Textbook of Adult Emergency Medicine

Abstract

Peter Cameron, George Jelinek, Anne-Maree Kelly, Lindsay Murray and John Heyworth Churchill Livingstone; Edinburgh, 2000 757 pages soft cover RRP $114.95 ISBN 0-443-06280-3 Emergency medicine has developed apace in the last two or three decades and it is now recognized, worldwide, as a distinct discipline. The manner in which emergency patients present to hospital, the variability in their degree of urgency, the wide range of diseases and disorders they exhibit demand of emergency physicians a paradigm of approach and appraisal which is, perhaps, unique among those who profess specialty status. The contributors to a Textbook of Adult Emergency Medicine are, in the main, active and experienced practitioners of this relatively new discipline and the philosophical principles of their craft are evident throughout. There is a pleasing emphasis on evidence-based practice and many faulty shibboleths of conventional wisdom are addressed. There can be no more cogent demonstration of progress in emergency medicine than the comparison of a casualty officer’s handbook of 30 years ago with this modern text. In the United Kingdom, the nascent specialty of accident and emergency medicine derived from initiatives by the British Orthopaedic Association’s Accident Services Review Committee (1960) and the Casualty Surgeons Association (now the British Association of Accident and Emergency Medicine) in 1967. Orthopaedic or general surgeons were usually in charge of casualty departments and in their writings there was a distinct bias to matters surgical. In the book under review, orthopaedics has been relegated to a minor role and readers directed to specific texts. Future editions, however, might benefit from guidance on the management of common fractures which are treated in emergency departments, with particular emphasis on plaster techniques and pain relief for specific cases. In the USA, the American College of Emergency Physicians (1967) heralded the recognition of emergency medicine as the twenty-third Board-certified specialty a decade later. Seminal texts on the particular domain and responsibilities of emergency physicians soon followed with emphasis on the need for rapid but structured appraisal, based on sound clinical evidence, ever-mindful of the ‘worst-case scenario’. Sir William Osler opined that ‘to study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all’. The contributors to a Textbook of Adult Emergency Medicine are all master mariners who have produced an essential manual for those who aspire to or practise emergency medicine, in which the complex is made comprehensible and the commonplace is illumined. The editors are to be complimented on the commonality of format, style and expression in 133 topics, by 113 contributors and on ensuring a lucidity of language which facilitates understanding. The reader is guided through a recurring sequence from an initial, boxed paragraph on ‘Essentials’ (which will provide a valuable aide-memoire for pre-examination studies) to a more detailed, but nonetheless succinct, account of clinical features, aetiology, management strategies and prognostications, and to a final list of ‘Controversies’ indicating areas of concern or contention — a ready reference for those seeking inspiration for research. The range of topics from Resuscitation (Section 1) to Toxicology (Section 27) is comprehensive. Traditional chapters such as ‘Triage’, ‘Trauma’ and ‘Cardiology’ are supplemented by consideration of the ethical, legal and administrative obligations of emergency medicine. Practising at the interface between the community and inpatient services an emergency physician has a singular role in meeting the needs of a more discerning and demanding public and as an intercessor between disciplines. That such responsibilities should be conducted in a caring environment, with adequate staffing and resources is rightly emphasized; a far cry from the ‘casualty’ department of days now gone. Inevitably, in a text of this size a few typographical and factual errors have escaped editorial scrutiny but will be addressed in subsequent editions. Overall, however, this is a splendid book and is highly recommended to all students and practitioners of emergency medicine.