Essential Guide to Acute Care

Abstract

This small textbook provides a novel approach to understanding acute illness. Instead of offering the traditional how-to-manage-a-diagnosis format, it explains the underlying physiological changes in acute illness. This is vital because few staff really understand basic concepts, such as how to give oxygen effectively. The hope is that understanding the pathophysiology will lead to more rational and timely management of ill patients. As such, the book is aimed at those who deal with the acutely ill patient'medical trainees, students and critical care nurses'and aims to tell the reader ‘what you really need to know’ but cannot find in standard texts. The book is laid out in 10 chapters. The first, appropriately enough, is the ‘at risk’ patient. This chapter outlines some recent developments in critical care outreach and the importance of early warning systems. Subsequent chapters cover different systems but are based on physiological concepts rather than organs. The order roughly conforms to an ‘ABCDE’ approach so there is logic to the process. Key issues are discussed and each concept is backed up with diagrams, equations and ‘mini-tutorials’ on specific areas. Worked examples are provided of complex equations to illustrate their clinical use. At the end of each chapter, there are self assessment questions in the form of clinical scenarios with the answers in a subsequent discussion. The scenarios are simple and many are very similar, but they are used effectively to reinforce key points. The authors provide a simple and readable description of the underlying pathophysiology of acute illness'quite an achievement! The description could have been even more valuable if it had been connected with clinical observation. For example, the importance of respiratory rate is emphasized at an early stage, but its mechanism is not described. Conversely, the chapter on circulatory failure describes the pathophysiology of shock, but does not link it to the identification of a shocked patient. This book goes a long way towards telling those dealing with the acutely ill, ‘what they need to know’. It is not intended as an immediate reference book, but would be useful for rapid, relevant revision of basic physiology and concepts after the event. Or better still'before. E. McLaughlin M. P. Shelly Manchester, UK