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Surgical Critical Care
  1. C D Johnson
  1. Department of Surgery, Southampton General Hospital, UK

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    Robert Ashford and Neal Evans. (Pp 247; £22.50.) Greenwich Medical Media, 2001. ISBN 1-84110-066-8.

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    I approached this book with interest, hoping that it would help me take on the responsibility of managing patients in a surgical high dependency unit. However, as the authors point out, this book is principally aimed as a revision guide for those undertaking the MRCS examination. It has been based on the MRCS syllabus, and covers that knowledge base. At this point I have to declare a prejudice—that I dislike books that are lists of topics or headings. These may be suitable as a “revision guide”, but my personal preference is to learn from a more detailed text, and then for revision to skim through the already familiar text.

    The first section deals with cardiovascular problems. This is a thoughtful and relatively detailed description of cardiac physiology, resuscitation, assessment and monitoring, and management of a number of specific cardiac problems. It contains more information than the other sections, which deal with respiratory problems, other organ failures, problems in intensive care and the principals of the intensive care unit (ICU) treatment. The final section on practical procedures suffers from a lack of detail and an absence of illustrations.

    Does the book meet the targets set by the authors? It could serve as a revision guide if the reader has already studied a larger text. The headings are all relevant, and the lists and revision points are all appropriate. However this book would not serve a senior house officer or registrar working in the ICU because it lacks detail.

    In my own specialist area, I note that the description of acute pancreatitis is superficial, it erroneously records duodenopancreatic reflux as the pathogenetic mechanism of gallstone pancreatitis, and fails to describe the role of prophylactic antibiotics in the management of patients with necrotising pancreatitis, and the benefits of endoscopic sphincterotomy in patients with severe gallstone pancreatitis. The section on fluid replacement describes the use of normal saline for replacing body fluid loses, with no mention of potassium replacement.

    I found the sections were an appropriate division of the subject matter, but it was frustrating that the content list of each section had no page numbers to guide the reader quickly to specific topics.

    The section on respiratory disorders was well structured, with clear definitions, a description of respiratory function tests, a very comprehensible discussion of acid-base balance, illustrated by different cases and an outline of the principals of respiratory support.

    The authors have succeeded in providing a revision guide for those undertaking the MRCS examination, but trainees working on the ICU, or those studying for the examination before the revision period will probably look for a more detailed text.

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    • The reviewers have been asked to rate these books in terms of four items: readability, how up to date they are, accuracy and reliability, and value for money, using simple four point scales. From their opinions we have derived an overall “star” rating: * = poor, ** = reasonable, *** = good, **** = excellent.

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