Emergency Medicine Australasia (2004) 16, 86–90

Blackwell Publishing, Ltd.Book Reviews

Book ReviewsBook ReviewsBook ReviewsEmergent Field Medicine

MJ VanRooyen, TD Kirsch, K Clem, CJ Holliman, McGraw Hill, New York, 2002, 900 pages, soft cover, RRP $A193.95, ISBN 0-07-135142-6. Distributed by McGraw-Hill Australia, telephone: + 61 2 9900 1800, Fax: + 61 2 9878 8881 or Email: cservice_sydney@mcgraw-hill.com

I found the title of the book from the guys at the Centerfor International Emergency, Disaster and RefugeeStudies at Johns Hopkins a little misleading. ‘EmergentField Medicine’ conjures up the image of pickingthrough the debris of an Afghan village pulverized byan earthquake, administering to survivors of a Pacificisland swept away by a tsunami or medevackingvictims of some far flung battlefield to definitive care.Instead the introduction of the book states that theauthors’ intent was to create a resource ‘to assist alllevels of health care workers in the day to day practiceof medicine in areas of great need and limitedresources’, ‘a field guide to health personnel workingin remote settings’, ‘a complete resource for basicmanagement of injuries and illnesses’ and hopedit would be as valuable to ‘those working in ruralTanzania as … those in urban Bangkok’.

A pretty tall order I have to say. Not really surewhat urban Bangkokites would have to say about beingconsidered a remote setting either!

Well how does the book do? If I were a western-trained doctor going to work in the third world whatwould I need to know? I guess I’d need to know alot about public health issues, how to manage withlow tech medicine and poor resources, a fair bit abouttropical and nutritional diseases and a bit about otherareas of medicine outside my expertise.

To my surprise in fact this book does reasonablywell. The initial chapters (1–5) are on public health andrefugee type issues and give a reasonable summary tothe more in-depth texts available. They even go intohealth education techniques and how to constructlatrines and water storage systems!

The bulk of the book (chapters 6–22) are on main-stream medical topics such as wound management,gynaecology and infectious diseases. Though theyare of necessity fairly brief and basic they are a usefuloutline especially for those not familiar with the

areas (I found the obstetric bit fascinating! ) or forother health care workers. There are lots of bulletpoints, tables and key points so that a large amount ofinformation is presented in a few pages.

The final chapters on running a field laboratory arevery useful with good drawings of the various tropicalnasties you can expect to come across at the businessend of a microscope (e.g. malaria parasites and a hugeselection of helminths). Finally the book closes witha good chapter on healthy travelling for the aspiringhumanitarian and some very useful appendices largelyfrom the WHO listing contents of mobile medicalkits, health charts and a few other gems.

So to summarize, if I was venturing into the thirdworld and only had one book to take, this wouldprobably be the one. I would want to supplement itwith more in- depth resources on some areas if mybaggage allowance permitted but overall well doneto the guys from Johns Hopkins.

Aled Williams, MB ChB, MRCGP, MPH + TM, FACEMEmergency Physician

Sir Charles Gairdner HospitalNedlands, WA, Australia

February 2004161Book ReviewsBook ReviewsBook ReviewsBook Reviews

Field Guide to Wilderness Medicine, 2nd edition

PS Auerbach, HJ Donner, EA Weiss, Mosby, Philadelphia, USA, 2003, 709 pages, soft cover, RRP $A86.90, ISBN: 0323 01894 7. Available from Elsevier Australia, telephone: + 61 2 9517 8999 or 1800 263 951 or website: www.elsevier.com.au

Paul Auerbach, Howard Donner and Eric Weiss haveproduced this second edition to bring the Field Guideinto line with the contents of the 4th edition of theparent text, Wilderness Medicine (Paul Auerbach, Ed).Sixteen new chapters and six new appendices expandthe guide to a substantial mini-text of 709 pages.However, it is very compactly presented and of a sizeyou could consider taking with you.

New chapters on emergency airway management,cardiopulmonary emergencies and neurologic emerg-encies fill obvious deficits in the 1999 edition. Theaddition of avalanche safety and rescue, improvised

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litters, knots and survival strategies move beyond pureclinical medicine. Appendices on a range of medicaland survival kits provide lists for the inexperienced touse as a reference in developing their own customizedkit. An appendix that lists doses and administration of24 antibiotics might suggest an over-emphasis thatis not borne out in the text. A discussion of oxygendelivery has application to remote travel with relativelysubstantive resources, such as on a small expeditionship in polar regions.

Advice ranges from how to make snowshoes or distilwater in the desert to how to assist a breach deliveryor improvise a chest drain. As an American book forAmericans there are trade names for medicamentsand pieces of kit that are unlikely to be availableelsewhere, and weights and measures are Imperial.

The Field Guide is written for a wide audience, toinclude nurse, paramedic and allied health careproviders. While much of the medical content will bevery familiar for active emergency doctors, the intendedpractice environments may not be. Its extent anddiversity ensures that there is something of interestfor anyone who might be involved in medical carein remote and potentially hostile environments withlimited resources.

Chris Curry, FACEMEmergency Physician

Fremantle HospitalFremantle, WA, Australia

February 2004161Book ReviewsBook ReviewsBook ReviewsBook Reviews

Goldfrank’s Toxicologic Emergencies, 7th edition

LR Goldfrank, NE Flomenbaum, NA Lewin, MA Howland, RS Hoffman, LS Nelson (eds), McGraw-Hill, New York 2002, 2170 pages, hard cover, RRP $A424.95, ISBN 0-07-136001-8. Distributed by McGraw-Hill Australia, telephone: + 61 2 9900 1800, Fax: + 61 2 9878 8881 or email: cservice_sydney@mcgraw-hill.com

The seventh edition of this classic clinical toxicologyreference text continues to be edited by the emergencyphysicians and pharmacists of the Bellevue Hospitaland New York Poisons Centre; internationally re-cognized authorities in the field of clinical toxicology.Chapter authors represent a veritable Who’s Who ofNorth American clinical toxicology. The layout of the

latest edition is essentially unchanged except that astudy guide has been added. Coverage of the disciplineis comprehensive and well set out. Sections aredevoted to assessment and management, biochemicaland molecular principles, systems pathophysiology,pharmaceuticals, drugs of abuse, botanicals andchemicals. The case presentation at the beginningof each chapter is somewhat distracting in a referencetext. With the exception of the material on envenoma-tion, the coverage is generally relevant to Australasianemergency medicine practice.

In some chapters, readers may find the managementsection confusing. There is often detailed discussionof management options in terms of decontamination,antidotes and invasive enhanced elimination proceduresbut without clear risk stratification and indicationsfor the various options. This usually reflects the lackof supporting evidence and, occasionally, an over-aggressive North American approach.

One of the great strengths of the book are the antidotesin depth monographs. Emergency physicians andtrainees will find this to be an excellent authoritativewell-referenced source of information on any antidotethey are likely to use in emergency department practice.

Despite the hefty price tag, the latest edition ofGoldfrank’s remains an ideal choice for those depart-ments wishing to acquire a comprehensive qualityclinical toxicology reference.

Lindsay Murray, MBBS, FACEMEmergency Physician and Clinical Toxicologist

Sir Charles Gairdner HospitalSenior Lecturer in Emergency Medicine

University of Western AustraliaPerth, WA, Australia

February 2004161Book ReviewBook ReviewsBook ReviewsBook Reviews

Emergency Pediatrics: A Guide to Ambulatory Care, 6th edition

RM Barkin and P Rosen, Mosby, Philadelphia, 2003, 968 pages, soft cover, RRP $A184, ISBN 0-323-01901-3. Available from Elsevier Australia, telephone: + 61 2 9517 8999 or 1800 263951 or website: www.elsevier.com.au

A sixth edition? I still have the first, a favourite whenI was an emergency registrar who had previouslyavoided children. The sixth is bigger, and at 968 pagesand nearly 1.5 kg, nearing the limit for a soft cover

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book designed for the ED library, especially as it isglued and not sewn.

Peter Rosen and Roger Barkin are well-knownemergency medicine practitioners, editors, and teachers.Their ‘Emergency Medicine’ is a standard text, andRosen is Editor-in-chief of the Journal of EmergencyMedicine. So why does this effort seem to suffer fromlack of editorial control?

Some good design features have been kept. Paediatricnormal values and emergency drugs are inside thefront cover, and commonly used drugs inside the back.Section headings are listed on the back, with matchingtabs on the facing edges. But with ‘diagnostic categories’just one section covering most systems and taking upa quarter of the book, this doesn’t help much.

Part I, ‘Pediatric care in the Emergency Depart-ment’ is six pages detailing normal development, andnothing else. Part II, ‘Advanced Cardiac Life Support’confusingly starts by describing the ED and waitingroom environment, triage, and the psychosocialreasons why patients present. Two chapters later, wefind ‘Cardiopulmonary Arrest’. Some contributorshave kept to a standard format, which concludes withdisposition and parental education, but not all. Pity,this was a strength of the earlier editions.

I road-tested it by looking up specific disorders.The very short chapter on infectious diseases doesn’tinclude mumps (look in ENT under ‘Parotitis’) ormeasles (Chapter 31, Cough or chapter 42, Rash — seetable). Vomiting has a chapter but it tells me ‘alsosee Chapters 32 (diarrhoea) and 76 (GI disorders)’, anddehydration is somewhere else again. There is tokenacknowledgement of the concept of treating pharyngitisand otitis media without antibiotics, but much morewritten about whether 10, 14 or 40 day courses areneeded.

An appendix to the trauma section describesprocedural analgesia and sedation, and quite well,but analgesia in other contexts is not covered.

The $184 tag might be value for money if the bookcould stand alone. Since one would still need a generalpaediatric text or manual, and relevant chapters ofRosen’s Emergency Medicine and other major textscover paediatric critical care equally well, EmergencyPediatrics is not an essential item.

Diane Campbell, FACEMLocum Emergency Physician

Bunbury Regional HospitalBunbury, WA, Australia

February 2004161Book ReviewsBook ReviewsBook ReviewsBook Reviews

Emergency Medicine Clinics of North America — ‘Bioterrorism’

Vol 20 No. 2 May 2002 by RC Darling, JL Mothershead, JF Waeckerle and EM Eitzen, Saunders, Philadelphia, 280 pages, hard cover, RRP $A150.70, ISBN: 07216 0119 7. Available from Elsevier Australia, telephone: + 61 2 9517 8999 or 1800 263 951 or website: www.elsevier.com.au

Worldwide attention has become more focused on bio-terrrorism with the recent seizure of ricin in the UK, andthe mailing of letters laden with anthrax spores in the USA.

Readers to this journal will probably be well awareof the structure of the Emergency Medicine Clinicsof North America (EMCNA). This issue examines avariety of issues concerning bioterrorism, includingits history, a clinical discussion on agents that could beused, medical management of patients, mass casualtyplans, mental health issues and preparation for abioterrorism event from an emergency department,community and national perspective.

As an American text, clearly much of the infra-structure and preparation chapters are not as relevantfor an Australiasian readership, however, there ismuch that is very relevant. Discussions of the potentialagents that could be used in a bioterrorism attack areeasily read and understood, (my mother was a ‘fevernurse’ in the 1950s and has told me terrible tales ofsmallpox cases she nursed. After reading this sectionI hope that I never see a case) as are the sections onthe mass casualty management. In an excellent chapter,Fred Burkle uses an epidemiological approach to refinethe triage of patients in such an event.

This edition of EMCNA is not a book that all of uswill sit down and routinely read, however, we live in arapidly changing world where the threat of a bioter-rorism is ever present. As emergency physicians weneed to be aware of this excellent resource and for thoseof us who have to plan for such a catastrophic event thisis a book you will need to read and have as a reference.

Heaven help us if we ever have to put theory intopractice!

Mark Little, FACEMEmergency PhysicianClinical Toxicologist

Sir Charles Gairdner HospitalNedlands, WA, Australia

February 2004161Book ReviewsBook ReviewsBook ReviewsBook Reviews

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Occupational, Industrial, and Environmental Toxicology, 2nd edition

MI Greenberg (Editor-in-Chief ), RJ Hamilton, SD Phillips and GJ McCluskey (eds). Mosby, Philadelphia, USA, 2003, 650 pages, hard cover, RRP $A217.80, ISBN: 0 32 301340 6. Available from Elsevier Australia, telephone: + 61 2 9517 8999 or 1800 263 951 or website: www.elsevier.com.au

A major study by the Institute of Internal Medicineof the United States National Academy of Scienceshowed that medical education was deficient in thearea of environmental medicine and occupationaltoxicology.1 Indeed the lack of expertise leads thepatient down the path of multiple medical referralsto different specialties, roaming the internet, andturning to alternative medicine in search of ananswer.

In this book the editors have recruited authors froma variety of medical fields including, medical toxicology,occupational medicine, paediatrics, emergency medicineand internal medicine; pharmacy; and allied specialtiessuch as engineering and environmental sciences. Thisprovides the proper overview necessary to navigatethrough this difficult area.

The sections are well set out with chapters fallingunder the three main headings of the title. This allowscross-referencing and a holistic approach to under-standing the aetiology and management of these con-ditions. The chapters themselves provide a good overviewand are well presented with good photographs.

However the reader looking for more detailedinformation will certainly need to look elsewhere. Thebook is not designed to be an ‘end point’ but a ‘startingpoint’ in sorting out whether a problem relates to atoxicological exposure. The information is sufficientlywell presented to make that step easily.

For the general emergency physician the layout ofthe book provides a reader friendly introduction toaspects of toxicology not routinely seen in emergencymedicine practice. One drawback however, is the lackof clear ‘take home points’ or ‘essentials’ sections thatwould aid scanning of information.

For those interested in toxicology, I wouldrecommend the book as a readable, wide rangingstandard reference. At a RRP of $217.80 the text isgood value for money.

Reference1. Pope AM, Rall DP, (eds). Environmental Medicine: Integrating

a Missing Element into Medical Education. Committee onCurriculum Development in Environmental Medicine, Instituteof Medicine. Washington, USA: The National Acadamies Press,1995.

George Braitberg, FACEMAssociate Professor of Medicine

Director of Emergency MedicineCo-Director, Toxicology Service

Austin HealthHeidelberg, Vic., Australia

February 2004161Book ReviewBook ReviewsBook ReviewsBook Reviews

Emergency Medicine Secrets, 3rd edition

VJ Markovchick and PT Pons, Hanley & Belfus Inc., Philadelphia, USA, 2002, 616 pages, soft cover, RRP $A99.09. ISBN: 1-56053-503-2. Available from Elsevier Australia, telephone: + 61 2 9517 8999 or 1800 263 951 or website: www.elsevier.com.au

The book is divided into 20 sections with 131 chapters.Some of the contributors are well known authors.There has been an increase of 90 pages since the lastedition published in 1999. The general layout is clearand consistent. Each chapter is written in a questionand answer format. The common emergency diagnosesare covered. There are additional chapters on safetyerrors, the critical review of emergency medicine litera-ture, tropical and travel medicine, complementary andalternative therapies, and ‘tricks of the trade’ with tips.In topical areas, controversial issues such as the useof adrenaline versus vasopressin is discussed succinctly.Each chapter has a bibliography which is up to date.

Being a North American book, there are chaptersthat cover managed care and legislation covering thetreatment of uninsured patients. The chapter on bitesand stings reflect local patterns. Australasian environ-mental issues are not covered. Management practicefor the treatment of community acquired pneumonia,the use of culdocentesis and the use of meperidineas an opioid treatment modality for migraine woulddiffer from that in Australasia.

Unfortunately, SI units are not used. The index iscomprehensive.

The book is aimed at all students of emergencymedicine. Overall, the book is appealing with its

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question and answer format. Each chapter is relativelyshort but covers the major issues. It is a good sourceof questions when I do my rounds with the junior staff.The book is worth a look.

Matthew Chu, FACEMDirector of Emergency Medicine

Canterbury HospitalCampsie, NSW, Australia