Doctor’s Bag Companion
- John Holmes
- Aust Prescr 2020;43:27
- 3 February 2020
- DOI: 10.18773/austprescr.2020.003
Ellerton K, Craig S
Melbourne: Kirrily Ellerton and Simon Craig; 2019.
This small volume is designed to be a rapid reference for GPs confronting a patient with an urgent medical issue or emergency. The book is a convenient A5 size and is ring bound, enabling it to be opened flat on a working surface. The pages are thick and fluid resistant, making it ideal for use in an acute clinical setting. Colour-coded text boxes allow the reader to access specific topics rapidly. The pages also have strips of colour on the margins, but these do not relate consistently to specific parts of the book and do not facilitate navigating the book’s content. It may be a publication glitch.
The material is didactic and is drawn from recognised medical authorities in Australia and New Zealand. However, it is not a replacement for proper training and knowledge. Doctors experienced in managing emergencies may benefit from quick access to the information in this book, especially in a rapidly changing clinical situation.
The book is nominally divided into paediatric and adult sections, and addresses the most common and significant emergencies in the different age groups. For adults, topics include cardiac arrest, chest pain, anaphylaxis, asthma and chronic obstructive pulmonary disorder, dystonia, hypoglycaemia, seizures, migraine and alcohol withdrawal. Paediatric topics include cardiac arrest, seizures, anaphylaxis, asthma and acute pain. In all age groups there is also a summary of appropriate antibiotic use in important acute infections. Additional sections include the management of sexually transmitted diseases, palliative care and nursing home patients. There are picture guides for wound and burns management. There is a useful quick reference chart for vital signs on the back cover. Perhaps consideration could be given to including an aid for estimating a child’s weight in kilograms (e.g. weight = (2 x age) + 8). It would also be useful to include a couple of blank pages for a doctor to add their own notes.
The paediatric section is organised so that each opened double page corresponds to a body weight in kilograms. The resuscitation data and drug doses are provided specific to these weights. However, there are major problems with this approach. Definitions of ‘paediatric’ vary, although it is usually defined as being from birth to puberty. Indeed, most clinicians would treat patients over 50 kg as adults. Yet in this book, weight ranges in the paediatric section continue up to 70 kg. This leads to anomalies, particularly in recommendations in cardiac arrest resuscitation that are at odds with those of the Australian and New Zealand Committee on Resuscitation (ANZCOR).1 In cardiac resuscitation, ANZCOR states that adult algorithms should be followed for patients over the age of eight years (which corresponds to a weight of approximately 25 kg). ANZCOR guidelines also state that for single rescuers the initial ratio of compressions to breaths in CPR should be 30:2 in all age groups, and 15:2 in paediatrics (≤ 9 years) only if there are two or more rescuers. This book’s recommendation of a compression:ventilation ratio of 15:2 up to a body weight of 70 kg is not in line with ANZCOR.
Weight-related doses and fluid volumes in the paediatric section are very useful but unfortunately they are taken to extremes with unnecessary precision. For example, the dose for buccal midazolam in a child weighing 17 kg is given as 1.02 mL of a 5 g/mL ampoule – this degree of precision is clearly unnecessary. Doses should be rounded off to be more appropriate to actual clinical practice.
This book is potentially an excellent resource that could be very useful for medical practitioners who may deal with emergencies on an occasional basis.
It provides a ready reference to facilitate rapid and safe clinical assessment and management. However, there are some flaws that should be addressed before the book can be unreservedly recommended. If these could be addressed then this would be a very valuable addition to every doctor’s bag.
Consultant Emergency Physician, Qld