Oliver Phipps and Jason Lugg's Rapid Emergency and Unscheduled Care describes itself as a ‘revision pocket book that covers the key facts in a simple and memorable way’. It is mainly targeted at less experienced healthcare staff, such as students and the newly qualified. It will also be of some use to those with slightly more experience.
The book is ideal for those wishing to have a pocket-sized aide-memoire, covering core details across several disciplines of primary and urgent care that health professionals are likely to come across from day to day. This book might also appeal to community nurses—especially those working in primary and urgent care—ambulance workers; allied health professionals (AHPs); and doctors.
Despite being a fairly thin volume, it covers a surprising number of subjects in enough detail, making it more than simply a collection of bullet points. The paper the book is printed on is quite thick and the printing is good quality with no smudging or misaligned typesetting. It has no diagrams or pictures so if you also require anatomical diagrams, you may need to look elsewhere. On the other hand, it does have a selection of useful summary tables in each chapter with details to differentiate between similar types of complaint. For example, the fairly comprehensive table on wrist pain has direction towards which bony and soft tissue structures are most likely to be affected depending on the mechanism of injury or area of pain/deformity.
It covers patient assessment, management and treatment; from the patient's first face-to-face encounter with a health professional, aetiology, what to specifically include in each targeted assessment, and the most salient observations related to that ailment. It goes on to describe what further laboratory tests and other investigations may be required pre-hospitally, in primary and secondary care, and offers ideas on some courses of treatment or alternative pathways.
As well as a diverse range of acute and chronic medical conditions, there are also references to dealing first-hand with both blunt and penetrating trauma in the respiratory and gastroenterology sections.
This, along with specific mention of pre-hospital approaches on several occasions, sets it apart from other smaller reference volumes which don't handle the crossover quite so well.
The chapters cover cardiovascular; ear nose and throat (ENT); endocrine; gastroenterology; genitourinary; infections, sepsis and infectious diseases; mental health; musculoskeletal; neurology; obstetrics and gynaecology; ophthalmology; overdose and poisoning; respiratory; skin; and the electrocardiogram (ECG). Relevant scoring systems are included, such as the Wells Deep Vein Thrombosis (DVT) score in the cardiovascular section, and the House and Brackmann grading system for Bell's palsy within neurology.
Cardiovascular covers the usual fare, as well as ischaemic limb. It falls down slightly as the algorithms reproduced from the Resuscitation Council UK for ALS [amyotrophic lateral sclerosis], bradycardia, and tachycardia are from 2010—the book was published in 2016 and updated guidelines were available in 2015. This chapter could have usefully contained the section on ECG, rather than having it at the opposite end of the book, describing several abnormal, peri-arrest and shockable/non-shockable rhythms.
Of particular note is the section dedicated to mental health. This includes characterisation of different presentations of psychoses, varying degrees of severity, potential alternative causes for the change in personality and/or behaviour, and a short summary table of the different legal processes and personnel required should the patient be considered to pose a danger to themselves or the public. Section 135 of the Mental Health Act 1983 is not mentioned; however, this was revised in January 2017 so that initial assessment may now take place on the premises where the patient is, in circumstances where this is deemed necessary, and the practitioner may choose that removal of the patient to a place of safety is not required.
The book is let down slightly by typographical and grammatical errors; such as ‘tine pedi's’, ‘tine corpora's’ and ‘tine curries’ (tinea pedis, tinea corporis and tinea cruris respectively). There are some unfinished sentences, and what should be a description of the aetiology of plantar fasciitis instead contains the details of the mechanism of injury most likely to cause fracture of the calcanium. The typos and outdated algorithms aren't in themselves enough to detract from the usefulness of this reference manual. If you are new to primary care, it will serve you well as guide for directing your review of systems and performing further investigations, as well as throwing in some alternative differentials to consider.
It is intuitively laid out and contains a lot of relevant information considering its small size. All in all, it's a handy addition which you will find yourself dipping into, whether prior to patient arrival at a GP surgery, minor injury clinic, or for whoever is attending on the way to a patient in a double-)staffed ambulance. As a paramedic fairly new to working in primary care, I'll be keeping a copy in my work bag.