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Immediate care of the critically ill child. By Macnab AJ, Macrae D, Henning R. (Pp 660, paperback; £45.) Edinburgh: Churchill Livingstone, 1999. ISBN 0 443 05394 4
Few would disagree that in the past two decades, world leaders in the relatively young specialty of paediatric intensive care have emerged in Australia, Canada, and the United Kingdom. It is a welcome pleasure, therefore, that the exceptional talents of many of the individuals working in these centres have been brought together to create a much needed practical text encompassing the principles and practice of caring for critically ill and injured children.
The major strength of this book is that it takes into account one of the most important aspects of paediatric critical care, namely that the initial management of these children takes place in a wide diversity of settings. For many children ultimately admitted to a paediatric intensive care unit (PICU), the first few hours of care may have the most significant impact on their clinical course and outcome. This book targets the practitioners most likely to be involved in these situations, and provides key information and a problem based approach that is difficult to achieve in standard texts.
Like most multidisciplinary texts, the bulk of the book is divided into systems, and by and large system disease andfailure are addressed separately. This distinction doesn't always work, and the inevitable repetition and need for cross referencing can be distracting. Some sections seem to assume no prior knowledge of paediatrics, and others appear to be aimed at the experienced paediatrician. In spite of this, there is a reasonable and logical flow to the text, and many extremely useful tables and diagrams. Key learning points and common errors are highlighted in most chapters, and constitute a list of useful tips based on the considerable collective experience of the authors. This sort of approach is as close to bedside teaching that you can get in a textbook, and will be appreciated by trainees in particular.
Areas that stand out include the management of fluid and nutritional problems, toxicological and metabolic emergencies, and the diagnostic investigation of children with cardiac and neuromuscular problems. It is always difficult to do justice to non-clinical topics like the ethical and psychosocial aspects of critical care, but, at least by including them, the emphasis on the whole patient remains intact. Due attention is given to non-accidental injury and the challenges of transporting patients, the latter reflecting modern, increasingly centralised paediatric intensive care.
In a subspecialty defined by rapid intervention and practical procedures, it is especially difficult to strike the appropriate balance between background detail and clinical practice. On the whole, this book accomplishes this very well. It is not a comprehensive reference text for tertiary care paediatric intensivists, but covers first line treatment to optimise the transition from emergency patient to PICU patient. Until recently, this was mainly undertaken by specialist registrars and consultant anaesthetists, but, in the United Kingdom at least, the next generation of consultant paediatricians will increasingly be called upon to manage critically ill children in those crucial first hours. That group, however reluctantly, will particularly benefit from this useful text.