FATAL SEQUENCE: THE KILLER WITHIN
Author: Kevin J. Tracey, MD
Bibliographic data: Dana Press, 2005. ISBN: 1-932594-06-X, 225 pp, hardcover, US$23.95.
Reviewer's Expert Opinion:
Description: This is a case presentation intended to review advances and research issues in the care of patients with infection and organ failure. Purpose: Readers are provided a series of telling anecdotes and insights into the ups and downs of shock and sepsis research as applied to the care of a severely injured patient. Audience: Trainees, practitioners, and, most importantly, the nonmedical reader with interest in infection are an appropriate audience. The author is a noted sepsis researcher with involvement in much of the seminal work related to infection and its management. Features: The reader begins with a hectic ambulance ride to a burn center. The course of a severely burned child is traced through resuscitation, operating room management, and postoperative care. During the course of the patient's month-long hospital stay, Dr Tracey describes that shock and infection manifest by the most severe complications including multiple organ failure. From this experience, Dr Tracey places treatments available in the mid-1980s in the context of later work describing the patient response to infection, which sometimes complicates care of this problem. He ends with his own more recent work on nervous system control over immune response. Although specific references to original work are not provided, detail is sufficient to allow the concerned reader to do database searches for additional information. A concluding subject index gives access to medical terms. Assessment: This is a good read for the clinician and layperson with an interest in infection and shock. Dr Tracey has been a central figure in this work for two decades. While his concluding statements regarding neurological modulation of immune response await confirmation over time, Dr Tracey provides insight into some of the work that frames the way clinicians think about and treat an important clinical problem.
David J. Dries, MD
(University of Minnesota Medical School)