Gordian Fulde and Sascha Fulde.
Churchill Livingstone/Elsevier Health Sciences
ISBN: 9780729541466 Publication Date: 27-09-2013 RRP: $109.93 (free delivery in Australia/NZ).
For further information see: http://www.elsevierhealth.com.au/emergency-medicine/emergency-medicine-paperbound/9780729541466
I have a previous fourth edition of this book by the highly credentialed Professor Fulde, which I was given whilst at medical school and has done good yeoman service over the years, but this new edition is an impressive replacement. It is also nice to see that Sascha Fulde is carrying on the family tradition. Professor Fulde recently appeared on the news bemoaning the prevalence of alcohol-fuelled violence, and is obviously still very much a ‘hands-on’ clinician as well as an academic writer. This bodes well for the practicality of the contents.
The new edition is considerably heavier, coming in at around 1,030 thin pages, but does have an in-built protective plastic cover which can be wiped clean, which is a definite advantage in terms of infection control. The old book was monochromatic and contained some tables and diagrams, but no photographs. The new edition has a blue, white and black colour scheme, and includes a number of black and white photographs as well as tables and diagrams.
Being a Basic and Advanced Life Support instructor, as soon as I opened the book I loved the fact that it has both the BLS and Adult ALS algorithms inside the front cover, and if you flip it over and look inside the back cover both the Choking and Infants and Children ALS algorithms can be found there. How easy is that!
Turn over another page and you find the “Quick Reference”, compiled by Fiona Chow. This section of 115 pages (with a list of Abbreviations at the end) is a handy little guide. An index is provided on the first page, but with white text on a blue background it is a little difficult to read in less than optimal lighting conditions. The two ALS algorithms are followed by that for newborns and a summary of suggested drug usage in adult and paediatric cardiac arrest. Sections follow on miscellaneous drugs used in adults and children. As well as recommended dosages and route of administration, some indications are also given. There are helpful sections on cardiology and ECGs, respiratory medicine, trauma, metabolic equations and electrolytes, thromboembolism and coagulopathy, neurology, important procedures, toxicology, drug infusions, paediatrics, orthopaedics, obstetrics and gynaecology, dental, common conversions, antibiotic prescribing and normal values. There is potentially some overlap with the discussion of antibiotics as common antibiotics are also listed in the earlier drugs section.
The book proper commences after the Quick Reference section. The Contents sets out a summary of what is in the following forty-eight chapters. These have been written by an impressive list of contributors, and the book has been reviewed by a shorter but equally impressive list of personnel.
As you would hope with an emergency medicine textbook, the chapters have a strong practical orientation and provide a lot of ‘how to’ guidance as well as enough of the ‘why’. Chapter 2: Securing the airway, ventilation and procedural sedation, is very comprehensive and detailed, and would provide a lot of comfort to the inexperienced practitioner. Chapter 3: Resuscitation and emergency procedures, provides a very helpful step-by-step guide to several common procedures such as IV cannula insertion. Chapter 4: Diagnostic imaging in emergency patients would probably have benefitted from some illustrations to go with the descriptions provided. The same might apply to the following chapter on ultrasound. A number of chapters dealing with cardiac and respiratory emergencies follows, including a thorough effort to explain the nemesis of many a student and doctor, the ECG.
It is nice to see a separate chapter on pain management in the ED, which is appropriately followed by a chapter on trauma. The chapters then jump around a bit. For instance, neurosurgical emergencies are some distance away from neurological emergencies. In the interim, the book travels through aortic and vascular emergencies, orthopaedics, hand injuries, urological emergencies, burns, patient transport and retrieval , mass casualty incidents and a handy chapter on ‘The seriously ill patient – tips and traps’. As someone who works in the pre-hospital setting and has trained in disaster medicine, I thought it was great to see both the retrieval and mass casualty chapters in this book as coverage of disaster medicine is certainly very common in American emergency medicine textbooks. (Upon checking, they were in the earlier edition also.) Following neurology, the book moves on to chapters on gastrointestinal and endocrine emergencies and then acid-base and electrolyte disorders (another subject which strikes fear into many hearts but is comprehensively and clearly covered here). The very pertinent topic of poisoning, overdosage, drugs and alcohol follows. This is very detailed and provides advice and information for a number of commonly abused substances.
The final third of the book also jumps around quite a bit in terms of topics and ordering. Common orphans drowning and Envenomation follow next, then electrical injuries, hypothermia and hyperthermia, childhood emergencies, geriatric care, gynaecological emergencies, ophthalmic emergencies, ENT, dental, psychiatric presentations, dermatology, infectious diseases, the immunosuppressed patient and ED haematology.
The book concludes with a collection of six practical and interesting chapters which contain “something for everyone”. These are rural and indigenous emergencies, advanced nursing roles (which should enhance understanding of what nurses actually do and thus team work), the general practitioner; working with IT (which deals with the vexed issue of interactions between GPs and EDs and provides a template for that essential discharge letter), administration, legal matters, governance and quality care in the ED (a catch-all chapter which contains some important advice on legal issues, including “How do you avoid a law suit?”), and two final chapters of immeasurable worth to residents and medical students: a guide for interns working in emergency medicine, and a student’s guide to the emergency department. It is nice to see that Sasha and Tiffany Fulde and Richard Sullivan, all doctors-in-training, have between them contributed to the pearls of wisdom in these chapters.
Whilst writing this review in the late afternoon and the transition to artificial light, I did find the pale blue headings in the chapters a bit difficult to read as they do not stand out well against the bright white of the pages. Paragraphs of pale blue text fortunately do not occur frequently in the book, but they are even harder to read in artificial light, especially as the pages are a bit shiny and the light source reflects off the surface of the page.
Another small criticism that I would have from recently ‘road-testing’ the book out on location is that the Index at the back could be better. For instance, I went to look up “penetrating eye injury” under E for eyes but it wasn’t there (not there under ‘penetrating’ either). I knew it would have to be in a book about emergency medicine, so went to the Contents and found the chapter on Ophthalmic Emergencies and of course it was there. There was one other similar example that I came across during testing.
My only other comments about things that ideally I might have liked to see is more intuitive chapter groupings and perhaps a few more diagrams and pictures where these could contribute to better understanding. Even if that is not possible, are there online resources that people could be referred to, such as YouTube? For instance, knowing how to reduce a shoulder dislocation is much easier if you can see it done properly first. (Apparently there is a separate eBook available for purchase which contains enhanced content, but this does not assist the purchaser of the print edition.)
As a review of the section on penetrating eye injuries demonstrates, this is a book grounded in emergency department practice rather than a first aid manual. It assumes that the first aid has been done and that the patient has come into the department and that you are getting on with history, examination and management. It is an enormously impressive resource, even though it did not always have quite as much detail as I would have liked on a particular topic. I guess everyone’s needs will vary in this regard, depending on your pre-existing knowledge and level of training and inquiry, but the authors have done a very good and solid job in covering the basics. Some chapters do drill down into a lot of detail.
The authors are also to be commended for including cutting-edge and imaginative topics amongst the chapters that are really going to provide practical value for doctors at the front line.
I feel this is a “must have” book for any Australian doctors interested in or involved in practising emergency medicine. It is written for local conditions by local authors from a variety of clinical backgrounds.
It is probably a bit thick and heavy to carry around in your pocket, but indispensible to keep in your bag for ready reference. For those with smartphones and tablets, the back cover of the book refers to standard and enhanced eBook versions and a PocketED app.
Verdict: Highly recommended!
May I send you a digital copy of my novel, Reluctant Intern, to read and possibly review on your blog?
ReplyDeleteDescription:
Addison Wolfe never wanted to be a physician. He wants to be an astronaut. NASA turned down his application, forcing him to seek employment as a doctor. The problem with obtaining a physician's license is the need to complete an internship to acquire one. Wolfe finds himself in an undesirable rotating internship in a very busy public hospital. Inexplicably, the Director of Medical Education seems to have developed an instantaneous dislike of him and the remainder of the internship class. Another mystery is why an attractive female physician expresses a romantic interest in him on the first day of internship.
“The absolute worst time to go to a teaching hospital as a patient is the month of July. Recent medical school graduates, known as doctors, start their real training on July first. They don’t know anything. They don’t get any sleep. They are underpaid and overworked. Their stress is at catastrophic levels. Is it any wonder they make mistakes?” – Anonymous
“In local news today,” the reporter said, “state and federal authorities are in the process of taking into custody the entire intern class at University Hospital in Jacksonville. Officials cited the number of deaths attributed to this class as the reason. It seems that wrong doses of medications, inappropriate surgeries, failure to diagnose lethal conditions, and other mistakes have led to hundreds of deaths….”
“The overdose?” Wolfe asked.
“Yes,” Dr. Rubel replied, “that will be her legal cause of death, of course. The real cause of death was the autopsy. Barbiturate overdose, followed by refrigeration outside and then here in pathology, slowed her metabolism down. She was actually alive when they started the autopsy. The flexing of her limbs when the saw touched her brain happened because of nerve conduction, brain to extremities. But it was too late; we cannot put her back together. A hard lesson for those poor boys to learn. You, too, gentlemen. It is also true for those who are clinically dead from exposure or drowning. Remember this: a patient is never dead until he is warm and dead. Don’t forget that!”
The senior resident started his description, “EMS responded to a report of a cardiac arrest at 1:07 a.m. in Junior’s Topless Bar, on East Bay Street….”
Figueroa again jumped to his feet. “What is this, a bad joke?” he asked. “Two EMTs walk into a bar…. Let’s be reasonable, guys. The most likely reason for needing a paramedic in a bar at 1 a.m. is a knifing or a gun shot wound, not a heart attack.”
The autopsy and x-rays were condemning. The thirty-nine year old, black male had no history of heart disease. No medical history of any kind. He did have a bullet entrance wound to the back of his head with no exit, bullet still in his brain.
The patient was a massively obese woman who complained of a headache. The intern knew only that she was complaining of a headache and had requested aspirin. Extremely busy, and assuming the nurse would let him know if it were not a good idea to give the patient aspirin, he quickly flipped to the order page and signed the order that had been written by the nurse. Figueroa asked the intern if he had talked with the patient. No. Had he examined the patient? No. Had he even skimmed the chart? He had not. He asked if he knew what allergies the patient had. The intern did not know. At the time he approved the order for aspirin, did he realize the patient was on warfarin, another clotting inhibitor? No. Did he know that aspirin also inhibited platelets and clot formation? Yes. Did he know the patient had a history of blood clots? No. Did he suppose that a blood clot in someone's brain, or a ruptured berry aneurysm in the same area might cause headaches? Yes, he knew that. The autopsy pictures revealed stenosed carotid arteries, two small clots in the patient's brain, and massive bleeding from a ruptured berry aneurysm.
Hi Bill,
ReplyDeleteThanks for your message. I would be happy to have a look at your book with a view to writing a review, and based on the extracts above it sounds as if there are a lot of anecdotes based on experience and observation of near misses and otherwise! I will need to apologise in advance that I am a bit slow reading a lot of text on screen, so it might take a little bit of time to get through it. If you are able to provide me with an email address to contact you then that might be the easiest way to arrange to receive a copy from you. Best wishes!