Reviews / Récension
Book reviews
Can J Rural Med vol 2 (2):95
© 1997 Society of Rural Physicians of Canada
Oxford Handbook of Critical Care. Mervyn Singer and Andrew Webb. 554 pp. Illust. Oxford University Press, Don Mills, Ont. 1997. $45.95. ISBN 0-19-262542-X
The Oxford Handbook of Critical Care is a dandy little book for those caring for severely or moderately ill adult patients. It covers most bases, fits in your pocket, has thoughtful bookmark ribbons and boasts waterproof covers, so if the patient vomits all over you or the pressure bag bursts, you can still look up what to do next.
I like the way in which critical care -- that mysterious, clannish and elitist discipline -- has been reduced to some 500 pages of well-organized, clear, succinct prose that even residents in obstetrics could understand. (There is a section on obstetric emergencies such as HELLP [hemolysis, elevated liver enzymes and low platelet count], amniotic fluid embolus, eclampsia and postpartum hemorrhage.) Of course, this is a handbook and therefore does not replace what can be learned from a full textbook or picked up by hanging around a busy ICU for a few weeks. Nonetheless, it is an excellent reference and does deliver on its promise to provide immediate guidance and practical information for any situation likely to be encountered -- all in a book smaller than the Book of Common Prayer (another useful ICU reference).
Some lab units of measure (such as kPa [kilopascal] for blood gases) and some medications mentioned in this handbook are unfamiliar to me, but this is a minor hindrance. The arrythmia section is weak, and other texts address this worrisome problem better.
If you are caring for critically ill patients in your hospital, this is one of the books to have. Even if such patients don't remain in your hospital, the Oxford Handbook of Critical Care will help you in asking your referral hospital or consultants to do the next indicated step, so that you can avoid dumping an undifferentiated mess on their doorstep. Buy it.
Keith MacLellan, MD
Shawville, Que.
Anyone Can Intubate. 4th edition. Christine E. Whitten. 237 pp. Illust. KW Publications, PO Box 26455, San Diego CA 92196, USA; tel 619 566-6489, fax 619 271-1425. 1997. US$19.95 (plus US$3 shipping and handling). ISBN 0-929894-14-6
This soft-cover book, written by an anesthesiologist at the Kaiser Permanente Hospital in San Diego, Calif., is billed as "a practical step-by-step guide for health professionals."
The first 5 chapters cover the basics: anatomy, pulmonary physiology and assessing respiration, establishing an airway (including the topic of bag-mask ventilation), pre-intubation and predicting the "difficult" airway, and equipment. The author then proceeds to the main emphasis of the book: oral intubation of the adult patient.
In step-by-step fashion, Whitten discusses equipment choices, positioning of the patient and the operator, proper technique and avoidance of common errors. A supplemental chapter, "Studies in difficult intubation," deals with such matters as intubating the obese patient and intubating a patient who is lying supine on the floor, as is sometimes necessary in cardiac arrest. Intubation of children and nasal intubation are also discussed, although these topics are not the main thrust of the book. There is also a chapter on induction agents and muscle relaxants (for rapid sequence induction).
The book is an easy-to-read and enjoyable educational tool. Whitten's writing style is clear and concise, and the line drawings illustrate their intended points well. The book is strong on the details that are often overlooked in published works, such as how to properly tape the endotracheal tube to a patient's face. Whitten anticipates common errors in technique in a section that I found very useful; many of these errors have the sad ring of familiarity.
To those of us in rural areas, orotracheal intubation is one of the few genuinely life-saving skills in medicine. Only by intubating a few hundred patients under supervision is it possible to truly master this technique, but such practice is a luxury most of us lack. This book is the next best thing and should be on the shelf of every rural physician in Canada. Chain up your copy!
Gordon Brock, MD, CCFP
Temiscaming, Que.
CD-ROM review
Management of the Difficult Airway. Thomas P. Engel, Richard L. Applegate II, Deborah Chung and Antonio Sanchez. Available from Cook Critical Care (Canada) Inc., 111 Sandiford Dr., Stouffville ON L4A 7X5; tel. 905 640-7110. 1995. $55. Requirements: 486 or Pentium PC compatible computer with 8 megabyte RAM, colour display, Microsoft Windows 3.1; or Apple Macintosh or Power Macintosh with 8 megabytes RAM, colour display, system 7
This CD-ROM was created by four anesthesiologists in California for Cook Critical Care, a manufacturer of medical equipment. The authors have assumed that the user has a knowledge of basic orotracheal intubation technique. The CD-ROM seems intended as a showcase for airway management and intubation aids and cricothyroidotomy kits.
There is a short opening chapter on the relevant anatomy and pathological conditions, and a good chapter on recognition of the "difficult airway." For most of us, one of the most useful chapters would be the one covering airway options. This chapter contains good, 1-page descriptions and photos of 11 types of intubation aids, such as gum rubber bougies, lighted stylets and laryngeal mask airways. The ASA (American Society of Anesthesiologists) algorithms on airway management are included, but they seem to be designed more for the urban anesthesiologist than for the rural family physician: I found them overly complicated and designed mostly from the point of view of elective surgery, where the patient can be awakened if intubation fails or a more experienced intubator can be called in immediately.
The CD-ROM concludes with videos demonstrating, on mannequins, how to use the 3 cricothyroidotomy kits produced by Cook Critical Care -- the Patil, Arndt and Melker kits. Retrograde intubation and the Cook airway exchange catheter are also shown, but these techniques and equipment are more in the province of the anesthesiologist. There is a description of commercial jet-air ventilation equipment, but, unfortunately, no video showing how to perform this procedure with a simple no. 14 catheter.
Although Management of the Difficult Airway does emphasize the products of a single company, the content is well presented and the disk would be useful if you are familiar with basic endotracheal intubation and wish to learn about the various aids available. The demonstrations of cricothyroidotomy are helpful: this is an important technique for the rural physician and it would seem prudent for all rural hospitals to stock at least one type of cricothyroidotomy kit. Not many of our patients need cricothyroidotomy, but those who do, need it very, very badly indeed!
Gordon Brock, MD, CCFP
Temiscaming, Que.
