292 injury (1987) 18, 292-293 Printedin Great Britain

Book Reviews

Aids to Operative Surgery. Graeme J Poston. 213~ 135 mm. Pp. 214. 1986. Edinburgh, Churchill Livingstone. f7.95. Soft- back. The aim of this book is to provide a concise revision aid in those areas of operative surgery most commonly discussed in the final FRCS examinations.

One of the most praiseworthy aspects of the book is that it stresses the systematic approach to describing any operative procedure-an aspect often forgotton by the agitated candi- date during the viva itself. Adoption of such a system should at least allow a candidate to discuss any procedure with some degree of familiarity even if the finer detail is lacking.

Each procedure is well set out and discussed in enough detail to act as a revision aid. It is not the author’s intention that the book should be used alone, but when read in con- junction with a major textbook of operative surgery it will provide maximum benefit. A total of 118 procedures are described with no obvious major omissions and although the book is not fully comprehensive, by adopting the system advised, personal additions are easily made. There are no illustrations, but these are bountiful in more major texts, and only stress the fact that this is a revision aid.

In summary the author is to be congratulated on a splendid book that I can thoroughly recommend to all future FRCS candidates and aspiring junior surgeons. It will also prove a useful reference book for medical students and theatre staff alike.

M. WINSLET

Emergency Care. 4th Edition. Harvey D. Grant, Robert H. Murray, Jr and J. David Bergeron. 28Ox212mm. Pp. 633. 1986. Hemel Hempstead, Prentice-Hall International. ~14.95. Softback. This textbook is specifically produced to accompany a formal emergency medical technician (EMT) course, an intense paramedical course currently expanding in the USA, which is at an early stage of development in the UK.

The book begins with a very elementary section on ana- tomy and physiology but then proceeds to cover every aspect of paramedical care in depth, from early patient assessment to basic life support techniques and medical emergencies. Subsequent chapters deal with the management of specific types of injury, triage techniques and ‘in the field’ emergency care. There is even an extensive section on how to gain access and disentangle victims trapped in motor vehicles.

Although many countries do not have a direct equivalent of the EMT for whom this book is designed, the subject of emergency care and first aid (in the true sense of the phrase) is dealt with in such depth and clarity that the book would be of great interest and value to the nursing staff in the A&E department, as well as members of the ambulance service and other ancillary staff dealing with casualties. Medical students and some junior doctors working for the first time in an A&E department may also find some sections of this book of value, as first aid and emergency care are areas where under- graduate teaching is often sadly lacking.

In summary this book would be a useful addition to any casualty, nursing or ancillary staff library and is very good value for money, particularly in view of the large number of illustrations it contains.

M. WINSLET

Trauma Management for Civilian and Military Physicians. S. Wiener and J. Barrett. 266X2OOmm. Pp. 582. 1986. East- bourne, W. B. Saunders. f68.00. Hardback. Written by a professor of medicine and the director of a trauma unit, this book is intended for those involved in primary care in military and civilian practice.

A recent survey of surgeons about to achieve consultant status in the United States revealed that very few had opera- tive experience on more than 15 trauma victims during their surgical training. To this end the book is intended for the surgeon in training, and also casualty non-surgical and surgi- cal staff. It is also intended as a rapid review for those who do not deal with trauma patients on a daily basis.

Correct emphasis is given throughout to the priorities in resuscitation, in particular airway care, the control of haemorrhage and vascular access and fluid replacement. Im- portant aspects dealing with priorities of primary care are given in bold type. Algorithms are used to summarize import- ant decisions in key chapters on regional injuries and resusci- tation. Of particular value are chapters highlighting the dif- ficulties and pitfalls in trauma management, including the differential diagnosis.

The book begins with chapters on penetrating low-velocity and high-velocity missile injuries and the multiple effects of explosive devices on human organs and tissues. It clearly deals with current thoughts on the pathogens and patterns of injury and the concepts of cavitation and treatment priorities.

Lessons learned and relearned in the Korean, Vietnam and Falklands Wars are stressed and, in particular, the import- ance of vascular access and adequate fluid replacement, wound toilet and delayed wound closure.

The next chapters deal comprehensively with advanced trauma life support under headings including airway obstruc- tion, shock, resuscitation, burns and regional injuries, the latter under headings of high- and low-velocity injuries as well as blunt trauma.

Particularly well covered are chapters on analgesia, vascu- lar access and hypovolaemic shock. Emphasis is placed on crystalloid resuscitation in volumes of 3:l crystalloid to fluid loss. Although apparently successful this method is contrary to my own clinical practice and experience, where bulk volume crystalloid replacement may compromise the multiply injured, especially where some degree of fluid restriction is necessary in the head- and chest-injured patient.

Support is given to the value of open thoracotomy and internal cardiac massage for hypovolaemic cardiac arrest and, where indicated, distal aortic occlusion. This procedure, which I have found often life saving and commonly under- taken in the emergency room in the United States, is seldom undertaken in this country.

The chapter on head injury is comprehensive and perhaps the best in the book, with particular reference to management