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Development Reflexive Rehabilitation

I am of the generation who have spent years carrying 340 grams of the Oxford Handbook ofClinical Medicine in my white coat pocket. I now have a replacement in the form of Acute Medicine weighing in at 430 grams! Acute Medicine (also with a soft washable cover!) is divided into four sections; common presentations, specific problems, procedures and useful information. The layout is easy to follow with practical headings such as problems, priorities and further management. Treatment protocols are exact and there are precise instructions for preparing and administering infusions of drugs including rates in ml/minute, which make this an extremely useful handbook. The full range of medical emergenices is covered and the emphasis is on diagnoses not to be missed. Advice is sensible; for example the invaluable tip on acute chest pain 'if you cannot make a confident diagnosis of a minor and self-limiting disorder, admit the patient'. There is a detailed chapter on the management of arrhythmias but a rather cursory description of the role of thrombolysis in myocardial infarction, which can be a difficult clinical decision when 'time is myocardium'. The only other major omission was, perhaps, a chapter on the management of the unwell immunosuppressed patient, including those with HIV infection, although some aspects of this are covered in 'other chapters'. The section on procedures is very clear; the step by step instructions must be good since the procedures sound so easy! Furthermore, should there be problems these have been anticipated under the heading 'trouble shooting'. 'Useful information' is largely composed of tables with all those numbers that are never in one's head when one needs them, such as peak flow rate in a 45 year old male who is 5'6" tall, as well as the essential 'dermatomal' man. The index is inadequate but mitigating this is the excellent lay-out, such that one can flip through and find the page needed even in a moment of stress. There is an enticing further reading list, largely composed of references to recent review articles in major journals (mostly 1985 onwards, including two in press 1990!). Acute Medicine is an attractive, easy guide to use. It is not a book for medical students, but I strongly recommend its use by those having to make and implement decisions in the emergency situation. It would be appropriate as revision material for the MRCP examination, particularly vivas. L. Restrick Whittington Hospital, London N19 5NF.