Book Review

Pediatric Emergency Medicine: Concepts and Clinical Practice

N Engl J Med 1993; 329:1359-1360October 28, 1993

Article

Pediatric Emergency Medicine: Concepts and Clinical Practice
Edited by Roger M. Barkin, with six others. 1185 pp., illustrated. St. Louis, Mosby-Year Book, 1992. $125. ISBN: 0-8016-0210-8

Pediatric emergency medicine has greatly enlarged its scope and position in pediatric care over the past decade. Emergency departments now have a heightened awareness of the special needs of children, and consequently, the approach to the evaluation and treatment of critically ill or injured children has been refined. The recent development of a sub-board in pediatric emergency medicine is recognition of the progress in the field. The advances in pediatric emergency medicine have generated an impressive array of literature, a trend that is now augmented by another excellent work.

This book will quickly gain acceptance as an authoritative reference. Barkin has enlisted the support of six associate editors and over 90 contributors in this well-written and detailed textbook.

The book contains eight sections. The first, an introduction to the care of children in the emergency department, highlights some of their special needs and emphasizes systems expressly designed to meet their unique requirements.

Next, pediatric resuscitation and neonatal emergencies are explored. The authors present a comprehensive review of the pathophysiology of the ill child, therapeutic options, and treatment strategies. Drug dosages are included, as is a detailed section on techniques for obtaining vascular access. Since the American Heart Association has recently published its new recommendations on advanced life support for children, the reader will need to update the dosages of epinephrine to be consistent with the new guidelines. The chapters on neonatal emergencies briefly examine the common causes of neonatal distress and should be of interest to centers faced with the sometimes difficult problem of emergency deliveries requiring resuscitation.

Two other sections address pediatric trauma. The initial section presents an overview of multiple trauma and is followed by individual chapters on major-organ trauma. The second section on trauma reviews the management of musculoskeletal injuries and soft-tissue trauma and in particular provides information on common orthopedic injuries, wound care, and proper techniques for wound closure. Each of these areas is discussed in great detail, and the authors augment the text with diagrams of splints, suture techniques, and radiographs to stress important teaching points.

The section on environmental problems, although brief as compared with the other sections, provides an overview of human and animal bites, cold- and heat-induced injury, near-drowning, burns, and high-altitude illness. Pharmacologic principles for treating poisoning and specific toxins are discussed in the penultimate section.

The final section, which encompasses half the text, reviews pediatric emergencies as they relate to each body system. The chapters in this section are extensive and include the spectrum of signs and symptoms as well as specific diagnostic entities related to each system.

The authors maintain consistency in both their style and organizational structure. The book abounds with written material, sometimes to the exclusion of quick reference charts, and makes little attempt to use algorithms. I found it to be remarkably up to date; the authors should be commended for presenting such current information. Each chapter is supported by an extensive list of references, providing an opportunity to supplement discussions in the book.

Overall, Barkin and colleagues should be congratulated for their efforts in developing this exceptional textbook. I would recommend it to any facility or professional involved in the care of ill or injured children. It is worthy of a place in every emergency department's library, since I suspect it will be an authoritative work for years to come.

Robert J. Vinci, M.D.
Boston City Hospital, Boston, MA 02118