UCONN Emergency Medicine Interest Group

Archive for the ‘REVIEWS’ Category

Web Spotlight 2: Free Emergency Medicine Talks

In REVIEWS on February 17, 2012 at 6:18 PM

Free Emergency Medicine Talks
Summary
Format:MP3 storage site.
Author: Joe Lex of the Temple University Hospital EM program.
Audio/visual media?: yes, audio online.
Recurring features: Joe’s “pick of the week”, a single talk highlighted (you guessed it) weekly.
Why you should check it out: pretty much as much audio content as you could possibly stand to listen to, and then some, on a huge variety of topics that are well-organized by tags corresponding to the subject (e.g. critical care, endocrine emergencies, resuscitation, radiology, toxicology, wilderness medicine, etc.). The range and depth of the lectures is so broad that there’s pretty much no topic in EM that isn’t covered. Lectures and talks are generally either 30 minutes or 1 hour in length, either one-offs or as part of a collection from national/international conferences.

Advertisements

Book Review: Emergency Radiology – Case Studies

In REVIEWS on December 17, 2011 at 8:37 PM

This review is for the book Emergency Radiology: Case Studies, by David Schwartz, which can be purchased here. The reviewer has received no financial renumeration for this review.

I read this book prior to and during my radiology rotation to improve my knowledge about radiology specifically relevant to EM. There are several other books dedicated to this topic, but I felt this one struck the best balance between brevity and comprehensiveness. I felt that this case-based emergency radiology text was extremely helpful and well-written.

The text of the book is 559 pages. It is divided into 7 sections: chest X-ray, abdominal X-ray, upper and lower extremity X-ray, C-spine X-ray, head CT, and facial X-ray. Each section has a number of cases which serve to illustrate a particular point. The majority of the material presented was based on plain films, which I felt was appropriate, given that these are the most likely films that an emergency physician will have to interpret before the official radiologist reading; the exception to this is the section on head CT, which is, of course, a very important modality for EPs to be facile with. Notably, many of the cases describe initially missed findings by the radiologist, the emergency physician, or both, which resulted in a bounceback or other adverse outcome. The cases are also mostly not obvious- the book specifically addresses many more subtle findings that would and are often easily missed if they are not specifically looked for, such as hidden infiltrates on CXR, soft tissue swelling as a marker for fractures, and stroke mimics. Thus, the book definitely goes beyond the introductory level, and would very likely be a valuable read even to an experienced emergency medicine resident or attending.

Strengths of the book included the very clear writing style by a single author, excellent quality and quantity of images (there is nothing, in my opinion, more frustrating than trying to learn from terrible quality images), focus on radiology that is critical in EM, level of detail, and range of material presented. Weaknesses included omission of some topics that probably would be helpful (eg. hip dislocation), and general lack of ultrasound (although I understand that this is more of a conventional radiography book). In the end, I would definitely recommend this book.

Overall score (out of 5 stars):

Web Spotlight 1: Life in the Fast Lane

In REVIEWS on November 27, 2011 at 3:57 PM

This is the first in a new series of posts highlighting some of the best online-based EM resources that can be found. Many of these are already present in the Links section, but this series is designed to give a little more information and guidance on what is out there, with a reduction in the risk of “information overload”. So, without further ado, here we go!

Life in the Fast Lane
Summary
Format: multiauthor blog.
Authors: a group of primarily Australasian emergency physicians and intensivists. Lead authors are Mike Cadogan and Chris Nickson.
Audio/visual media?: yes, although primarily just images.
Recurring features: links to current literature of interest, clinical cases (with special series on toxicology and EKG cases), rapid Q&A based explorations of topics of interest (e.g. noninvasive ventilation), and (sometimes questionable) humor.
Why you should check it out: virtually a one-stop shop for EM education needs. Very connected to other sites as well, so you will learn more about what it out there. The recurring series are excellent, especially the Q&A based cases and overviews of interesting topics, as they give you a chance to think about the answer before actually seeing it, and can be read through in just a couple of minutes. The EKG cases are great, and while are more advanced than what we are getting in medical school, are very accessible by the writing style. One very minor point to note is that given the authors are primarily from Australia and New Zealand, there may be some slight differences in drug names/drugs used (e.g. suxamethonium vs. succinylcholine), spellings, and scope of practice (for example, it appears that there are rural GPs in Australia that seem to be able to do virtually anything) but I have not to date found this to be a significant issue.

Book Review: Goldfrank’s Manual of Toxicologic Emergencies

In REVIEWS on November 13, 2011 at 7:00 AM

This review is for the book Goldfrank’s Manual of Toxicologic Emergencies, by R.S. Hoffman, L.S. Nelson, M.A. Howland, N.A. Lewin, N.E. Flomenbaum, and L.R. Goldfrank, which can be purchased here. The reviewer has received no financial renumeration for this review.

I purchased this book and read it through the toxicology rotation due to a personal interest in the subject matter. I wanted a text that would be comprehensive and detailed, but not so long that it would not be readable within approximately a month’s time (i.e., reading the big Goldfrank’s was not a viable option), and not so abbreviated that I would feel like it was too basic. Overall, I found this book to be an excellent choice.

The text of the book is 1066 pages (not including the index). It is divided into 3 main sections: General Approach to Medical Toxicology (discussing some basic principles of approaching the poisoned patient), Fundamental Principles of Medical Toxicology (primarily organized by organ systems and discussion of special populations), and Clinical Basis of Medical Toxicology (the heart of the book, discussing individual toxins and antidotes, as well as a final section discussing disasters, poison control centers, and epidemiology). The chapters discussing individual toxins or group of related toxins are generally organized in a consistent manner, with a discussion of pharmacology, pharmacokinetics, pathophysiology, clinical manifestations, diagnostic testing, and management. Where appropriate, the chapter on the antidote follows its respective toxin.

Strengths of the book including the overall homogeneity of the book, depth of discussion with practical information including dosages on management, mostly appropriate use of tables and charts, and comprehensive range of the material. Weaknesses include occasionally too brief discussion of certain toxins and lack of references. If you are looking for a fairly definitive reference in toxicology, that is a readable length, I would recommend this book.

Overall score (out of 5 stars):

Book Review: Introduction to Clinical Emergency Medicine

In REVIEWS on October 9, 2011 at 8:00 AM

This review is for the book An Introduction to Clinical Emergency Medicine edited by S.V. Mahadevan and Gus M. Garmel, which can be purchased here. The reviewer has received no financial renumeration for this review.

I purchased this book and read it in its entirety prior to beginning my first EM rotation, with the thought that it would be a good and comprehensive overview of emergency medicine that would be more digestible than reading through Tintinalli or some other “classic” textbook. In addition, I was somewhat sucked in by the novel organization of the book with chapters based on complaint, rather than problem, with the idea that each chapter would give me a method of approaching a patient with said complaint. While the book did seem to accomplish these goals to some degree, I found a number of flaws that made me walk away wishing I had put in the extra time to just read Tintinalli’s instead.

The text of the book is 752 pages (not including the index). It is divided into 4 main sections: Principles of Emergency Medicine (eg. airway management, shock, trauma, etc.), Primary Complaints, Unique Issues (eg. abuse, environmental emergencies, legal aspects), and Appendix (containing mostly information on common procedures done in the ED). More or less, each chapter is written by a different author (some authors contributed >1 chapter). This was a problem in the previous book review that I did due to lack of homogeneity between chapters, but in this book, there is a relatively rigid format with each chapter in Primary Complaints (which comprises the bulk of the text) describing the scope of the problem, relevant anatomy, approach to history (ie. what questions to ask and what they imply), physical exam, differential diagnosis, testing, treatment principles, special patients (eg. elderly, pediatric, and immunocompromised), disposition, and pearls/pitfalls. This format is followed by almost every chapter, and does make the book more consistent throughout. The material itself is quite basic, which you might take as a good thing or a bad thing, depending on what you are looking for. If you are truly looking for an introduction to emergency medicine, getting the basics is probably helpful. However, I found the lack of “new” information to me often frustrating, and I was frequently left wanting more. Another significant problem was the overuse of tables (a pet peeve of mine), and especially how general and lacking in detail the information therein provided was. This was a problem particularly in the differential diagnosis section, which relied heavily on the table format. Given that the actual book is mostly organized by complaint, rather than problem, there is very scant information about individual problems as a result of this; for example, identification and treatment of pulmonary embolism is treated only very superficially (which I’m not singling out- almost all disease in the book is described in the same manner).

Strengths of the book included the overall homogeneity of the book, excellent images, and the novel way in which emergency medicine is presented, as well as the relative brevity; individual chapters were generally less than 10 pages long. Weaknesses included the superficial treatment of individual diseases and overuse of tables and lists. I may have been somewhat biased in this review given that the book does present itself as an introductory text, rather than a comprehensive text, and thus if that is what you are looking for, this book may be a decent read. However, given that the book is 752 pages, and other introductory books targeted to medical students are significantly shorter (for instance, Blueprints is ~300 pages), while (if you restricted yourself to clinical topics only) other more definitive textbooks are not that far off in size, I feel this book occupies somewhat of a strained middle ground.

Overall score (out of 5 stars):

Book Review: Avoiding Common Errors in the Emergency Department

In REVIEWS on August 20, 2011 at 2:25 PM

This review is for the book Avoiding Common Errors in the Emergency Department edited by Amal Mattu, which can be purchased here. The reviewer has received no financial renumeration for this review.

I purchased this book for my second EM rotation after having finished an introductory textbook to emergency medicine (review forthcoming) based on good reviews and the strength of the editor’s name, who I had listened to several lectures from. My goals were to get into more EBM and learn about subjects that I hadn’t necessarily been exposed to or taught thus far. The initial management of chest pain, trauma, abdominal pain, and so forth are all crucial topics in EM, but we do get exposed to them quite frequently. What about the other areas that we don’t necessarily get taught?

The text of the book is 928 pages (not including the index). It is divided into 28 sections covering the gamut of EM, from airway to wound care, which are subdivided into 400 chapters, each of which range from about 2-5 pages in length, with associated references. Each chapter is written by a separate author. Consequently, there is not a lot of homogeneity in the style of the book, and the quality of each chapter does vary somewhat, although most of them are quite good. I would liken the experience of reading the book to having a short discussion with a different respected attending about a particular point of interest. Occasionally, there does appear to be some overlap in material covered, which is probably to be expected given the number of authors. Some of the chapters end with a “key points” section, but the majority do not, which is a shame, since I found that quite helpful as a succinct summary of the material. The material itself, as I alluded to earlier, does cover some of the basics, but also explores in brief many subjects that I would consider more advanced or technical. For example, how to evaluate children for spinal cord injury without radiographic abnormality (SCIWORA)- clearly, a high risk area, but one that I had not previously heard about. Similarly (and appropriately, given the title), the book frequently warns against errors that rely on the “common wisdom” handed down from generation to generation of physician, such as ignoring troponins in renal failure patients or avoiding epinephrine use in digital blocks. Short of reading an actual full-blown comprehensive EM textbook such as Tintinalli’s or Rosen’s, these topics probably wouldn’t routinely be encountered in a didactic way- but surely do in a clinical setting.

Strengths of the book included the overall comprehensiveness and wide range of topics discussed, as well as the brevity of the writing. Each chapter can easily be read less than 10 minutes, and most in significantly shorter than that time period. Weaknesses included the disjointedness of the writing style (again, probably to be expected in a book written by this many authors), and probably less forgiveably, the number of typos and spelling errors (which sometimes gave me pause to wonder if the actual information being presented was correct). Some more images to illustrate the more visual parts would probably also improve the book. As a final side note, although the publisher promotes this as a “pocket book” for reference, although this book might technically fit into a lab coat pocket, it is rather large and heavy to make that really practical.

Overall score (out of 5 stars):

Book Review: Minor Emergencies – Splinters to Fractures

In REVIEWS on July 3, 2011 at 4:51 PM

This review is for the book Minor Emergencies – Splinters to Fractures, 2nd edition by Philip Buttaravoli, MD, which can be purchased here. The reviewer has received no financial renumeration for this review.

This is a book that I purchased because I felt that many of the everyday clinical problems that I might encounter in the ED (or just walking around in a hazardous world) had not been formally taught in the curriculum, and had not been encountered by myself yet in my outpatient rotations. We learn a lot about carcinoid tumors, pheochromocytomas, the histology of thyroid cancers, and enzymatic pathways, but not very much about how to handle poison ivy exposure, finger dislocations, torn earlobes, or foreign body removal- despite the fact that we are very likely to encounter these problems at some point in our career. The author makes the point in the preface that the assumption is that “if you haven’t completed your training, you can’t do any harm if the conditions to which you are assigned responsibility aren’t very serious”; however, “care still needs to be appropriate so that the condition won’t deteriorate into a true threat to life or limb”. I fully agree with the author that minor emergencies, as much as any other medical issue, deserve to be treated seriously and with an eye towards providing evidence-based, cost-effective, and efficacious evaluation and treatment.

To this end, I believe that this book definitely fulfilled those goals. The text of the book, not including the index, is 807 pages long and divided into 184 chapter (and 8 appendices). Each chapter ranges from about 2 to 6 pages in length. The chapters are organized in sections, ranging from Neurologic and Psychatric Emergencies to Musculoskeletal Emergencies. Each chapter follows a uniform format with an initial discussion of the presentation of the complaint, followed by recommendations on what to do, and recommendations on what not to do, and concluding with a general discussion  of the topic. There are numerous references provided in case you want to explore a topic more deeply. The book is in full color and there are both photographs and clearly done illustrations. Notably, there are no tables in the book, which I take as a refreshing change from the usual medical textbook, which I feel often substitutes tables for clear and concise writing.

Strengths of the book included brevity of the writing, excellent illustrations, comprehensiveness, and attention to practical detail. The only disadvantage that I can see is that the book cover promises that there is handheld software included with the book; however, I contacted the publisher (Elsevier), and they informed me that the service used to run the software has been discontinued.

Overall score (out of 5 stars):

Book Review: Wounds and Lacerations – Emergency Care and Closure

In REVIEWS on June 3, 2011 at 6:19 PM

This review is for the book Wounds and Lacerations: Emergency Care and Closure, 3rd edition by Alexander T. Trott, MD, which can be purchased here. The reviewer has received no financial renumeration for this review.

This is a book which I picked up for my outpatient surgery clerkship in preparation for both that rotation and my upcoming EM rotations. I had hoped to learn from a reputable source the very basics involved in wound repair, which I felt were somewhat lacking in the general curriculum, as well as some advanced techniques. I was looking for a book that was evidenced-based, rather than tradition-based, and covered a fair amount of ground while not being overly arduous to get through in a 3 week period.

Overall, I feel that this book fulfilled those goals, and generally quite well. The text of the book, not including the index, is 316 pages long and divided into 22 chapters. It begins with an overview of emergency wound care and assessment, and gradually builds up in a logical succession in a sequence of how you would close a wound in the ED, beginning with assessment, followed by anesthesia, then cleansing, then choosing suture material and instruments, then techniques both for repairing simple and complex wounds. The book then transitions to special situations, such as facial or hand wounds, bites, burns, foreign body removal, etc. The book makes sure to cover even the “simple” but essential issues involved in wound care which are probably not ever going to be formally taught. For example, in the chapter on wound cleansing, there are subsections dedicated to what sort of solutions to use, how to irrigate properly and with the correct instrument, positioning the patient, and so on. Likewise, there is a 28-page chapter on wound dressing and bandaging with copious illustration.

Strengths of the book included brevity of the writing and many illustrations (tri-color only, unfortunately) and attention to all portions of wound care in a primary survey of the subject. Weaknesses included the fact that the text and the illustrations were sometimes a bit awkwardly out of sync, which might be confusing if attention was not paid to which figure number in the text matched up to which figure (in other words, the figures on one page often were referenced to on the previous page, rather than the current page). The subsections could also sometimes occasionally be a little too brief, although I am hesitant to consider this a significant weakness, since it ensured that the most essentially information didn’t get lost in text (as I feel often happens in textbooks).

Overall score (out of 5 stars):

%d bloggers like this: