Znjury Vol. 26, No. 6, pp. 429, 1995

Elsevier Science Ltd Printed in Great Britain.

Book reviews

Injury, Vol. 26, No. 6, 429, 1995

Major Trauma. 2nd Edition. Cohn Robertson and Anthony D. Redmond. Oxford University Press, Oxford. 0 192 62447 4. 734.95, 1994, 192 pp.

This relatively small (and very inexpensive) text aims to provide a broad practical guide to the initial assessment, investigation and primary treatment of the multiply injured patient. It also covers much of the epidemiology, scoring and pathophysiology of trauma. The content is well judged for its intended readership of junior and middle-grade staff working in Accident and Emergency departments, though it would also make a useful read for any medical student or junior doctor about to undertake a surgical exam.

The book is in four parts with a total of 12 chapters. The order in which the chapters appear could have been more appro- priately arranged. Each chapter is split into a series of short sections, with concise text, good use of illustrations, tables and lists of key points making it light work to read. The style is deliberately didactic, which may not suit every reader, though it does have the advantage of adding an air of clarity to the topic.

Whilst not specifically mentioning it, the book closely parallels the teaching of the Advanced Trauma Life Support courses which have now become widely established in the UK. As would be expected there are no particularly contentious opinions. Important points which could have been further clarified are the structure of trauma teams and centres, and practical guidance on the management of the agitated, restless patient.

The chapter on spinal and skeletal injury was rather superficial in its coverage. There was no mention of the importance of skin care and early liaison with a spinal injury unit in cord injury, or guidance on the immediate care of open fractures such as photographic documentation and appropriate dressing.

On balance this is a well written and accurate book providing a practical approach to the immediate management of major trauma.

P. C. Shewell

Handbook of Neurorehabilitation David C. Good and James R. Couch. Pp. 672. 1994. New York: Marcel Dekker, $185.00. This comprehensive account of the principles and practice of neurorehabilitation techniques will serve as a useful reference book for all members of the multidisciplinary neurological and spinal injury care teams, including rehabilitation physicians, physiotherapists, occupational and speech therapists and special- ist nurses.

Despite detailed background information on neuroanatomy and physiology, the main focus of the book is practical. It emphasizes the need for accurate assessment of the level of disability of an individual patient, and goes on to look at the

specific needs which are to be addressed in their rehabilitation programme and the practicalities of achieving this. Much of the book deals with the management of problems common to many patients with nervous system injury, regardless of its aetiology, such as gait disturbance, spasticity and bladder dysfunction, while there are also chapters dealing with the unique combina- tion of deficits occurring in disorders such as multiple sclerosis, cerebral palsy, stroke and the like.

The chapter on the treatment of spasticity is particularly up-to-date, referring to work with intrathecal baclofen, while the section concernmg the management of chronic pain is very informative but lacks both breadth and details of the many available neurosurgical interventions possible today.

Although the book has a distinctly North American style, the English reader will also find it clear and well organized, and it appears to achieve what it set out to do. Its appearance is functional but legible; the illustrations of the orthotic and adaptive equipment are particularly useful and enhance the chapters dealing with these subjects.

Overall the book will be a useful addition to the shelves of rehabilitation centres, giving a number of readers from various disciplines a modem approach with useful further reference points.

Paul Byrne

The First Aider’s Pocket Companion. Stuart A. Gray. Pp. 64. 1994: Altman, f 4.99. The author is well qualified to dispense practical advice tor newly trained first-aiders. This pocket book lives up (or down?) to its title, but one might hope that it would be removed from its pocket, not in an emergency but for a few minutes’ revision when there is nothing else to do. The page for notes that accompanies each section offers the owner a chance to record his own experience or impression of the conditions, which are listed in alphabetical order, e.g. irrespirable atmosphere as a cause of asphyxia and the possible presence of a wound with a dislocation or fracture.

In more detail, it might be added that when a first-aider sees a victim of head injury, in the absence of bruising, wounds, bleeding and suffocation, the face is likely to be pale rather than hot, dry and flushed because the first-aider’s ‘signs of com- pression’ take some time to develop. Also, one may question the propriety of the advice ‘not to move’ an unconscious person who may be suffocating.

On page 40 the recommended ‘upright sitting position’ conflicts with the diagram showing recumbency with the head raised; and on page 54, the description of shock given is fhat of severe exsanguination. Pallor is often the only or most obvious sign.

P. S. London