Case Studies in Paediatric Critical Care

Abstract

The use of case studies as a method of teaching and informing the reader has both advantages and disadvantages compared with the standard textbook. The advantages include the ability to make the disease seem more realistic by having the problem related to a patient scenario. This makes it often easier to understand and appreciate. One of the disadvantages is that only a few cases can be covered in a small handbook. This book covers a wide range of the major diseases and illnesses found in a paediatric intensive care unit. The chapters are divided up into a case study which is described in detail, continues with a well written and organized discussion which is referenced to key papers, and finishes with a set of bullet-point learning points. There are a few important illustrations which complement the text and are very useful. Some of these are repeated as colour plates in the central section of the book. This book, I feel, strikes an excellent balance. There are useful chapters on major illnesses such as bronchiolitis, asthma, and diabetic ketoacidosis. Others cover some of the important and difficult clinical challenges in neonates, such as inborn errors of metabolism and coarctation of the aorta. Trauma is covered in head injury, the multiply injured child, and non-accidental injury. The case histories bring these medical problems alive and explain the timeline of the process when medical intervention occurs. The use of narrative discussion, giving clear explanations of the background pathophysiology, and the reasons for management decisions works very well. Backed up by a few clear learning points, this book becomes a useful self-teaching tool. Overall, all the major technologies used in the care of critically ill children are covered. The layout and descriptions make this book stand out as one which seems more realistic than the standard medical textbook. There are, however, a few faults. One or two of the topics are very rare in the UK, whereas others, such as the management of a diaphragmatic hernia, long-term ventilation, or dealing with a death, are more common. The order of the chapters also seems to be random. The use of case histories can lead to the possibility of unusual therapies or omissions in a real story. Variations in the practice of medicine in other countries can also lead to confusion. For instance, the earlier use of an i.v. bolus of salbutamol and a slower ventilator rate in severe asthma would be more common in the UK. However, I think that this book is excellent and I would recommend it to trainees, consultants, and interested clinicians in paediatric intensive care. It is a useful addition to the intensivist’s library.