Parkland Trauma Handbook
Fiemu Nwariaku and Erwin Thal, eds
2nd edition, Mosby, 1999
ISBN 0815126182
Trauma care is a comparatively new specialty
whose origins lie in the advent of that particularly unpleasant 20th
century feature, mass warfare. The need to deal with large numbers of
acutely injured patients brought about not only the concept of triage
but also the need rapidly and effectively to treat life threatening
trauma.
After a plane crash in 1976, an American surgeon established the
advanced trauma life support (ATLS) protocols, which were the basis for
those in use internationally today. The use of these structured
protocols has improved mortality dramatically, and for this reason
other protocols have become increasingly widespread in trauma practice.
The Parkland Trauma Handbook is a concise review of the
subject, written by surgical residents at Parkland Hospital, Texas,
USA. It is divided into six sections. The initial section discusses
general issues such as trauma epidemiology, ATLS protocols, and injury
scoring. It also contains an interesting chapter on mechanisms of
injury and ballistics-I hope that this will remain of academic
interest only to most British doctors.
The following section covers initial assessment, dealing with shock,
and provides a well illustrated chapter on catheterisation,
cannulation, and insertion of chest drains. The next three parts
present, condition by condition, treatment protocols from head injury
to black widow bite. Each of these starts with a discussion of the
mechanisms and epidemiology of the injury and then a review of the
pertinent anatomy, which is particularly helpful in integrating basic
sciences with clinical reality. The authors then set out protocols for
diagnosis, including the indications for different types of
investigation and what the results mean for treatment. The final part
of each chapter deals with surgical and medical management, often
finishing with a "pearls and pitfalls" piece giving a couple of
tips from the experience of the residents.
The final topic is critical care. This is a new feature of the second
edition and is unusual in a surgical book as such issues are normally
regarded as the responsibility of anaesthetists. This helps to
emphasise the multidisciplinary approach required for best outcome.
Like most handbooks this is not really meant to be read cover to cover,
rather to be dipped into as the situation arises. It is not a textbook
of trauma care, and those seeking detail, discussion, and underlying
mechanisms will be disappointed. It will, however, fit nicely into a
pocket for those rotations in accident and emergency and trauma
surgery. It will not turn you into a trauma specialist, or even make
you look a little more like George Clooney, but it should give you a
better insight into what is going on in this high-pressured specialty.
Andy Conway Morris, third year medical student, University of Glasgow
Email: email
studentBMJ 2000;08:89-130 April ISSN 0966-6494
