Colour Atlas of Emergency Trauma. D. P. Mandavia, E. J. Newton, D. DemetriadesCambridge University Press: Cambridge, UK, 2005, 295 pp; indexed, illustrated ISBN: 0-521-78148-5; Price £150.00
One day, last week, the first patient that I saw in the Emergency Department was suffering from a false finger nail that she could not remove, having used super-glue to put it on. Not an emergency trauma, which features in this colour atlas put together by a team from the Department of Emergency Medicine at the Los Angeles County-USC Medical Center. The emergency trauma of this volume is what we have come to expect from watching emergency room: the penetrating trauma of urban violence and the blunt trauma of high speed motor vehicle accidents.
The atlas has eight sections, covering injury to the head, face, neck, thorax, abdomen, musculoskeletal system, spine, and finally skin and soft tissues (mostly burns). Each section begins with a brief introduction, followed by outlines of the appropriate Clinical Examination, Investigations, and General Management. As might be expected the management recommendations follow the principles of advanced trauma life support. Each of the main sections concludes with a series of paragraphs describing Common Mistakes and Pitfalls. These are especially useful. The bulk of the atlas consists of images of injuries or procedures and a short, often pithy, commentary. The images include clinical photographs, radiographs of almost every variety, as well as line drawings.
In the main, the format works very well. Some of the images are outstanding. The 3D CT reconstructions of depressed skull and facial fractures are particularly effective as are the illustrations of Foley catheter tamponade for a penetrating injury to the heart and in penetrating injuries to zone III in the neck. One or two of the photographs are less successful: the photograph of a scalpel about to perform a cricothyrotomy is barely identifiable, and that of a thoracostomy needle in place, below the middle of the clavicle does not allow the landmarks to be seen. Photographs of operative scars will only have meaning to practising surgeons. It is a shame that the excellent line drawings illustrating lunate and perilunate dislocations have a typographical error in the title and that the ‘photograph of chylothorax following penetrating chest trauma …’ actually only shows a test tube of milky fluid.
So, what sort of book is this? It is almost easier to describe what it is not. It certainly is not a comprehensive textbook of trauma or trauma care, neither is it a step-by-step manual of practical procedures, nor even a pocket reference. Rather in size and layout it resembles a coffee table book, and as such it succeeds brilliantly. It is a book to dip into an experience, if only at a distance, conditions are rarely met. Its concise text allows the reader to review a broad range of conditions very quickly.
In some of its comments, it shows the differences in practice between Emergency Medicine in one of the world's biggest trauma centres and the UK. The authors consider trauma ultrasonography to be part of the primary survey, and as such to be one of the prerequisite skills of the Emergency Physician or Trauma Surgeon. A view that is not universally shared in this country. Similarly the auto transfusion of blood in chest trauma is considered ‘easy, safe and cheap’. Recent experience on this side of the Atlantic has shown that unless this is done regularly, it is far from easy.
Given that there are less than 300 pages, there are some omissions. No mention is made of the ‘clam shell’ thoracotomy or of the Seldinger technique for inserting chest drains. Although there are illustrations of Colles's fracture of the wrist, there is no mention of the fractures described by Smith and by Barton, which would probably be more useful as these are often confused.
To whom is this book for? Any senior trainee in Emergency Medicine or Surgery will find it useful as an aid to revision, especially for the most severe injuries. For those who are relieved to have passed their final examinations, this book will be equally useful for teaching and as a reminder of what to look out for the next time something ‘big’ comes in through the door.
Later, the same week, a man was brought in with a shotgun injury to the chest. He needed a surgical airway and a thoracotomy. Just like the atlas … I, for one, will refer to it often.