Emergencies In Chronic Spinal Cord Injury Patients

Edited by IM Eltorai and JK Schmitt 3rd edition. Published by Eastern Paralyzed Veterans Association; 2001, USA ISBN 0 9708873 10; $39.99, 278 pp.

The intention of this book is to be a quick reference for practitioners giving care to patients with spinal cord injury, as well as to the carers not familiar with the subject. It is further stated, in the preface, that the purpose was to develop guidelines for management of emergencies in patients with chronic spinal cord injury. This goal has to a certain extent been achieved. The 30 authors involved have made a great effort to describe the important issues regarding emergencies when working with chronic spinal cord lesioned persons. The majority of the content is easy to read and the information is up to date.

The chapters include the typical acute and critical situations for individuals with spinal cord lesions: autonomic dysreflexia, pulmonary embolism and deep venous thrombosis, pulmonary complications, cardiovascular problems and acute arterial occlusion of the lower extremities, gastrointestinal emergencies and the acute abdomen, and urologic emergencies, and the management of long-bone fractures. But chapters with relation to more mixed situations are also included, such as the spinal cord injury (SCI) ventilator-dependent patient troubleshooting, hyperglycemic and hypoglycaemic emergencies, fluid and electrolyte disorders and acute renal failure, dislocations in the lower extremities, osteomyelitis due to pressure ulcers, decutibus ulcer emergencies, so-called minor burns, infections and fever. More general topics related to persons with spinal cord lesions include spasticity and spasms, acute and chronic pain, management of pregnancy, and thermoregulation. In addition, practical issues like gaining venous access, and nursing management of the complications of SCI are described, as well as psychiatric and psychosocial emergencies in patients with spinal cord lesions.

It is of course important to prevent early as well as late complications and be aware of psychosocial emergencies etc, but if the intention is to create a quick reference guideline for acute problems in individuals with spinal cord lesions, issues like these could probably be left out here.

The book would be better if the editors had edited the various chapters to avoid unnecessary repetitions. The editing should also aim for a greater uniformity of the chapters. This is particularly important since this book is to be considered as a quick reference manual and not as a textbook. For the same reason the number of references could be cut down. In addition, it would be advisable in future editions to make even more of the information available in a schematic form and in algorithms. At the same time some of the text could be omitted. Furthermore, it would be helpful with a more extended index.

If the book is to be at hand during clinical work, it would be more convenient, if it was a little smaller, to allow it to fit easily in the pocket of a white coat.

Even though there is room for improvement, the book is valuable and a good purchase for undergraduates, trainees, allied health professionals and doctors working with spinal cord lesioned individuals.