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Radiology for anaesthesia and intensive care
  1. J R Benger

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    Richard Hopkins, Carol Peden, Sanjay Gandhi. London: Greenwich Medical Media, 2003, pp 332. ISBN 1-84110-119-2

    This book is clearly aimed at anaesthetists preparing to sit the FRCA examination. Any doubt regarding this is quickly dispelled by the two chapters that follow the introduction: “About the FRCA Examination” and “The Pre-Operative Assessment”. Hardly surprising, therefore, that it is of limited relevance to emergency medicine.

    Each of the book’s seven main chapters begins with a general introduction to set the scene and introduce underlying concepts, before moving on to a series of realistic “case illustrations”, in question and answer format, accompanied by an explanation and additional background information. This is a clear and effective layout, but because the whole case is often presented on a single page it is sometimes a little too easy to read the answer before the question, or perhaps I’m just a natural cheat.

    There are, however, some useful sections. I found the chapter on imaging the chest, particularly in relation to chest radiological interpretation, interesting and educational, but the abdominal section was too heavily weighted towards computed tomography and contrast studies to be of substantial use.

    A sizeable section of the book is dedicated to trauma radiology, but while the chapter on the cervical spine is informative and up to date, that on chest and abdominal trauma covers management at a basic level, with little imaging of interest.

    As emergency physicians take on a greater role in the management of head injury, and computed tomography becomes more widely available, I find myself interpreting more and more head scans. For this reason I thought that the chapter on computed tomography of the head was probably the best in the book. It makes a good introduction to those who are approaching this subject for the first time, and has some excellent scans, clearly described with useful clinical detail. There is also a short final chapter on ultrasound in intensive care units, which overlaps considerably with the recent development of “FAST” scanning in the emergency department. I am doubtful, however, that a textbook can teach more than the basic principles underlying such an essentially dynamic skill.

    For those about to sit the MFAEM or FFAEM exams there is some useful information in this book, but probably not sufficient to justify the purchase price. The two major problems are the inevitable anaesthetic slant, and the limitations of the medium itself. This anaesthetic slant is constantly manifest in the presentation of cases that are particularly relevant to anaesthesia (lots of rheumatoid arthritis, for example), followed by questions such as “are there any precautions necessary prior to anaesthesia?” Some might argue that with the increasing performance of intubation by emergency physicians these questions are now becoming more relevant, but on the other hand detailed imaging is a rare luxury before rapid sequence induction in our departments. The limitations of the medium are inherent to all books that profess to teach radiology: particularly in an A5 format large radiographs are reduced to small pictures in which the detail is lost. This may be one of the reasons why the section on head computed tomography is so effective: the pictures are about the same size as the original films. For me, however, there is no substitute for handling and examining the real thing. Until digital radiology finally arrives in the south west of England, that is.

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