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Emergency Medicine: Diagnosis and Management (6th ed.)

Tam, Wing S.

European Journal of Emergency Medicine: February 2013 - Volume 20 - Issue 1 - p 69
doi: 10.1097/MEJ.0b013e32835958ac

Department of Emergency Medicine, Prince of Wales Hospital, Shatin, Hong Kong

Emergency Medicine: Diagnosis and Management (6th ed.) is a valuable introductory handbook for the junior emergency physician and a condensed reference book for the seasoned emergency physician. The organizational structure is both logical and consistent: almost all medical conditions are divided into ‘diagnosis’ and ‘management’ sections, with both sections having multiple bullet points. This review will treat the ‘diagnosis’ and the ‘management’ sections of the book separately.

The ‘diagnosis’ sections generally include important background information on each medical condition, and then suggest appropriate blood tests, imaging studies, and other diagnostic tests. It is a useful resource for the reader who is working with a particular diagnosis in mind but is unsure of what diagnostic tests he or she should order. For example, if a junior doctor were to have the diagnosis of pulmonary embolism in mind for a patient who is short of breath and has pleuritic chest pain, but is unsure of whether to first order a D-dimer or a computed tomography scan of the thorax, this book offers detailed instructions, stating how to use the modified Wells score and the Pulmonary Embolism Rule-out Criteria to choose the appropriate test. This book avoids simply providing a list of diagnostic tests and explains the significance of each test in relation to the appropriate medical condition by listing the various elements of the test the doctor should pay attention to.

Although the diagnosis sections of each medical condition are very helpful, occasionally, the authors resort to offering a long list of differential diagnosis without further elaboration, presumably because of space constraints. For example, the reader will be disappointed to find under ‘Blistering Conditions’ only a long list of possible causes for a blistering skin rash, information that is unlikely to be useful when making a diagnosis. Furthermore, the diagnosis section sometimes also includes treatment, which may be confusing for the reader.

The ‘management’ components are extremely well written and provide detailed and accurate instructions for managing the emergency patient. In general, the bullet points under the management of each medical condition correspond to the initial emergency steps that must be taken to stabilize the patient. Further advice includes subsequent medications that should be given, with very clear instructions on the dosage and methods of administration, and a description of scenarios for which the junior doctor should contact the senior emergency physician immediately. The management sections also include practical information on when to consult other specialties and the proper disposition of the patient. For instance, if a junior doctor is unsure whether to admit or to discharge a patient who suffered from transient ischemic attack, the corresponding section in the book lists detailed criteria of when to admit and when to discharge the patient on the basis of the risk of recurrent stroke using the ABCD2 score.

With respect to specific chapters, ‘Acid-base, electrolyte and renal emergencies’ deserves special mention because of the clarity with which the author treats the subject of interpretation of blood gas and electrolyte disorders. It incorporates useful tables, charts, and formulas into a very well-written text. Some chapters, however, such as the ‘Orthopaedics emergencies’ and ‘Practical procedures’ chapters, are relatively weaker. The orthopedics chapter would benefit from diagrams of the classification of common fractures, such as hip or ankle fractures. The chapter on practical procedures may need to be updated, as it lacks appropriate elements of ultrasound guidance in the text, as procedures such as central line insertion, needle thoracentesis, femoral nerve block, and pericardial aspiration are no longer performed blindly in most emergency departments in developed countries. The free online resources on the website associated with this book are useful and contains many ECG, images, and clinical cases. It would be even better if the website and book can be better integrated in future editions.

In summary, Emergency Medicine: Diagnosis and Management is an excellent introductory handbook that is succinct, easy to read, and covers a wide arrange of topics effectively. The step-by-step approach used in writing this book provides a clear framework in managing the emergency patient and can be helpful in the preparation for viva examinations. Although certain aspects of the book could be improved, the majority of this book is written with outstanding clarity and attention to detail that few other handbooks on emergency medicine can match. This book is definitely a must read for all interns and emergency medicine trainees and will also serve as a quick reference for the seasoned emergency physician.

Wing Sun Tam

Accident and Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong

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Conflicts of interest

There are no conflicts of interest.

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