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D Grundy, A Swain, editors. (Pp 88; £16.95). BMJ Books, London, 2002. ISBN 0-7279-1518-5
An old adage states that anyone can become an expert if they choose a small enough field. Emergency physicians have to know a little bit about the emergency management of everything, our expertise being limited not by condition but by time. I found it refreshing to read the ABC of Spinal Cord Injury, which illustrates perhaps the limits of specialisation and the holistic approach that such patients need, not only from the medical specialties but also from the nursing, physiotherapy, occupational therapy and community support teams.
The book is clearly written and illustrated in the BMJ ABC series format. The chapters are arranged to follow the time course sequence of a patient with spinal injuries. Emergency physicians may be most interested in the first five chapters, covering epidemiology and prehospital care, initial management and assessment, radiological investigations, medical management, and early complications. I have great difficulty remembering each individual muscle group or exact dermatomes while in the resuscitation room so I was particularly interested to read about the American Spinal Injury Association (ASIA) impairment scale and the associated form allowing clinicians to accurately record neurological deficit. A copy of this form would be a welcome addition to the emergency medical notes, comparable to the Lund and Browder charts that we use for burn patients. Other current topics in the emergency management of spinal injury such as the use of corticosteroids in the acute phase and the use of emergent MRI are also discussed.
Perhaps one of the disadvantages of the book to the emergency physician is hinted at by the title, ABC of Spinal Cord Injury. The number of patients that we see with potential spinal injuries is great but thankfully few patients will turn out to have significant injury. “Clearing” the spine is a vital skill for the emergency physician to learn, but cannot be covered by a book dealing with only the injured patient.
A few minor criticisms. There is wide spread use of acronyms and jargon. AUS is not a country with kangaroos but artificial urinary sphincter and SARS (sacral anterior root stimulation) in a spinal injury unit would not provoke immediate isolation. Interestingly while poikilothermia is used by both a physician and a nurse author, only the nurse fully explains its meaning.
The greatest value of this book lies in reading the chapters outside your own area of expertise. I recommend this book to all clinicians involved in the management of patients with spinal cord injuries. Most particularly, we should all jump out of our little boxes of specialisation and read the chapters by the paramedical specialists and about the care of patients with spinal injuries in the developing world. While the book will not cover every question that the experienced clinician needs to ask it will raise awareness that management of patients with spinal cord injury is like life itself and is best approached with a broad mind.