Emergency Medicine Manual, Sixth Edition

Emergency Medicine Manual, Sixth Edition, is the latest edition of the companion handbook to Emergency Medicine: A Comprehensive Study Guide. The content and layout remain essentially unchanged. The book is “written by and for health care workers who are engaged in the practice of clinical emergency medicine.” The text is separated into sections and chapters based on Emergency Medicine: A Comprehensive Study Guide. Each chapter follows the same format of clinical features, diagnosis and differential, and emergency department care and disposition. Those who have used and trusted previous editions of this book will be pleased with the new edition.

For a new edition to be superior to the previous version, it must accomplish several tasks, including: (1) add new compelling topics, (2) keep the content of previous editions up to date with current clinical practice, (3) increase the utility and accessibility of facts with clinical reasoning subtext, and (4) increase coordination between authors of complementary chapters. The new edition does very well on the first aspect. There is a new chapter on bioterrorism, a new subsection dedicated to severe acute respiratory syndrome (SARS) (amazing, considering the SARS epidemic was only last year), and new toxicologic chapters on theophylline toxicity and hypoglycemic agents. Also new are 12 color plates of dermatologic conditions, which are rather superfluous because most of these entities, including varicella and fifth disease, should be readily familiar to the practicing emergency physician.

On keeping the content up to date, the new edition is hit or miss. On some subjects, such as indications for a computed tomographic scan before lumbar puncture and the benefit of dexamethasone in meningitis for adults, the latest recommendations from robust clinical trials are deftly interwoven into the text.1., 2. However, in the chapter on head injury, the text suggests computed tomography for isolated loss of consciousness despite a major clinical trial and an American College of Emergency Physicians clinical policy recommending more restrictive indications.3., 4.

The authors have succeeded in increasing the utility and accessibility of knowledge in this edition. A constant threat with books of this size that are meant to be all encompassing is a cookbook mentality without the appropriate clinical context. Adding nuance and clinical reasoning into a book of this breadth without doubling its size is certainly a challenge. Improvement in this area gives confidence that the respective authors have thoroughly overhauled their subjects, making them more available to the reader. An example includes a discussion of the proper use of d-dimer with its various assays in ruling out pulmonary embolism, which is helpful when explaining to colleagues of other services why testing for d-dimer is not supported in patients with at least a moderate pretest probability. This is opposed to the previous edition, which simply stated the sensitivity of d-dimer and its high rate of false positives.

As in all texts with multiple authors, there is some redundancy and some failure of clinically similar chapters to complement each other. The redundancy is actually beneficial if it helps the clinician find the sought information. However, the failure to complement may leave readers to scratch their heads. For example, the chapter on peripheral vascular disease uses Wells criteria for risk stratifying patients with possible deep venous thrombosis, yet the pulmonary embolism chapter does not use Wells criteria for pulmonary embolism. Why not? Are the Wells criteria for pulmonary embolism not as sound as the criteria for deep venous thrombosis?

In conclusion, Emergency Medicine Manual, Sixth Edition, is of undisputed utility to the practicing emergency physician in daily practice. Nonetheless, as with all works of great endeavor, there is room for improvement in the next edition.