MEDIA REVIEWS

Q & A COLOR REVIEW:

GENERAL CRITICAL CARE

EDITED BY H. MATHILDA HORST

AND RIYAD C. KARMY-JONES

New York: Thieme, 2003, 192

pages, $34.95 (soft cover)

The practice of medicine is an art,based on science.

SIR WILLIAM OSLER

The management of patients in thecritical care setting requires a bal-anced orchestration of applied phy-siologic principles and appropriateuse of rapidly evolving technolo-gies in diagnosis, monitoring, andtreatment, while anticipating andfine-tuning an ongoing disease pro-cess. Patients present to us sicker,older, and often debilitated by yearsof living with chronic diseases. Theglobalization of society presentshealth care professionals with thechallenge of considering a widerdifferential diagnosis and anticipat-ing emerging infectious diseases.Clearly, medicine in general, andcritical care medicine in particular,are increasingly challenging prof-essions in which to keep up-to-date.A new title in the area of critical

care serves to quiz the clinical mindand encourage health care pro-viders to both review and expandtheir current body of knowledge.General Critical Care, a question-and-answer format specialty reviewbook, is the newest in the Thiemeseries of similar Q & A Color Rev-iews. Deceivingly slim, compact,and pocket-sized, it delivers a vastarray of questions and detailedanswers, submitted by over 40international authors, on topics thatpractitioners of anesthesia, emer-gency medicine, trauma and gen-eral surgery, and critical care might

encounter. The goals of the text,state the editors in the Preface to theedition, include not only presentingdifferent aspects of critical caremanagement, but also helping thereader ‘‘. . . understand the scienceand Gestalt of critical care medi-cine.’’ Hence, questions encouragethe reader not only to consider thecontroversies surrounding the useof certain invasive monitoring tech-niques, for example, along withtheir limitations and complications,but also to understand the basicengineering and physical principlesupon which they rely and how theyactually work.The organization of the manual

was well planned, and the book isof high quality for a softcover edi-tion. Questions are presented oneven-numbered pages, with theirdetailed responses on the followingpage.Manyquestions havemultiple-choice answers, some require sim-ple one-word answers, but mostsupply lengthy explanations suchas would be encountered in didacticsessions or on bedside clinicalrounds. Case studies are presentedin random order, as patients wouldin everyday practice. Many casesare accompanied by high-qualityglossy photos, radiographs, and de-tailed diagrams. The reader may,for example, be challenged to in-terpret pulmonary artery cathetermeasurements or arterial wave-forms, explain the indications forand risks of invasive monitoringtechniques, outline the limitationsin the use of the Glascow ComaScale, or diagram the steps in theenergy cycle or coagulation scheme.And while the clinical questions arechallenging, the editors also includeplenty of questions that bring into

489

focus their emphasis that the basicprinciples of applied physiology,biochemistry, pharmacology, andmicrobiology are also important.Although the majority of questionssurround adult critical care andpostoperativemanagement, a hand-ful of cases in pediatrics and obstet-rical critical care are also presented.Two indices are included in

the back of the book that cross-reference to their respective ques-tions. A broad classification indexlinks questions to organ systemsand diseases, while a more detailedindex refers links questions to theirspecific and sometimes esoterictopics, such as ‘‘refeeding syn-drome’’ or ‘‘systemic inflammatoryresponse syndrome’’.The authors state that their title is

intended to serve as both a referenceand a reviewbook, although I foundthe latter use to be most appropri-ate. To be useful as a reference book,inclusion of the sources each con-tributor used to formulate his or herquestions would be helpful, so asto direct the student to outside read-ings, especially when discussing ordefending treatment options thatmay be controversial.Page by page, case by case,

General Critical Care stimulates andchallenges the medical mind. It re-minds the health care provider thatcritically ill patients are complex tomanage and that constant attentionto minor detail is paramount, whilestressing that adhering to funda-mental scientific principles and fol-lowing clinical instinct also playa major role. Whether preparing toshine on clinical rounds or studyingfor oral or written board exams,advanced medical students, physi-cian extenders, physicians, and

tapes, staples, adhesives, suturesand techniques, animal bites,foreign bodies, plantar puncturewounds abscesses, burns, postop-erative care and antibiotic use inwound management.The chapter on biology of wound

healing is reminiscent of biochem-istry but much more palatable. Thischapter, like the others that follow,contains an easy to follow table and

portant to preface the next part ofthe text. The photo of the suturedabdomen of a mummy is a uniquepart of the history of this medicalpractice and offers the reader es-sential history to laceration repair.The choice of adhesive tape forwound closure is discussed nextincluding the indications for use,a description of the various types oftapes available on a table for ready

490 PREHOSPITAL EMERGENCY CARE OCTOBER / DECEMBER 2003 VOLUME 7 / NUMBER 4

nurse specialists caring for our mostill patients will find this booka welcome addition to their medicallibraries.

MARY J. SCHLAFF, MD

Department of Emergency

Medicine

William Beaumont Hospital

Royal Oak, Michigan

d

LACERATIONS AND

ACUTE WOUNDS, AN

EVIDENCE-BASED GUIDE

ADAM J. SINGER AND

JUDD E. HOLLANDER

Philadelphia, PA:

F.A. Davis Company, 2003,

209 pages, $33.95 (soft cover)

If a student or academician werelooking for that evidence-basedmanual on how to care for an acutetrauma to the integumentary sys-tem, this book would satisfy thatsearch. The authors (both well pub-lished in this field) edit an almostcomplete beginner’s guide towound care for anyone who istasked with that responsibility. Thebook is aimed at medical students,interns and residents, physicianextenders, and attending physicianswho are trying to learn or to reviewthe essentials of caring for la-cerations and bites. The book doesnot emphasize the specific care ofeach body part, each with its in-herent pitfalls and anatomy, but israther a general text on wound care.The exception to this is the chapteron plantar injuries.This is a paperback book that

is light enough to carry in a back-pack or briefcase without addingtoo much weight, for the readyreference of its owner, but too wideto fit in any lab coat.The book is broken up into eigh-

teen discreet chapters beginningwith the biology of wound healing,assessment, preparation, anesthesia,

picture that correspond to readabletext. Next is wound assessment, thischapter could have been rolled intoanother or just skipped. With itbrevity it still contains some impor-tant facts that the student or resi-dent may have not considered priorto the wound care. With woundpreparation being just as importantas the closure itself, the next chapterwith it’s diagrams and photoswritten by both lead authors is welldone and within the theme of thetext; readable and not to long. Toget any wound closed, anesthesia isvery important. Dr. Bartfield doesa great job describing variousanesthetics (and for the novice theimportance of toxic doses), alongwith a discussion and graphics onregional nerve blocks versus localwound anesthesia. With this chap-ter, you can save the expense ofbuying the much larger hardboundprocedure book used by most emer-gency medicine attendings andresidents. Given that for some localanesthesia may be too overwhelm-ing, the authors dedicated an entirechapter to procedural sedation. Thischapter reviews various medica-tions and the procedure itself, butseems out of place for this book.I would offer that it be mentionedwithin the anesthesia chapter asa consideration. There are entiretreatises dedicated to this prac-tice and I would hope not eventhe student would rely upon asummary of this activity for itsuse.As this is a book on wound repair

the next chapter on the variousoptions for wound closure is im-

reference, and their deployment forwound closure. Following tapes isstaples for wound closure. Thischapter includes graphic detail inutilization, indications and contra-indications, along with descriptorsof each stapler currently availableand their benefits of use. Theauthors also have a chapter ontissue adhesives (one of the morewell known research topics for theauthors). They describe again his-tory, utilization, indications, contra-indications, disadvantages to use,along with aftercare. Once a woundis prepped and ready for closure bysuture, the next obvious questionwould be what types of materialswill be used? The chapter on se-lecting sutures and needles forwound care is a perfect resourcefor the novice clinician trying tofigure out the ‘‘What?’’ ‘‘When?’’and ‘‘Why?’’ of suture utilization.Included in the text is a very largetable comparing almost all suturematerials and their common uses.So if your health care facility hasonly one brand you will still be ableto find the types of materials neces-sary for your wound based on thisguide. And finally in this groupingis the actual chapter on suturingand it provides the basic materialfound in almost every wound careguide on the various wounds, andtheir basic management. But it alsoincludes the benefits and indica-tions for particular suture techni-ques not often described in otherguides.The next set of chapters are

thoughtful, and also are completewith diagrams and written details