★★★★★ 3
A little too beginner; doesn't translate well to USA patterns of practice
Format: Paperback
The book title really says it all, it really is the BEGINNER'S guide to the ICU for junior doctors and allied health professionals - more like an introduction to important concepts rather than a guide really. The strengths of the text come from its stated purpose of being a absolute, beginner's guide to critical care. The book would be appropriate for perhaps a 4th year med student or a intern who is very early in residency w/ little ICU experience or a newly minted APP; there's little to be gained by a advanced resident, fellow or practicing physician. The chapters are very short which provide a mere grazing-the-surface of important critical care concepts - some chapters are too short to really be useful (e.g. the paltry coverage of ultrasound in crit care (p. 159) is only 10 pages including pictures). The book, editors and authors are UK-based which makes the units of measurement, choice of drugs and some practice patterns, not consistent with what is typical in the USA.
For this reason I cannot recommend this text for American learners; e.g. blood glucoses are measured in mmol/L internationally, however USA, Germany use mg/dL where a normal BG in UK may be "4.4" but in the US one might consider a normal BG "80". This carries over again with concepts of ABG's and their utility in ventilator settings, respiratory emergencies and sepsis, etc. which become more confounding when using the PaCO2/PaO2 kPa instead of the mmHg used in American ICU's. When a BEGINNER is trying to learn the FUNDAMENTALS of crit care I recommend that a learner be introduced to the concepts using data measurement they are expected to utilize in practice rather than going through the mental gymnastics of doing conversions and THEN making a treatment decision.
The theme of UK and USA differences continues into drug therapy. For example when covering RSI and sedation the authors discuss the utility of sodium thiopental, however this drug has not been available in the USA for many years. In addition there were some other areas where some recommended drugs did not correlate w/ typical USA patterns and others that received hardly any mention (e.g. little mention of vasopressin as an adjunct in pressor support, other paralytics in RSI such as succinyl choline, rocuronium, CCB's and BB's in atrial fibrillation). Least of all there are multiple areas where drug/device names that refer to the same agent but would confuse a beginner starting in the USA (e.g. albuterol = salbutamol, aceteminophen = paracetamol, norepinephrine = noradrenaline, Guedel = OPA etc.).
Lastly, on the topic of UK vs worldwide differences the epidemiologic data mentioned refers to UK populations making it somewhat of an abstraction of the prevalence of disease in your area of practice if you're outside the UK. Which is fine, just be aware of that.
The chapters, however, are well organized and majority begin with a clinical case which I find is a approach that cements concepts in learner. If anything I feel that some are much to short, even for a beginner. I'm specifically referring to the Cardiac Arrythmias chapter (p 233). There is much to cover on this topic and the 5 pages dedicated to it is simply not enough and there is no further recommended reading. And importantly, the EKG figures were switched around on p234 and p235, which again does a beginning learner a disservice. I did find the chapters dedicated specifically to ICU concepts useful such as "Fighting the Ventilator" and "Endotracheal tube and tracheostomy problems" which cover just enough ground for the trainee. Unfortunately, none of the chapters have in-text citations with little primary references - I did have some questions regarding some chapter authors recommendations and I'm unable to look up where the works cited to review the quality of evidence.
There are multiple chapter authors and unfortunately this creates some redundancies. I could only find one area where there was a contradiction between authors which one author stated there is no contraindication for insertion of a NPA in setting of base-of-skull fracture (p.79) and on the next chapter another author stating that "nasopharyngeal airway is contraindicated if there is the possibility of a base of skull injury!" (p.87) - less than 10 pages apart. Again, there's no primary texts referenced and I can't confirm where the best, up to date evidence lies.
In SHORT: this is a useful text to the BEGINNER who is looking to obtain a broad overview of critical care CONCEPTS. It is pretty easy to read through and simple to digest where I a motivated learner could get through the full 440 pages relatively quickly and gain a good grasp & appreciation of the concepts of critical care. The text accomplishes its goal of being a BEGINNER'S GUIDE to ICU and explicitly identifies its target audience in the title: . . . . A Handbook for Junior Doctors and Allied Professional. I do NOT recommend the text to American trainees for the reasons above (drugs, units, differences in practice patterns) and I don't recommend the text to practicioners who have more experience.
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Reviewed in the United States on January 19, 2021
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