Book Review

Pediatric Trauma: Initial Care of the Injured

Child

C James Graham, MD

Copyright © by the American College of Emergency Physicians.

Pediatric Trauma: Initial Care of the Injured Child Arensman RA, Statter MB,

Ledbetter D J, et al (eds) 1995, Raven Press 288 pages, $59

This book is a primer on the initial assessment and management of pediatric trauma, focusing on an important and growing body of knowl- edge. It is concise but covers most topics in adequate detail.

The text is divided into chapters based mainly on body region (eg, thoracic trauma, head trau- ma, abdominal trauma), with additional chap- ters on basic resuscitation, stabilization and transport, antibiotics in trauma, and child abuse. Thoracic trauma is categorized well in two chapters. The first addresses six immediately life-threatening injuries and the second addresses six potentially life-threatening tho- racic injuries. Fifteen management algorithms for various clinical situations are also provided. The appendix comprises short descriptions of four procedures.

Some of the chapters are particularly well written. The chapter on cervical spine injuries is a nice summation of anatomy, mechanism of injury, evaluation, and treatment. The chapter on extremity trauma is not an exhaustive trea- tise on pediatric fractures but is a well-written summary of emergency initial management. The burn chapter is an excellent summary of the initial management of serious burns, as well as outpatient treatment of less serious burns.

The text has some significant limitations, however. The chapter on abdominal trauma is somewhat contradictory and confusing. The tables in the chapter refer to numbers of

patients; I assume these numbers are taken from a particular research study, although such a study is not referenced in the text. On page 80, in a discussion of assessment, the author states, "The team approach is the most effi- cient method to evaluate and rapidly resusci- tate a severely injured child. The team should be headed by a pediatric surgeon or senior surgical resident, an anesthesiologist . . . . and the emergency nursing staff." There is no men- tion of the role of the emergency physician in evaluation and resuscitation of the injured child. The discussion of which children should undergo computed tomography after head trau- ma is poor. The text states, "Virtually all head injured children except those with only very minor injuries require a OT scan." This issue deserves more discussion.

Finally, the issue of nasotracheal intubation in the traumatized child is cloudy in the text. For example, on page 10, the text states, "Nasotracheal intubation should not be per- formed in infants and small children." On page 23, however, the text states that blind nasotra- cheal intubation should be attempted in patients with known cervical spine injuries or those in whom radiographic studies are unavailable. On page 259, the text states, "If the C-spine is unstable, attempt blind nasotra- cheal intubation." Such inconsistencies with regard to important issues should be clarified.

In spite of that limitation, this book is a good discussion of the initial management of the injured child. I recommend it particularly to students and house officers who want a con- cise but complete text on the subject.

C James Graham, MD Pediatric Emergency Medicine Arkansas Children's Hospital Little Rock, Arkansas

5 3 8 ANNALS OF EMERGENCY MEDICINE 27:4 APRIL 1996