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Rosen and Barkin’s 5-minute emergency medicine consult. Second edition

Article  in  Emergency Medicine Journal · June 2006

DOI: 10.1136/emj.2005.027839

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492
On the positive side there were some
excellent areas to the book—unfortunately
these were left to the latter sections when
many a medical student would have downed
tools and headed for the nearest library (or
bar) in search of inspiration.
The sections on practical issues, regional
nerve blocks, wound care, and reductions of
dislocations were excellent, as was the some-
what late arrival (chapter 66!) on airway
management.
The toxicology and pain management
sections were interesting and comprehen-
sively written and the appearance of a pre-
hospital care section was a useful addition,
although lacking in relevant detail.
The textbook inadvertently manages to
highlight important differences between
United Kingdom and United States practice
(computed tomography scans within 25
minutes of arrival in acute stroke!!) and once
the varying terminology had been mastered
(acetaminophen, albuterol, CBC, and BUN)
there were some useful areas to learn from.
Overall, I felt that this book is trying to
bridge the gap between smaller pocket books
and large texts, such as Rosen, and fails to
match either in terms of content, interest, or
readability. Would I recommend it? Probably
not.
If this book was reorganised into a more
logical fashion, became system based, and
was more European friendly, then it may
become a useful addition to the emergency
department library.
Lee Gray
Gray’s Anatomy, 39th Edition
Edited by S Standring. Churchill Livingstone:
Elsevier, 2004. ISBN 00443071683.
This icon of anatomical literature was
launched in 1858. Henry Gray was 25 years
old when he first conceived of writing a
comprehensive anatomy text. Three years
later the book was produced. Though Gray’s
clear prose was a major step forward from
contemporary works, its major advantage
was the size and quality of the illustrations
produced by Henry Carter. He was a con-
temporary of Gray in St George’s Anatomy
department but subsequently went to work
for the East India Company before the first
edition was published. Gray himself saw the
success of the first and second edition, only to
die shortly after from smallpox in 1861.
The subsequent years have seen many
changes in how anatomy is taught—if taught
at all. Certainly its key position in under-
graduate medical training in the UK has
declined along with the number of hours in
the syllabus. As a result the public can rest
easy in their beds knowing our junior doctors
can confidently, competently, and empathi-
cally say to the patient they have no idea
what their radiograph shows or indeed what
structures may have been damaged following
a fracture. Inevitably therefore anatomy is
becoming a post-graduate subject, studied by
people with a particular area of interest but
little overall anatomical knowledge. To meet
this need there has been an exponential rise
in the number of books, CDs, and internet
sites detailing comprehensive or specific
anatomical areas of the body.
The 39th Edition of Gray’s therefore comes
at an opportune time but faces may challenges.
In response, the BMJ Editorial group have
www.emjonline.com
set out an objective of producing an
‘‘Anatomical basis for clinical practice’’. The
question for this reviewer was, ‘‘does it pro-
vide an anatomical basis for the Emergency
Physician and could I dispense with my Last,
Ellis, and Cunningham books?’’ To answer
this I accepted that I would not be able to read
it but could consider areas of the book relevant
to our speciality from three perspectives:
N Does it provide enough information?
N Does it provide the information in a
comprehensible and memorable fashion?
N Does it provide the link between applied
anatomy and clinical practice?
Content
The book is now based on seven body systems
to best reflect clinical practice. It also makes it
easier to navigate the 116 chapters to get to an
area of interest. There has also been an update
of text, over 800 new illustrations and an
increase number of magnetic resonance, com-
puted tomography, and other radiological and
operative images used by specialists and
generalists. Neuro-anatomy has been almost
completely revised and there has been expan-
sion of the clinical aspects of several areas—for
the emergency department doctor the most
notably being wrist kinetics, fascial planes of
the head and neck, and the temporomandib-
ular joint. The book also comes with a PIN
code, which enables the reader to link to a
website providing the complete text in an
electronic format as well as updates.
Unsurprisingly on reviewing my chosen 15
areas of interest I found the content more than
adequate for the practicing emergency clinician
and those revising to take the Part A exam. What
was unexpected was the number of errors in the
text and figures. These vary from the anally
retentive—forexample, gettingthecomponents
of the bifurcated ligament the wrong way round
(pg 1527)—to clinically important—for exam-
ple, mislabelling the mitral and tricuspid valves
(fig 56.4) and upper limb dermatomes
(fig.48.19). It is always easy to criticise and I
am aware that a work of this magnitude will
have things that will creep under the radar
irrespective of the 50 reviewers credited with
carrying out this job for the 19 editors.
Comprehensibility
From its first edition, diagrams have been the
biggest use in explaining the anatomy. This
edition is no exception—some of the figures
verge on being works of art as well a clearly
providing a clear message. The surface
anatomy sections take this one stage further
and morph computer generated internal
structures onto live human models. The end
result is a fascinating series of photographs
essential for teaching functional anatomy as
well as revising sites for local anaesthesia.
Conveniently the textbook comes with two
CDs. One has all the figures from the book,
which can be down loaded into Power-
Point presentations. The other provides 3D
reconstructions of limbs, spine, and heads and
neck. These are useful but less sophisticated
then other anatomical software available.
Though the line drawings are consistently of
a high quality the legends are not. Besides the
occasional mislabelling, the arrows sometimes
disappear against the background colour leav-
ing the reader lost as to which structure the
label is referring to. Several of the radiographs
take this to the ultimate level by having black
numbers on a black background. One of the
lateral radiographs of the ankle and foot (fig
PostScript
115.10) added to the mystery by having 12
legends but only 11 arrows.
I found the text very different from the
narrative style of Last or the sprinkling of
historical anecodotes of Ellis. By and large it was
plain and unimaginative with only the occa-
sional summary to help the tired reader clarify
his thoughts. There is no prioritising of facts or
hints on how remember them at 2 am in the
resuscitation room. It is therefore a classic
reference book. There is nothing wrong with
this but it does assume that the reader will be
able to understand and retain what is being
written because it will not be discussed again.
Indeed, I often got the impression it was
important to know your anatomy before read-
ing Gray’s. Consequently the trigeminal sensory
central connections still remains a mystery to
me. A further example is found when suppina-
tion/pronation are mentioned in the classifica-
tion of ankle fractures. As these movements had
not been previously explained, the uninitiated
reader is left trying to work out what it means. If
you persist, it is explained en passant seven
pages later under the title of ‘‘Biomechanics of
standing, walking and running’’.
Clinical practice
Some of the chapters are obviously written with
the clinician in mind. Structures are built up in
a comprehensible fashion with frequent refer-
ences to the clinical usefulness of the anatomi-
cal facts being discussed. Of the 15 chapters I
read, the knee was good but the spinal cord and
basal ganglia were superb. The basal ganglia
section was a masterpiece in synthesising
anatomical, pathological, and pharmacological
text with excellent diagrams. With such good
demonstrations I found many lost opportu-
nities—for example, the cerebrovascular supply
is comprehensibly covered but is not linked to
strokes or computed tomography images; the
kinetics of the wrist is discussed but no
conclusion or clinical relevance is provided
and many conditions and procedures are
described but no anatomical figures accompany
them. These would have been ideal places to
summaries key anatomical features in a com-
prehensible and memorable way.
Conclusion
My critical review must be taken in the context
of a person wanting this anatomical icon to be
perfect. It cannot be and it was not. The
inclusion of so much new work is bound to lead
to new mistakes, which will take time to
eliminate. As it stands, it represents a consider-
able amount of hard work by a huge team of
people trying to make anatomy relevant and
accessible for the modern clinician. I commend
their endeavours and am sure subsequent
editions will build on the progress made so far.
For now I will use it for its diagrams (especially
surface anatomy) and some of its text—for
example, spine and basal ganglia—but will still
retain my Last for its comprehensible writing
and Cunningham for its limb diagrams.
Peter Driscoll
Rosen and Barkin’s 5-minute
emergency medicine consult. Second
edition
Edited by J Schaider, S R Hayden, R Wolfe, R M
Barkin, PPRosen.
Rosen. : Lippincott
Lippincott Williams
Williams &
& Wilkins,
Wilkins, 2003.
2003. ISBN ISBN 0781771722
0781771722
PostScript
This book is clearly aimed at the practicing
emergency physician working on the shop
floor who needs a rapid and concise summary
on a specific topic. It has over 600 topics,
organised into two to four page summaries in
a standard format, covering all aspects of care
from prehospital issues to patient disposition.
This format allows rapid access to the facts
and allows the user to gain familiarity
quickly. I say ‘‘user’’ as this is not a book to
sit down and read. The short, sharp, and
punchy text is reminiscent of Joe Friday in
the film Dragnet asking for ‘‘Just the facts
ma’am’’. It is certainly not a page turner and
there is no ‘‘padding prose’’ here, but this
reflects how people will use it.
One thing that initially concerned me was
how the editors had organised the topics. I
am normally an advocate of texts in emer-
gency medicine that use a presentation based
approach: this is not the norm here with most
texts being accessed through the pathological
diagnosis. However, I have found this text
most useful during our three times weekly
clinical ward rounds in the emergency
department: the diagnosis is usually obvious
by that stage and further information is being
sought on one particular aspect of the case. In
that role, as a rapid reference, and a source
of interesting information to liven up the
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discussion, it has proved its worth. My only
criticism is that you would really want this
text in your pocket, which is impossible in its
current 1000 page plus format. However,
there is a PDA version, which I could see
myself using on a more regular basis.
S Carley
Manchester Royal Infirmary, Emergency
Department, Manchester, UK;
Simon.Carley@CMMC.nhs.uk
Spotting the sick child
Produced by Ffion Davies. Leicester: Published
by OCB Media, 2004, £8.99. ISBN 1 904039
11 1. DVD.
Teaching medical students, junior doctors
and nurses how to recognise a sick child,
either in the emergency department or in
general practice, has been revolutionised in
recent years. The introduction of advanced
paediatric life support (APLS) and patient
advice and liaison services (PALS) courses
has had a bigger impact on medical education
and clinical practice than their founders
could have believed possible.
This DVD, from the team at the Leicester
Royal Infirmary, UK, offers an introduction
493
to the assesssment of sick children and is
aimed at nurses, nurse practitioners, health
visitors, general practitioners, accident and
emergency department junior doctors, ambu-
lance staff, emergency care practitioners and
junior paediatricians. It has an easy to follow
menu system to help navigate through its
contents.
The clinical material provides an introduc-
tion to problems such as rashes, abdominal
pain, fits, fever, dehydration, difficulty in
breathing and head injuries. It describes and
demonstrates a 3-min examination and uses
film of sick children as well as ‘‘head shot—
to camera’’ pieces by the main authors.
The material and format is ideal as an
introduction to these topics for the target
audience. It is well produced and edited. The
topics are covered efficiently without going
into too much detail, however, it is not meant
to be a substitute for attending an APLS or
PALS course. It can be used either on its own
or with supplemental teaching by an experi-
enced clinician in an interactive context. It is
an ideal product to have in an emergency
department library and I am sure it will be
well used.
G Hughes
www.emjonline.com