Book review: The Trauma Manual, 2nd edition ... emergency medicine physicians and surgeons (and ... support of the organ donor; paediatric trauma; geriatric.
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Book review: The Trauma Manual, 2nd edition Andrew Peitzman, Michael Rhodes, C. William Schwab, Donald Yealy and Timothy Fabian Publisher: Lippincott, Williams and Wilkins, Philadelphia2002, 585 pages, $39.95, ISBN: 0-7817-2641-7
The stated goal of the editors of this second edition of The trauma manual is to serve as a ready pocket reference for all who provide care for trauma patients. Although containing information for health personnel working in any and all aspects of trauma care (prehospital, emergency department, intensive care, operating room, and rehabilitation settings), the bulk of the text is aimed at emergency medicine physicians and surgeons (and residents), who provide most of the patient care during the first few hours after injury. The authors are from north American academic medical centres, the majority being surgeons (trauma and subspecialists) and others: anaesthesiologists, critical care or rehabilitation specialists, and a few emergency medicine specialists. Although written from an American–Canadian emergency medical system point of view, the contents should be useful to practitioners in a variety of emergency healthcare systems. This wide range of topics in a manual-sized book means many authors (78!) and short (5–15 pages) chapters. Although the majority of authors have a surgical background, the focus of the book is not on operative techniques, but is aimed at all members of the trauma team, especially emergency physicians. Chapters can be roughly divided into the following groups: injury mechanisms and pre-hospital care; transport and pre-arrival at emergency department organization; initial trauma management and imaging; injuries of specific anatomical regions; system-wide injuries (e.g. hypothermia, burns); supportive care (e.g. nutrition, pain management, care of the potential organ donor); and rehabilitation and special aspects (e.g. geriatric trauma). The text of each chapter is in outline format, which keeps the length of text concise and makes information easy to locate. The chapters on injuries in specific anatomical regions are organized as follows: introduction; anatomy and physiology; initial assessment and management; treatment details of specific injuries; and non-operative versus operative management (including ‘operative approach’ in some chapters). Most chapters end with a valuable list of ‘axioms’, summing up the most important points for the practitioner to remember. Many line drawings are included in the clinical chapters, and are clearly labeled. The few X-ray images (all adequately reproduced) in the book are all in the C-spine section. c 2002 Lippincott Williams & Wilkins 0969-9546
Ample up-to-date references are provided at the conclusion of each chapter for further reading. The first few chapters cover patterns of blunt injury and mechanisms of penetrating trauma, the physiological response to injury, and measurements of injury severity. Besides the Glasgow Coma Scale and Revised Trauma Score, scoring for the Penetrating Abdominal Trauma Index and Injury Severity Scores are explained. The full Abbreviated Injury Score is listed in the appendix. A sample TRISS diagram is also included. The next few chapters deal with prehospital triage, therapy and transport. Limitations of triage systems are adequately explained, and a few airway and breathing procedures (intubation, laryngeal mask insertion, needle thoracostomy) are illustrated with simple drawings. Following these, chapters on trauma teams and preparation of the emergency room before patient arrival include simple protocols and diagrams of trauma team members’ locations in the trauma bay. The next chapters deal with general resuscitation, testing, and imaging of the trauma patient. These are followed by specific chapters on injuries to particular anatomical regions (e.g. head injury, injuries to the spinal cord and spinal column, penetrating neck injuryy 18 chapters in all). The next section consists of chapters on priorities in intensive care unit care, pain management and anaesthesia for the trauma patient, and one entitled ‘Commonly missed injuries and pitfalls’. This is excellent and deserves to be read and reread frequently, as a reminder of how physical examinations, laboratory, or imaging tests may mislead us. Several special situations are covered: support of the organ donor; paediatric trauma; geriatric trauma; and care of the pregnant trauma patient. Finally, chapters on rehabilitation, venous thromboembolism, injury prevention and legal issues round out this manual. Prophylactic and treatment doses are given (including the use of low-molecular-weight heparin) for various forms of thromboembolic disease. The editors included three useful appendices: (A) the Abbreviated Injury Score (scoring for each anatomic region in detail); (B) tetanus prophylaxis; and (C) frequently used trauma forms (physician’s note, nursing flow sheet, and brain death documentation checklist). DOI: 10.1097/01.mej.0000072637.95490.c9
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The authors clearly attempt to describe evidence-based approaches to patients: no mention is made of the ‘routine’ use of skull X-rays (as in many texts); ‘limited fluid resuscitation’ is described in several chapters (but is not defined clearly enough, nor is a simple protocol given); simple slings are recommended for clavicle fractures; the early mobilization of elbow injuries is emphasized; and prophylaxis and treatment for deep vein thrombosis are discussed in detail. In a text of limited size like this one, more detailed discussions of many topics could not be included. However, it would have been nice to summarize the recent research on ‘limited fluid resuscitation’, and offer a flow chart diagram for the treatment of patients ‘needing fluids’. Femoral nerve block, commonly used in patients with femur or hip fractures, should have been mentioned. Although not applicable to European readers, a portion of the chapter on documentation is devoted to the EMTALA law (dealing with initial patient examination and transfer), but it is brief.
This book provides a clear, up-to-date approach to the acute management of trauma patients. Because of its size and format, The Trauma Manual can be read at one’s leisure, or can be referred to during rounds or while caring for patients. It is also available on the Ovid system at medical libraries. Detailed information on trauma care or emergency procedures (e.g. needed to prepare lectures) should be obtained in more comprehensive textbooks. This straightforward text will be particularly enjoyed by emergency medicine and general surgery residents. More experienced physicians will enjoy the text, not for any new information it offers, but for the concise organization that makes it easy to familiarize oneself (again) with a particular aspect of care. It is well worth the price. Ozgur Karcioglua and John Fowlerb a Department of Emergency Medicine, Dokuz Eylul University Hospital, Izmir, Turkey b Ephesus Emergency Medicine Training and Research Center, 1457 Sk. No. 27, Alsancak, Izmir 35220, Turkey
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