BOOK REVIEWS John H. van de Leuv, MD, CM m editor

Dayton, Ohio

The Diagnosis of Stupor and Coma, ed 2 F. Plum, J. B. Posner, R A. Davis Company, Phila- delphia, 1980.

Plum and Posner, in their third edition, have turned a somewhat readable Contemporary Neurology Series into a rather detailed description of the anat- omy, pathophysiology, and diagnosis of stupor and coma. Almost 100 pages longer, it has now become a reference textbook. As such, I know of none better. The book should be purchased for the emergency de- partment library to supplement, but not to replace, earlier editions. Unless the physician has strong in- terest in this subject, it is a laborious task to read and it is not recommended for the emergency physician's private library.

In an attempt to improve the references, the au- thors have placed them at the end of each chapter. Although there is only one completely new chapter, the number of references has been nearly doubled. Obviously in an effort to produce a book as up-to-date as possible, five of the eight chapters have the most recent references tacked on to the otherwise alphabet- ical format.

Surprisingly, the index is smaller than that in the first edition. This is a major shortcoming for such an excellent reference source. Most of the indexed sub- ject material refers to one page or to consecutive pages. More cross indexing is needed. Also, if the read- er wants to search out a subject that is referred to by more than one word, the subject may be difficult to locate. For example, central pontine myelinolysis is listed under "myelinolysis, central pontine." This re- viewer was unable to locate a listing for the syndrome of inappropriate secretion of the antidiuretic hormone, yet it is mentioned throughout the text. Another im- portant cause of stupor or coma is cerebral arterial vasospasm, and although briefly mentioned in the text, it is not in the index.

Chapter 8, which is new in this edition, tackles the problem of management of acute emergency prob lems. Perhaps th i s section is of greatest interest to emergency physicians. Unfortunately, the approach to emergency management is a somewhat simplistic for- mat using some treatment modalities as an aid to di- agnosis. I'm not sure if the obvious head-injured pa- tient would be given hypertonic glucose and a narcotic antagonist , or the diabetic in coma would not be treated with mannitol and have an intracranial bolt inserted. Except in acute adrenal insufficiency, admin- istration of steroids should be delayed until the treat- ing physician has ruled out diabetes and active tuber-

culosis; second, the working diagnosis should be a brain disorder that is known to respond acutely to steroids (I am not sure there is one). Although the au- thors point out the dehydrating effect of mannitol, they fail to mention that 50% glucose is even more effective. A management program in which both hypertonic agents could be given may be hazardous. It is difficult to tell what part of the management pro- gram applies to the emergency department or to the intensive care unit.

In sum, this book is a must for the emergency de- partment library and should be kept on the reserve shelf. The physician should hold all but the last chap- ter in high esteem.

William F. Bouzarth, MD Annals Consulting Editor

Ambulance Calls N. L. Caroline, Little, Brown, and Company, Boston, 1980.

Ambulance Calls is an excellent book for those in- volved with prehospital emergency medicine both educators and students. The book emphasizes and reinforces the principles taught in the 15-module "Na- tional Training Curriculum for Emergency Medical Technician - - Paramedic" and Dr. Caroline's text, Emergency Care in the Streets.

The material is covered in a question-and-answer format. Both a general topical index and an instructor index keyed to the modules of the National Training Course are provided.

As stated by Dr. Caroline in the preface: "The present text attempts to review the basic principles of emergency care in the field and to convey a bit of the mood and pace of that branch of medicine. In the first section, we go back quickly over some fundamentals: terminology, physiology, fluids and electrolytes, phar- macology, and the like just to touch base with the theoretic core of emergency medical care. And then we head out for the streets and take the calls as they come, each with its own unique challenges and dilem: mas."

We are currently using this text with our para- medic students and highly recommend it. Dr. Caro- line's humor and illustrations are appreciated by fac- ulty and students. They make learning a pleasure.

Anne Boyd, RN, EMT-P Paramedic Program Director

Good Samaritan Hospital and Health Center Dayton, Ohio

74/168 Ann Emerg Med 10:3 (March) 1981