Healing wounds | |
Wounds and lacerations. Emergency care and closure. 3rd ed. Alexander T Trott. Pennsylvania: Elsevier Mosby, 2005 (xv + 336 pp). ISBN 0 323 02307 X |
Wound management
is an integral part of the practice of emergency medicine and, from a medicolegal perspective, a high risk area. Professor Trott’s book, now in its third edition, provides a comprehensive review of the topic, moving on from a description of his own considerable clinical experience to an evidence-based approach. The teaching of most wound management principles is well served by a series of excellent illustrations but, disappointingly, there is not a single photograph of a real wound in its entire 336 pages. Also disappointing, the style is verbose and some ideas are peculiarly North American. I found the suggested approach to the injured toddler (“How did you get your ‘boo-boo’?”) particularly irksome. Personally, I prefer ketamine to a “child-life specialist” when it comes to distracting a child from a painful procedure or suturing that requires complete cooperation. The chapters on local anaesthesia, wound cleansing and hand injuries contain a lot of valuable information. However, four pages on “steri-strip” application and 20 pages on bandaging is perhaps a little extravagant, especially in the age of tubular fixation netting which isn’t mentioned as an alternative. Quite a bit of contemporary research is quoted. Of particular interest, two studies looking at the use of adrenaline in digital blocks with no reported complications. There is also a good review of the literature on subungual haematomas and nail-bed injury (trephination alone seems to be adequate if the nail is intact). The need to keep sutures dry is debunked by a reasonable evidence base, and even senior clinicians can benefit from the descriptions of nerve blocks and repair techniques for complex wounds and special anatomical areas. Wounds and lacerations would be a useful resource for inexperienced doctors and nursing staff in the emergency department, but at $119.50 it is reasonably expensive for a small book. There is little information in it that is not already contained in the large standard texts readily available in many emergency departments. Mark K Miller
|