Trauma: A Comprehensive Emergency Medicine Approach

Trauma: A Comprehensive Emergency Medicine Approach . Edited by Eric Legome, Lee W. Shockley . Cambridge, UK : Cambridge University Press ; 2011 ; 720 pp; $175.00 (hardcover ). If your practice is like mine, approximately one-quarter of your time working in the emergency department (ED) is spent on treating injured patients. Although the severity levels may be different, the proportion is roughly the same regardless of whether you work in a Level I trauma center in Boston, Massachusetts, or a community hospital ED outside of Seattle, Washington. No matter if you’re a newly minted emergency physician on staff at the local trauma center, or an old pro who just passed the emergency medicine recertification exam (again), emergency physicians need to be experts in taking care of trauma patients, irrespective of where they work. It is important to stay up to date on the critical issues in trauma management. Although attending an ATLS refresher course or watching a series of DVDs online might work for some, a handy (pre-Kindle) textbook still does the trick. For those of you who like the old-fashioned feel of a book in your hands while you are learning, perhaps Trauma: A Comprehensive Emergency Medicine Approach may be the answer for you. The editors, Eric Legome and Lee Shockley, have tapped over 50 leaders (and future leaders) in emergency medicine to write the first edition of this textbook. The authors were drawn from a wide array of practice settings, from community hospital practices to tertiary care, academic teaching hospitals. There is also a diversity of practice location. They hail from Seattle to New York and from Atlanta to Pittsburgh. The textbook is composed of 42 chapters, organized by sections covering the core topics in emergency trauma care. These include a section on the general approach to trauma care, a section on injuries organized by body region, a section on special considerations (trauma in pregnancy, geriatric trauma, etc.), a trauma imaging section, and a section on performing important skills and critical procedures in trauma care. Additionally, the text includes topics that are not typically covered in clinical trauma care manuals, such as injury prevention, injury research, rural trauma, and trauma nursing. As noted in the book’s title, this text is nothing if not comprehensive. The editors nailed the “comprehensive” part without compromising the degree of depth necessary to do justice to a given topic. It rivals the trauma section in Rosen’s Textbook of Emergency Medicine (Peter Rosen himself added his own chapter). I should note that nearly half of the pages have a color photo, radiographic image, drawing, figure, or a table. The publisher certainly did not skimp on the graphics. Frankly, I was struck with how beautifully the book was laid out. It made reading that much easier. As one example, the chapter on head injuries is very nicely put together, and in my opinion, written with just the right amount of detail. The authors review the epidemiology, anatomy, and pathophysiologic processes, including the cerebral hemodynamics, involved in traumatic insults of the brain. The authors describe the optimal management both in the prehospital setting and in the first few minutes in the ED. The authors discuss general principals of management, according to injury severity, and outline reasons to wake up your neurosurgeon. They discuss the evidence-based guidelines for judicious brain imaging of patients with head injury and briefly outline the development and performance characteristics of the three common clinical decision rules. They discuss the complications of traumatic brain injury (TBI), as well as the guidelines for the management of sports-related concussions. After noting specific differences in management of children and elderly patients, the authors conclude the chapter with a discussion on the direction of future brain injury research. The only minor suggestion that I have for the next edition (just food for thought, really) would be to include a section touching on military trauma. There are important differences between the injury patterns sustained in the civilian setting and those on the battlefield. There is a growing appreciation of the “polytrauma clinical triad” (i.e., chronic pain, posttraumatic stress disorder, and TBI) that is occurring with increasing frequency among military service members. However, the severity and long-term consequences of TBI may differ according to the mechanism of injury. For example, in the civilian context, falls, motor vehicle crashes, and assaults are the most common causes of TBI. In comparison, a leading cause of TBI among forward-deployed service members is improvised explosive devices that deliver stronger injury forces to the brain compared to those in the civilian trauma. Overall, this textbook is both impressive in its graphical presentation and comprehensive in its scope. I really cannot find very many faults with it. As noted above, emergency physicians need to be skilled in the management of traumatic injury, regardless of their practice setting. I suspect that that this text may soon be the new “criterion standard” reference for the ED management of trauma. I would recommend this book to anyone managing trauma in the ED setting, including residents in training, physician assistants, nurse practitioners, and attending physicians. It is well worth the read.

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