BOOK REVIEws

recitation. If, however, the reader has a research bent and a particular interest in glucagon, this extensively exhaustive text makes interesting reading.

Paula M Podrazik, MD, FACEP Joseph J Calabro, DO, FACOEP Department of Emergency Medicine Newark Beth Israel Medical Center Newark, New Jersey

Shock and Resuscitation ER Geller (ed)

1993, McGraw-Hill 603 pages, $70.00

This book has a lot of useful infor- mation for medical students, resi- dents, and practitioners. It is appropriately titled, has a minimum of redundancy, and provides both practical and academic information. It also provides a wealth of historical information, which I found enjoy- able. Many of the contributing authors include references as late as 1992, which is probably as up to date as you can get in a textbook. The rapid changes in this field will probably make a second edition necessary fairly soon, however.

This book is written primarily by surgeons and therefore has a decid- edly surgical bent. It would benefit from the inclusion of some authors from the pulmonary medicine-criti- cal care vantage point. The chapters on cardiogenic shack and septic shock, although worthwhile, could use some medical balance. The chapter on the pharmacology of resuscitation does not add much to the advanced cardiac life support (ACLS) text and in some areas does not incorporate new guidelines. The discussion of the use of furosemide, for example, seems superficial and incomplete, leaving out some of the newer problems and dosing schemes for this drug.

The book is so packed with infor- mation that sometimes the reading gets laborious. Some chapters seem overly long and might benefit from being divided. In particular, the very informative and well written chapter

on techniques of resuscitation would benefit from being separated into two separate chapters, one dealing with diagnostic considerations and one with therapeutic considerations.

Many of the chapters are well referenced and provide a very bal- anced view of the current controver- sies in shock and its resuscitation. Anyone who wants to present a talk on the treatment of neurogenic shock, far example, would benefit from obtaining the references in these chapters. Occasionally, how- ever, certain areas seem to be underreferenced. In particular, whenever the physical examination is discussed, there are almost no supportive references for suggested maneuvers and techniques. Some- times suggested regimens, such as the combined usa of c~-blockers and (z-constrictors (nor-epinephrine and phentolamine), are suggested with- out supporting data or discussion.

I would have enjoyed seeing a few more illustrations in some chapters. For example, actual pulmonary artery pressure tracings and intra-arteriel tracings as well as some tracings to demonstrate the problems associat- ed with hemodynamic monitoring, such as damping, would be very informative.

I especially enjoyed the chapters on hypovolemia and traumatic shock, resuscitative thoracotomy, neuro- genic shock, and head injury because they are well written and easy to read. The authors of these chapters provide much practical advice and do not hesitate to identi- fy areas where they are introducing their own bias. These authors also explain the reasoning behind their bias. I was pleased by the discussion on the use of hypertonic saline in shock and, particularly, in shock associated with acute head injury and increased intracranial pressure. Dr Trunkay's prioritized, no- nonsense, algorithmic approach to the initial evaluation of the trauma- tized patient is a delight to read. He summarizes the acellular colloid- crystalloid controversy succinctly and comes down squarely in favor of blood and crystalloids with a good discussion of why he feels this way.

The chapters on pediatric resusci- tation, poisoning and overdose, and burn resuscitation are good reviews, but for those readers who have or plan careers in emergency medicine, the Pediatric Advanced Life Support manual, a textbook on toxicology, and a text on burns would be better sources of information.

In conclusion, this book provides a lot of useful information for emer- gency medicine physicians. However, it is not easy to obtain information while working. Perhaps it's best use is as a supplement far residents to read while doing their trauma or surgical ICU rotation. It would also be useful for its bibliog- raphy in an academic emergency medicine library. When reading this book, bear in mind that it does not present an entirely balanced view of shock and resuscitation. It requires supplemental reading from the per- spective of critical care medicine as practiced by internal medicine physi- cians, and in some areas it is not authoritative.

Keith Wrenn, AdD Associate Professor Emergency

Medicine Vanderbilt University Nashville, Tennessee

Year Book of Emergency Medicine 1993 DK Wagner, WP Burdick (eds)

1993, Mosby, Inc 441 pages

The Year Book is full of valuable information covering a wide range of topics. It is written in an abstract format that covers nearly 900 jour- nals ranging from Acta Neurologica Scandinavica to World Journal of Surgery. A full menu of topics such as resuscitation trauma, respiratory emergencies, cardiac emergencies, neurologic emergencies, infectious disease emergencies, procedures, and emergency medical services are provided for review. Each of the 358 abstracts is factual, concisely writ- ten, and informative. The editorial

review that follows each abstract is written by a select panel of experts whose backgrounds include surgery, emergency medicine, pediatrics, and toxicology. They provide a focused review that is pertinent to emergen- cy medicine, and their comments provide valuable insight and per- spective for the emergency medicine practitioner. A sample of what you will find in this book is provided in the following abstract.

Magnetic Resonance Imaging in the Evaluation of Knee Injuries Boeve BF, Davidson RA, Staab EV Jr (Univ of Florida, Gainesville) South J Med 84:1123-1127, 1991

Background~The methods for evaluating knee injuries have limita- tions ranging from patient discom- fort and possible morbidity to a wide range of accuracy and expense. Several recent articles have favor- ably compared the accuracy of MRI with that of arthroscopy. Data from 10 articles on the role of MRI in the diagnosis of meniscal and anterior cruciate ligament tears of the knee were analyzed.

Methods--Fifteen articles com- paring MRI with arthroscopy were selected from MEDLINE and authors' references, and 10 articles were retrieved. Arthroscopy was consid- ered the standard to which MRt was compared. All patients had arthroscopy after MRI. The number of structures evaluated, sensitivity (SN), specificity (SP), positive predic- tive value (PPV), and negative predic- tive value (NPV) for tears of the medial meniscus, lateral meniscus, and anterior cruciate ligament were either obtained ar calculated from data in the articles.

Results--In the 10 studies, the medians for measurements of medi- al meniscus tears were 97% SN, 89% SP, 88% PPV, and 96% NPV. Measurement medians for lateral meniscus tears were 85% SN, 94% SP, 86% PPV, and 95% NPV. Anterior cruciate ligament tear mea- surement medians were 100% SN, 96% SP, 80% PPV, and 98% NPV. The high NPVs of MRI in the studies, many at 100%, suggest that diag- nostic arthroscopy is not necessary in evaluating patients with negative

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