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Accident and emergency: theory into practice
  1. P O Brennan

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    Edited by B Dolan, L Holt. (Pp 564; £35.95). Baillère Tindall, 2000. ISBN 0-702-02239-X.

    I was delighted to be asked to review this book as on the first superficial glance both the format and content looked very appealing. It is a wide ranging book covering both the clinical and professional needs of nurses in the accident and emergency department. It also seeks to uncover the theoretical and research basis for current day practice.

    In the clinical sections, problems are approached from an anatomical and physiological view, giving a sound basis for the assessment and management of cases. I particularly liked the clear anatomical diagrams, with just enough detail. I would have found the addition of some radiographs useful as they are of particular relevance. The book covers the whole case mix of any department, approached from both a systems approach and from an age banded approach.

    I did feel that certain sections were written from a theoretical viewpoint rather than from experience of current clinical practice. In particular, in the section preschool children on viral croup it was suggested that nebulised adrenaline (epinephrine) was the first line treatment. This is clearly not needed in the mild cases and should only be used in the severe cases when the child is to be admitted and will possibly need intensive care. It can cause dangerous rebound stridor and facilities for intubation must be ready.

    The section on abdominal emergencies was good, but the assessment of abdominal trauma by primary and secondary survey was mixed up and very confusing not following the ATLS guidelines. The patient was log rolled in both the primary and secondary survey.

    The section on minor head injuries was excellent. This is an area that often gets too little attention considering the number of patients presenting. The sections on pain management and violence and aggression were well written and useful, as was the whole section on psychological problems.

    I found it odd for the section on nurse triage to be so far into the book, as it is the first contact most patients have with a nurse whatever their condition. In view of the importance of the nurses role and responsibility in this area, the section was a little lost.

    The sections on Practice and Professional Issues overall, however, were excellent detailing clearly many conflicting issues in an A&E nurses role. An example was the thoughtful discussion on the need for precise and accurate patient assessment, but in a limited time with limited resources.

    Overall, the clinical areas of the book will be very useful as a bench reference book for nurses and the other areas are excellent to help nurses consider the breadth of professional issues they meet. I would recommend it to my nursing colleagues and also to my medical colleagues to give them some insight into the problems their nursing colleagues meet every working day.

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