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Civetta, Taylor, & Kirby’s Critical Care , Fourth Edition . By Andrea Gabrielli, A. Joseph Layton, and Mihae Yu . Baltimore (MD) . Wolters Kluwer Health, Lippincott Williams & Wilkins , 2009 ; 2707 pp; $249.00 (hardcover ).

Have you ever thought or said, “If I only knew then what I know now?” My professional ‘coulda-woulda-shoulda’ goes something like this: I wish I had spent an extra year or two and done the combined emergency medicine/internal medicine residency training program. Then I could have done a critical care fellowship and sat for those boards in the States. But I did not see it coming in 1990 when I finished my emergency medicine training. I worked in a busy place back then, but admitted patients didn’t linger in the emergency department (ED). That was especially true for admitted critically ill patients; they got tubed, lined up, a first blast of therapy, and then they vanished to critical care units where someone else assumed their care. Now it is all me (and us), as critical patients with multiple needs extending far beyond the realm of traditional emergency care become “rocks” in the ED, sometimes for hours, often for days.

Thankfully, there is an excellent reference available to augment the critical care medical knowledge we have all acquired by necessity over the past several decades, as EDs have taken on more and more critical care tasks. Civetta, Taylor, & Kirby’s Critical Care, Fourth Edition, is that reference.

For the most part, Critical Care is written for and by critical care specialists, but there is something for emergency physicians to learn from and love in almost every chapter. It is an international text with authors from across the globe sharing their expertise. Critical Care is organized in standard medical text fashion, with sections and chapters. Section headings span general concepts, monitoring, techniques and procedures, organ transplantation, special populations, disorders of all major organ systems, and many more. As mentioned, there is something for us—often many things—in every section: breaking bad news to patients, capnography, fluids and electrolytes, shock, toxicology, facial trauma, acute coronary syndrome, acute renal failure, hyperbaric oxygen, elevated intercranial pressure, and many more in this 2,700 + -page, plus-sized tome. It is not bloated, just packed with useful information, and with a handle on it, would barely fit as an airline carry-on bag. Even the material that we will (hopefully) never deal with, like “ICU Discharge Criteria and Rehabilitation Potential for Severe Brain Injury Patients” was fascinating. Although I did skim this one, the chapter referenced coma, vegetative state, epidemiology, and other topics that definitely intersect with my practice.

Critical Care chapters do not follow a template, but most end with a summary and sometimes an appendix or “pearls.” All chapters are heavily referenced, so if you feel like you need more information after paging through the presented material, it is right there waiting for you. There is also a series of appendices, a “critical care catalog” that details an enormous amount of useful data in table and chart form: body surface area nomograms, causes of acid-base disturbances, Glasgow Coma Scale, Injury Severity Scale, Revised Trauma Score, APACHE II, medications, and lots more. Who knew there was a “SOFA” score (sequential organ failure assessment score)? Maybe that is something to test residents with on their ICU-bound patients?

In addition to all this, each purchased text allows “access to the complete contents online, fully searchable, plus other valuable features.” True, one can read the textbook online and search through it, but the “other valuable features” seemed to be mostly the “opportunity” to buy more textbooks. This didn’t change my high opinion of Critical Care, but did put my view of Wolters Kluwer Health and Lippincott Williams & Wilkins nearer to death’s door.

Bottom line: I wish I knew this stuff, all this stuff. I wish I had studied it formally, but that was not an option (or not an option taken). However, if you, your department, or your medical librarian has an extra $249 and 4 inches of sturdy shelf space to spare, I would consider investing in Critical Care. It represents a real, reasonable way to shore up any critical care knowledge gaps and may help you provide better medical care when it is most needed.