and

Lung Sounds: A Practical Guide, includes companion audio pro- gram. 2nd ed. Wilkins RL, Hodgkin JE, Lopez B. Phila- delphia: Mosby, 1996, 114 pp. ISBN 0-8151-9287-8.

Ches t auscu l ta t ion p re sen t s a chal lenge to every n e w hea l th care professional, and beg inne r s are cons tant ly look- ing for references to improve thei r u n d e r s t a n d i n g and tech- nique. The ta rge t a u d i e n c e of this book is s t uden t s in the hea l th care field. This s econd edi t ion provides useful infor- ma t ion abou t the a n a t o m y and physiology of the respirato- ry s y s t e m a n d normal a n d a b n o r m a l b r e a t h sounds . However, t he m e t h o d of physical examina t ion out l ined in this book is out of s e q u e n c e and is not w h a t is currently t a u g h t in medica l and nurs ing educat ion. The s e q u e n c e of physical examina t ion r e c o m m e n d s inspect ion, auscul ta-

tion, palpation, and percuss ion. The s e q u e n c e of physical examina t ion r e c o m m e n d e d by Bates is inspect ion, palpa- tion, percuss ion, and t h e n auscul ta t ion (Bates B. A gu ide to phys i ca l e x a m i n a t i o n a n d h i s to ry tak ing . 6 th ed. Philadelphia: Lippincott ; 1995). In addit ion, the char ts r ev iewing the normal pu lmonary funct ion tes t s are confus- ing for the novice hea l th care professional, and the shor t pa r ag raph on arterial blood gases provides little information abou t in te rpre ta t ion of results.

This book also reviews definitions of the different b rea th sounds and correlates t h e m in an easy- to-unders tand fashion wi th their potent ia l diagnosis. The char ts in chapter 4 are easy to u n d e r s t a n d and provide a good reference for the beginner. The case s tudies p resen t a variety of scenarios tha t review the information p resen ted in the preceding chapters along wi th the accompany ing brea th sound on audiotape to ass is t the s tuden t in making his or her diagnosis.

The aud io tape provides excel lent examples of b r e a t h sounds. W h e n I first opened the book I found it difficult to de t e rmine w h e n I was supposed to use the audiotape; how- ever, I did find a reference to the use of the aud io tape in the table of con ten t s unde r Append ix A.

An a c c o m p a n y i n g post t e s t can be s u b m i t t e d to obta in con t inu ing educa t ion credits, a l though the book does not men t i on how m a n y credi ts can be ea rned or if a cost is i nvo lved . - -EC

Telephone Triage Protocols for Nurses. Briggs JK. Phi ladel - phia : L i p p i n c o t t - R a v e n Pub l i she r s , 1997, 448 pp., $36.95, Int. $39.00, ISBN: 0-397-55410-9.

As we con t inue to see m a n a g e d care play a s igni f icant

J Emerg Nuts 1998;24:49. Copyright © 1998 by the Emergency Nurses Association. 0099-1767/98 $5.00 + 0 18/64/88004

role in ED set t ings , and as the hea l th care sys t em b e c o m e s more complex, t e l ephone t r iage will b e c o m e a vital link for pa t i en t s looking for advice. Protocols tha t are legally and medical ly sound m u s t be es tab l i shed before advice can be given. This book provides readers wi th 411 protocols tha t cover a wide variety of hea l th problems r ang ing from abdomina l pa in to overdose. The book also covers car- d iopulmonary resusc i ta t ion for bo th chi ldren and adults, as well as e m e r g e n c y rescue brea th ing . The protocols are list- ed in a lphabet ica l order, w h i c h makes the book user friend- ly for the reader.

The protocols con ta ined in this book provide assess - m e n t ques t ions pe r t inen t to a part icular s y m p t o m and, b a s e d on a caller's response, will help de t e rmine w h e n a pa t i en t should seek care. This may m e a n a pa t i en t should take immedia t e action, ac t ion wi th in 2 to 4 hours, or act ion wi th in 24 hours. Each protocol conta ins home care ins t ruc- t ions t ha t the caller can use unti l he or she seeks medica l a t tent ion. I found the h o m e care ins t ruc t ions for breas t - feeding problems to be informative for nur s ing mothers . I also found the h o m e care ins t ruc t ions for pa t i en t s who have suffered a bee s t ing to be helpful.

The goal of t e l ephone t r iage is to assess a pa t i en t ' s symptoms an d de te rmine the u rgency of thei r need for care and whe re they should seek care. Some protocols in th is book refer to a part icular d iagnosis ra ther t han a specif ic symptom. For example, the car s ickness protocol directs the nurse to ask the caller abou t symptoms of dizziness, nausea , an d vomiting. These symptoms would already have b e e n a s se s sed before r each ing tha t potent ia l diagnosis . For this reason, I found the s y m p t o m - b a s e d protocols to be more useful.

This book would be a helpful guide for anyone inter- e s t ed in se t t ing up s t andard protocols for prac t ice wi th in the t e l ephone t r iage set t ing. However, t he protocols would need to be rev iewed an d a d a p t e d to the policies of part icu- lar ins t i tu t ions before b e i n g pu t into use. Persons u s ing an es tab l i shed t e l ephone t r iage program may find it s o m e w h a t helpful to compare t he se protocols wi th those of their own p r o g r a m . - - L M

BOOK REVIEWERS

Elizabeth A. Coyne, RN, MS, CRNP, CEN, is Clinical Nurse Specialist, Emergency Depar tment , Pennsy lvan ia Hospital, Philadelphia, Pennsylvania .

Lisa M a t t h e w s , RN, BSN, is Clinical Nurse, Beth Israel Deaconess Medical Cente r Heal th Information Line, Boston, Massachuse t t s .

February 1998 49