiple authors, there is some redundancy and some failure of clinically similar chapters to complement each other. The redundancy is actually beneficial if it helps the clinician find the sought information. However, the failure to complement may leave readers to scratch their heads. For example, the chapter on peripheral vascular disease uses Wells criteria for risk stratifying patients with possible deep venous thrombosis, yet the pulmonary embolism chapter does not use Wells criteria for pulmonary embolism. Why not? Are the Wells criteria for pulmonary embolism not as sound as the criteria for deep venous thrombosis?

In conclusion, Emergency Medicine Manual, Sixth Edition, is of undisputed utility to the practicing emergency physician in daily practice. Nonetheless, as with all works of great endeavor, there is room for improvement in the next edition. I am relieved to see that the authors and publishers did not subtitle Geriatric Emergency Medicine ''a comprehensive study guide,'' because it is not. However, the chapters cover body systems in a systematic manner, and each is divided into uniform sections: ''High Yield Facts,'' ''Epidemiology,'' ''Pathophysiology,'' ''Clinical Features,'' ''Diagnosis and Differential,'' and ''Emergency Department Care and Disposition.''

The first section of the book has chapters dealing with special considerations in geriatric emergency medicine, including the physiology of aging, pharmacotherapy and drug-related events, functional assessment, abuse and 

Computed tomography of the head before lumbar puncture in adults with suspected meningitis

Dexamethasone in adults with bacterial meningitis

Indications for computed tomography in patients with minor head injury

Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting