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Handbook for Emergency Physicians. Shah, K. Kelly editors. Published by Cambridge University Press, Cambridge. This book was written to provide a handbook to be carried by emergency physicians involved in caring for patients with neurological emergencies. In practice, the book is too large to be carried in a pocket but it does provide a valuable resource for reference for physicians in accident and emergency departments or intensive care units.


There are 38 chapters, most of them quite short, and each gives a concise description of the clinical problems. The chapters in Section 1 deal with neurological examination, neuroradiology, electroencephalography, and lumbar puncture. There are excellent quality illustrations of the various imaging techniques in this section and throughout the book. Section 2 deals with common neurological presentations including altered mental status, headache, weakness, dizziness, seizures, and gait disturbances.

Section 4 covers neurological trauma, and Section 5 paediatric neurological emergencies. The chapters on neurological conditions follow a similar standard format with a brief introduction, evaluation including physical examination, pathophysiology, differential diagnosis, investigations or diagnostic testing, management, and disposition.

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  • At the end of every chapter, there is a very useful brief summary of the relevant pearls and pitfalls. The chapter on neurological examination would be useful reading for FRCA examination candidates, and the chapter on neuroradiology gives an easily understood description of common pathologies detected by neuroimaging.

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    The chapter on lumbar puncture is also well worth reading. The chapter on brain death seems out of place in a book aimed at emergency department physicians. It deals with the topic sufficiently superficially for the differences between practice in the USA and the UK not to matter. It quotes a higher level of P a CO 2 for brain stem death testing than that in the UK guidelines, but many UK clinicians would consider this higher level more appropriate.

    The indications quoted for emergency CT scan in the chapter on traumatic brain injury do not exactly match those in the NICE guidelines, which are the current standard for the UK. There are a few factual errors and a number of typographical errors, most of which will be obvious to the reader.

    On page , it is stated that the use of rapid sequence induction is to avoid laryngeal spasm, when the purpose is to avoid aspiration of gastric contents.

    In addition, the rapid sequence induction algorithm on page would not be acceptable to British anaesthetists. Cricoid pressure should not be released until correct placement of the tracheal tube has been confirmed by capnography and the cuff inflated. Figure