Emergency Radiology: Case Studies (Schwartz)

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Emergency Radiology: Case Studies by David T. Schwartz
Review by Michael O'Brien, M.A., CCEMT-P

Contents

• Chest Radiology
• Abdominal Radiology
• Skeletal Radiology: Upper Extremities
• Skeletal Radiology: Lower Extremities
• Cervical Spine Injuries
• Head CT
• Facial Trauma

Chest Radiology
Schwartz's comprehensive section on chest films gently introduces the reader to the basics of radiology in the ED. He begins by discussing the advantages and limitations of AP vs. PA views and symptom vs. diagnosis-based decisionmaking. Within mere pages a novice will begin to feel comfortable reading chest radiographs. Schwartz masterfully covers the major radiographic findings of pneumonias, PE, CHF, pneumothorax, pneumomediastinum, and aortic dissection & injury.

Abdominal Radiology
With the advent of CT and ultrasonography, ED assessment and diagnosis of abdominal disorders has advanced significantly. Schwartz has undoubtedly kept pace with these changes. This section contains several radiographs, ultrasounds, and CTs pertaining to each major condition discussed.

Upper & Lower Extremities
These sections discuss extremity injuries by age group as well as their respective incidences. Great attention is paid to subtle fractures & the radiographic views that can reveal these hidden but important findings.

Cervical Spine Injuries
A brief but high-yield discussion of the NEXUS Low-Risk Criteria and the Canadian Cervical Spine Rule (CCR) opens the section on c-spine injuries. Ultimately, the author suggests the use of a hybrid test utilizing some of the subjectivity/simplicity from NEXUS with features from the CCR (such as clinically clearing patients >65 years of age). The remainder of the chapter presents cervical spine radiographs and multidetector helical CT studies in its examination of assorted types of cervical spine injuries (including odontoid fracture type II and III, Hangman's fracture, and degenerative changes).

Head CT
This chapter presents perhaps the most detailed introduction, by reviewing cranial anatomy and the intricacies of computer tomography to help the clinician understand how images are formed. This fundamental knowledge contributes to the reader's ability to visualize structures seen on CT films to aid in diagnosis. Studies of subdural, epidural, and subarachnoid hemorrhages are presented along with additional films depicting pneumocephalus and perfusion CTs of stroke.

Facial Trauma
The shortest chapter of the text certainly does not leave the reader wanting for more. Schwartz's coverage of orbital blow-out and Le Fort fractures is more than sufficient for the budding clinician or veteran physician desiring a high-yield refresher.

Reviewer's Impression
I opened this book as a critical care paramedic and medical student, not even a novice reader of radiography films or texts. By the end of the book, though, I felt as though I'd be able to identify many more of the immediate life threats my patients face.

Each chapter begins with an overview of the relevant anatomy that can be seen on radiographs. Each diagram is paired with a film clearly depicting the structures being studied. A fundamental understanding of human anatomy is required to follow these introductions, though.

Following the introductory pages, the remainder of each chapter is devoted to case studies (between three and seven per chapter) of the various maladies a clinician will face. Aside from a few minor spelling errors ("reight" vs. "right" ventricle), the text is easy to read and presents the material in a way that is anything but overwhelming.

At $155.00, this text is hardly an impulse buy; despite the cost, however, it is certain to become an indispensable reference for EM interns/residents and attendings alike.