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Emergency medicine procedures
  1. J Lee

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    E Reichmann, R Simon. New York: McGraw-Hill, 2003, £120, pp 1563. ISBN 0-07-136032-8.

    This book has 173 chapters, allowing each chapter to be devoted to a single procedure, which, coupled with a clear table of contents, makes finding a particular procedure easy. This will be appreciated mostly by the emergency doctor on duty needing a rapid "refresher" for infrequently performed skills.

    “A picture is worth a thousand words” was never so true as when attempting to describe invasive procedures. The strength of this book lies in the clarity of its illustrations, which number over 1700 in total. The text is concise but comprehensive. Anatomy, pathophysiology, indications and contraindications, equipment needed, technicalities, and complications are discussed in a standardised fashion for each chapter. The authors, predominantly US emergency physicians, mostly succeed in refraining from quoting the “best method” and provide balanced views of alternative techniques. This is well illustrated by the shoulder reduction chapter, which pictorially demonstrates 12 different ways of reducing an anterior dislocation. In fact, the only notable absentee is the locally preferred Spaso technique.

    The book covers every procedure that one would consider in the emergency department and many that one would not. Fish hook removal, zipper injury, contact lens removal, and emergency thoracotomy are all explained with equal clarity. The sections on soft tissue procedures, arthrocentesis, and regional analgesia are superb. In fact, by the end of the book, I was confident that I could reduce any paraphimosis, deliver a baby, and repair a cardiac wound. However, I still had nagging doubts about my ability to aspirate a subdural haematoma in an infant, repair the great vessels, or remove a rectal foreign body. Reading the preface again, I was relieved. The main authors acknowledge that some procedures are for "surgeons" only and are included solely to improve the understanding by "emergentologists" of procedures that may present with late complications. These chapters are unnecessary, while others would be better placed in a pre-hospital text. Thankfully, they are relatively few in number, with the vast majority of the book being directly relevant to emergency practice in the UK.

    Weighing approximately 4 kg, this is undoubtedly a reference text. The price (£120) will deter some individuals but it should be considered an essential reference book for SHOs, middle grades, and consultants alike. Any emergency department would benefit from owning a copy.

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