Hardwood-Nuss’ Clinical Practice of Emergency Medicine, Fifth Edition By Allan B. Wolfson, MD, Gregory W. Hendey, MD, Louis J. Ling, MD, Carlo L. Rosen, MD, Jeffrey Schaider, MD, Ghazala Q. Sharieff, MD . Philadelphia, PA : Wolters Kluwer Business, Lippincott Williams & Wilkins , 2010 ; $229.00 (hardcover ).

The Clinical Practice of Emergency Medicine, Fifth Edition, provides comprehensive instruction and review for the practice of emergency medicine. Since its inception, the purpose of this text has been to provide an accurate, complete, and concise resource on the various medical conditions that will be routinely encountered in the emergency department (ED). The release of the fifth edition has brought many improvements to this text. Various tables and figures have been added for quick reference. Many of the procedural figures are large in size, with excellent detail, making them exemplary for teaching. The website has been updated to include full access to the text online, which is an invaluable feature, as the entire text with figures and tables may be accessed from a remote site for reference and review. The website also offers multiple-choice questions with each chapter for independent study. The reader may build review tests with a varying number of questions, and explanations are available instantly. In addition, actual tests may be built for each chapter. Following completion of the test, a percentage score will be displayed. These two features are excellent for those clinicians preparing for board certification. With these improvements to the fifth edition, this text will continue to serve as an excellent resource for practicing clinicians, residents in training, and students.

This hardcover text contains 1,752 pages and is divided into 25 sections. Each section is further divided into chapters. The introductory chapter, “The Approach to the Emergency Department Patient,” discusses the uniqueness of emergency medicine and the skills required to develop an effective approach to the patient. This prelude sets the tone and provides the foundation for the remainder of the text. Each subsequent chapter has a consistent layout including definitions, ED evaluation, ED management, disposition, critical interventions, and common pitfalls. The strong organization of each of these chapters allows the reader to quickly find the pertinent material with ease.

The first section, “Resuscitation,” contains chapters that relate to airway management, airway procedures, cardiopulmonary arrest, shock, and vascular access. Its prominent position in the sequence of this text is critical, and the chapter is designed to facilitate the provider through the pitfalls of the critically ill patient. The airway procedure section provides an in-depth discussion on various airway devices. Each subsection provides detailed information on the device, as well as the appropriate patient population for each device. Included in these chapters are introducers, video laryngoscopy, fiberoptic devices, and retrograde and percutaneous transtracheal jet ventilators. Large figures are included for retrograde guidewire intubation and percutaneous transtracheal jet ventilation, making this section exceptionally helpful for these less commonly used procedures.

The second section, “Pain Management and Procedural Sedation,” has been moved to the front of the text, placing this critical section in an easy-to-access location. The subsections in Chapter 6, “Acute Pain Management,” have been changed to be more suggestive of the topics that they describe, compared to previous editions. The table on Pediatric Guidelines for Drugs for Pain Management has been removed. This is disappointing, as this table was invaluable for those providers who do not interact with this population regularly. Chapter 8, which deals with procedural sedation, continues to contain relevant material and a valuable table of pharmaceutical agents commonly used for sedation.

The section dedicated to trauma has been moved forward in the text, and the rewritten sections are complete and pertinent. Chapter 19 is specifically dedicated to airway management of the trauma patient and has been extensively rewritten from previous editions. There is a relevant table and figure regarding induction agents for airway management. Included are the appropriate dosing instructions, as well as recommendations on selecting the proper induction agent for specific patient conditions. Chapter 32 on penetrating chest trauma has been updated to include new radiographs and cardiac ultrasound images, in keeping with new trends in emergency medicine. One discrepancy was discovered while comparing the airway management guidelines in this chapter with those in the Advanced Trauma Life Support (ATLS) Student Course Manual, Eighth Edition. According to ATLS, a cribiform plate fracture is a relative contraindication for nasotracheal intubation, while this text states that these patients can be safely intubated using nasotracheal intubation. A reference citation would be helpful to clarify these contradictory statements. Chapter 20, “Traumatic Shock,” has a new table on the classes of hemorrhagic shock, while new vivid images have been added to Chapter 22 on head injuries.

Section IX on Obstetric Emergencies has been updated with many beneficial changes. Chapter 133, “First Trimester Vaginal Bleeding,” was previously titled “Emergencies in Early Pregnancy.” New content has been added, including treatment options for a nonviable pregnancy diagnosed in the ED. Chapter 135, “Hyperemesis Gravidarum,” is a new chapter dedicated to nausea and vomiting in pregnancy. It contains a table with dosage, route, and pregnancy class for antiemetic options. Moving this common topic to a separate chapter allows for easier reference compared to previous editions, when it was nestled within another chapter. Chapter 136, “Post-abortion Complications,” was previously titled “Complications of Inducted Abortion.” This chapter contains new information on sepsis and toxic shock syndrome. Included is a table containing appropriate agents to be used for uterine atony. These medications are placed in the appropriate order in which they should be administered, making this helpful for the practicing physician faced with this emergent condition. Chapter 137, “Hypertensive Disorders in Pregnancy,” has been rewritten and reorganized to contain up-to-date information on the differential diagnoses and treatment regimens of hypertension during pregnancy.

Several chapters have new authors and have been reformatted and rewritten, demonstrating a commitment to keeping the information in this text current. Specifically, Chapter 63, “Oral and Maxillofacial Disorders,” has been rewritten to include many helpful tables and figures on pertinent anatomy for odontogenic and parapharyngeal space infections. Chapter 68, “Ear Infections in Adults,” has been completely restructured. Included is a table of medications, dosages, and specific comments on drug cost, assisting the practitioner on treatment choice. Finally, Chapter 71, “Acute Hearing Loss and Tinnitus,” is a new chapter with appropriate content on these two conditions, making a great addition to the ENT portion of this text.

Overall, this text has several strong points. The format of the book is easy to read and to navigate, with a descriptive table of contents and an index for quick reference located at the very end of the text. In addition, this edition has undergone significant reorganization with new updates to various sections and chapters. A few of these revisions have been highlighted in the above paragraphs. The diagrams and charts simplify key information found in the text, drawing attention to the important facts. The increased number of tables and figures are exceptionally helpful for quick reference during clinical practice. They also help organize and compare pertinent material. The improved clarity of images is beneficial throughout this text. The website is of excellent quality and provides invaluable resources. One suggestion is to include a small information section either prior to or in the opening chapter explaining the new changes to the website. The website contains the entire text, additional tables that are not found in the written text (referred to as “E-tables”), and the multiple-choice questions. Alerting the reader to the attributes of this website would be helpful, as this is one of the features that sets this text apart from its competitors.

This text delivers exactly what it promises in the introductory chapter: a thorough, comprehensive resource for the practice of emergency medicine. The text is written in such a manner that anyone from the medical student to the board-certified emergency physician would find its contents useful. As a resident, this is a great text to use for clinical practice as well as board review. The multiple-choice questions that are available on the website are clinically relevant and provide a great review of each chapter. Likewise, while working in the ED, it proves to be an extremely valuable reference book. Due to its updated and well-organized format, it is easy to locate all the relevant information while managing clinical cases. This text is a worthy investment.