Book and Media Reviews

doi:10.1016/j.annemergmed.2008.08.036

Trauma: Contemporary Principles and Therapy

Flint L, Meredith JW, Schwab CW, et alLippincott, Williams & Wilkins, 2008784 pages, $199ISBN-10 0-7817-5650-2ISBN-13 978-0-7817-5650-1

During my days at Charity Hospital, when we were proud tobe part of the accident room and not the “ED,” we foundourselves at frequent odds with several trauma surgeons whoseemed to lack compassion and respect for evidence. Yet whenwe took the now-oft-disparaged advanced trauma life supportcourse for doctors (the text from which these surgeons oftenquoted), we competed for the chance to become instructors.

Two board cycles later—humbled by the weeks it took myEthiopian ruptured uterine patients to recover when I did theresuscitation, anesthesia, operation, and hospitalizationmyself—I no longer feel the need to ready myself to shout whencalling one of my surgical colleagues to attend a critical patientwith me. However briefly, I partook of what they do and respectthem for it.

Ignore for the moment the fact that Trauma: ContemporaryPrinciples and Therapy is not a guide for the practice ofemergency medicine (this niche may be addressed byCambridge Press, which plans to publish an emergencymedicine-centered trauma text by Legome and colleagues laterthis year). It matters not that the editors embrace multispecialtycare of the injured patient despite writing for an audience ofsurgeons, for the bulk of the text is devoted to decisions andresuscitative procedures that emergency physicians never needconsider. Yet this bulk is what I found utterly absorbing,because it lays out the evidence used to teach surgeons abouttrauma. As such, it provides a sound basis for emergencyphysicians and surgeons to collegially discuss the sharedmanagement of their patients.

Just-published and edited by Lewis Flint and colleagues, thisvolume joins ranks with Moore’s Trauma and Peitzman’sTrauma Manual as a concise evidence-based resource on themanagement of the injured patient. Economically written, itpacks into 784 pages an encyclopedic range of clinicalinformation.

Flint’s work follows a welcome evolution in recent medicaltexts. It encourages its 126 authors to provide evidence rather

than opinion, embeds its references, and follows a structured

408 Annals of Emergency Medicine

user-friendly format. As an afterthought, Lippincott also threwin a searchable online text, which unfortunately is too slow andfilled with software glitches to be of much use.

Happily, the text relays evidence that surgeons sometimesfind contentious when suggested by emergency physicians. Useadequate pain control! Meperidine is dangerous! Start thethoracotomy in the emergency department! If it’s bubbling,explore the neck! Don’t wait for the CT scan! Nonetheless, thetext also reminds us of evidence we often forget. Usescopolamine for patients who cannot tolerate anesthetics.Ketamine may be safer than propofol. Use norepinephrine firstfor septic shock.

Conceptually, Trauma is divided into 3 parts. The initial 22chapters (sectioned into systems, prevention, centers, and teams)provide a historical nod to those who developed the frameworkwithin which we now function. The next 36 chapters make upthe meat of the volume, comprising over half the text’s pages ina single section: the trauma patient. These function, from headto toe, as resources for the management of specific injuries.Where appropriate, each begins with a succinct but thoroughreview of anatomy before proceeding to discussions of injuryand management. Some chapters (eg, Hand Injuries) are simplyinadequate. Others are dated by older references. Most,however, are excellent and contain good tables, illustrations, andup-to-date references to support such newer concepts asnonoperative approaches to solid organ injuries, permissivehypotension, damage control techniques, and massivetransfusion strategies learned from the Iraq war.

Where many texts lose momentum in closing, the final 2sections of Flint’s text (chapters 59-69) are stronger thanexpected, serving as introductions to critical care nutrition,sepsis, sedation, transfusion science, and ethics. These sectionsare concise without the pretense of being comprehensive. I waspleasantly surprised to see definitions and short discussions ofnonmaleficence, beneficence, and end-of-life issues. The finalchapter is poignant and appropriate: “Gentleness with oneself isa lesson everyone benefits from . . . seeing others grieve oftenreminds us of our mortality.”

Overall, this is a text I will read and consult. Its pedigreemakes it impossible for other surgeons to ignore while itscontent puts it in a league far beyond advanced trauma lifesupport. Bottom line: recommended.

James Li, MDMiles Memorial HospitalDamariscotta, ME

doi:10.1016/j.annemergmed.2008.09.004

Volume , . : March