brown m, ,emergency! true stories from the nation's ers (1996) random house,new york 221 pp.,...

Emergency! True Stories from the Nation's ERs. Brown M. New

York: Random House, 1996, 221 pp., $21. Long before our Thursday n igh t s were reserved for ER,

t he NBC pr ime t ime hit, Mark Brown, MD, an e m e r g e n c y phys ic i an in California, was ga the r ing stories from fellow ED workers a round the country to compile into a book. Emergency/is t he result. Composed of fast-paced, first-per- son v igne t t e s of life in The Pit, t he re are no holds barred, b e g i n n i n g wi th his introduct ion, "The Doors," w h i c h se ts the tone for the book- - s t a rk , b lun t honesty.

As a nu r se in neu ro t r auma for more t h a n 10 years, I t h o u g h t I had hea rd it all, bu t no, t ha t d is t inc t ion rightfully be longs to the ED staff. Parts of th is book still left me wi th m y m o u t h h a n g i n g open. As expected , there are several s tor ies abou t i n a n i m a t e objects found in inappropr ia te bod- ily orifices, bu t there is so m u c h more. Wri t ten b y doctors, nurses , and phys ic i an ass is tants , I r ecognized t he voice of t ru th t h roughou t the book; only we in hea l th care know too well h o w t ru th is s t ranger t h a n fiction.

I l a u g h e d , I cr ied, a n d I a p p l a u d e d , e spec ia l ly t h e s e c t i o n w r i t t e n b y Ni ta Jones , RN, w h o k e p t a journal t h r o u g h he r yea r s of work ing in t h e e m e r g e n c y dep a r t - m e n t . " In t ima te S t r a n g e r s " t o u c h e d a chord w h e n s h e d i s p a s s i o n a t e l y tells of a code for a y o u n g v i c t i m of a motor veh ic l e a c c i d e n t w h o d id no t surv ive : "As usual, w e l a u g h s o m e a n d m a k e l i t t l e j o k e s a s w e work . We d o n ' t k n o w him. We d o n ' t w a n t to k n o w h i m r igh t n o w . . , r igh t n o w h e is t r a u m a #RT7698 and he is d u m p - ing, t e s t i n g our skills to t he max." W h e n a coworker later f inds a p i c tu r e of t he v i c t im in his wal le t and s h o w s it to Jones , she wri tes , "I s ta re at it a n d feel my th roa t t igh ten . Why did she h a v e to s h o w me t h a t p ic turerr Now h e is real. I l iked it b e t t e r w h e n w e w e r e s t rangers . " Oh, h o w I could re la te r

Similar pain shows in a poem by Dr. Higgins. He writes of his own injury to the spirit w h e n he m u s t tell survivors that their loved ones have died.

Dr. Brown pays grea t h o m a g e to e m e r g e n c y nurses by s tat ing, "ER nurses are the top guns of their profession. In few other areas do nurses prac t ice wi th such au tonomy and responsibi l i ty as they do in The Pit. They h a v e a repu- ta t ion for b e i n g independen t , assert ive, and t o u g h . . . "

J Emerg Nurs 1996;22:302-4. Copyright �9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/64/73509

Anothe r uplifting sec t ion was "An Open Letter to ER Staff" by an e m e r g e n c y phys ic i an who was called in to work on a busy Chr i s tmas Eve. He wri tes hones t ly of h is fat igue and

r e s e n t m e n t of h a v i n g to go in to work t ha t night , bu t once there a n d rece iv ing the heartfelt t h a n k s of the staff, com- m e n d s and app lauds thei r great t eamwork an d collabora- t ion on th is horrific Chr i s tmas Eve.

All in all, I loved the book and the courage it under- takes. I h ighly r e c o m m e n d it for all e m e r g e n c y nurses. My

only concern is h o w the general public will r eac t to the gal- lows humor so openly revealed; our joking and k idding a round h a s b e e n a wel l -protected sec re t unt i l now; hope- fully the public will not m i s u n d e r s t a n d or b e c o m e disillu-

sioned. More t han likely, the good will ou twe igh the bad. (RS., It is even be t t e r t h a n ER).--VP

Emergency Care of the Elder Person. Geriatr ic Emergency M e d i c i n e Task F o r c e / S a n d e r s AB. St. Louis: Beverly Cracom Publicat ions, 1996, 305 pp., ISBN 1-886657-00-9.

For any e m e r g e n c y cl inician w h o h a s b e e n sea rch ing in vain for a comple te text tha t addres ses the special pop- ulation of geriatrics, Emergency Care of the Elder Person is a practical, concise guide t ha t successful ly merges the dis- ciplines of geriatr ic and e m e r g e n c y medic ine . Descr ibed by the au thors as a "culminat ion of a 5-year e f f o r t . . , to fill a gap in the knowledge base and pract ice of emergency

medic ine wi th regard to the care of elder persons," it takes into considerat ion the physiology of ag ing and the specific clinical issues tha t complicate the emergency care of an older

adult. The chap te r on "Pharmacology and Aging" is espe-

cially helpful to the e m e r g e n c y clinician, clearly emphas iz-

ing the n e e d for a careful rev iew of an older pe rson ' s med- icat ions on p resen ta t ion to the e m e r g e n c y care set t ing. The au thors give practical advice such as "start low, and go slow" w h e n prescr ib ing or adminis te r ing medica t ions to an older person. Chapters on ethical issues and at t i tudes on ag ing remind us all of our own mortality. A chapter on

t rauma in older pa t ien ts descr ibes physiologic considera- tions, prehospi tal considerat ions, resusci ta t ion challenges, and possible causes for t raumat ic events.

The text includes pract ical tools, such as a geriatric

abuse protocol, inc luding a sample in terview wi th a possi- ble elder abuse perpetrator. It is easily read and adaptable to mos t emergency set t ings. An instructor 's manual , including

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