Book reviews

Emergency medicine Toxicology Pharmacology
Volume 190 - Issue 7

Toxicology Australian style

Author:  Mark Little

Med J Aust 2009; 190 (7): 391. || doi: 10.5694/j.1326-5377.2009.tb02457.x
Published online: 6 April 2009
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Therapeutic guidelines. Toxicology and wilderness. Emergency Medicine Expert Group.
Melbourne: Therapeutic Guidelines, 2008 (xxii + 311 pp). ISBN 978 0 9804764 0 8.

Poisoning is a common presentation to Australian emergency departments and a common cause of death in those under 40, yet there is a real paucity of Australasian toxicology texts. Toxicology and wilderness, a new release in the Therapeutic Guidelines series, is a subset of topics prepared by the Emergency Medicine expert writing group for the electronic eTG complete.

Toxicology and wilderness sensibly starts with in-depth information on the many aspects of resuscitation. There is a good overview on the approach to the poisoned patient, with a great nomogram to help assess the risk of torsades from a prolonged QT. The majority of the book is based on the toxicology of individual agents. It approaches each agent in a structured manner, detailing the indicators for toxicity, clinical presentation, key investigations and treatment. It has much helpful and sensible advice.

The authors seem to advocate routine activated charcoal for most poisonings that present within 1 hour, which I would disagree with. The discussion on antidotes is understandably brief, although I was curious to read in detail about dicobalt edetate for the treatment of cyanide poisoning, and not the currently recommended and far safer hydroxocobalamin. I felt that there were sections where better emphasis on the potential for severity of the poisoning or management issues could have occurred.

The book ends with a well written section on envenoming, then the unusual bedfellow of wilderness medicine.

I think the strength of this book lies in the ready access of the electronic format for hospital practitioners. I found the information a good starting point but, due to the restrictions of the structure of this series, a little light in some areas. As to whether it sits on your bookshelf — you need to browse through to see if it fits a need.

Author

  • Mark Little1
  • 1. Sir Charles Gairdner Hospital, Perth, WA
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