Getting into Gp Training

This is the third edition of the very successful CCrISP course manual written by a multidisciplinary team of surgeons and anaesthetists. The first edition was published in 1999 and the book has been extensively updated for its third edition. However, the original aim of the course continues: that is to encourage trainees to have an understanding of the pathophysiology of critically ill patients, particularly in surgery, and to develop and hone patient management skills as part of a team. The course is now mandatory for the trainee surgeon and this manual is an important adjunct to the course. The lead coordinating author is Ian Loftus, a vascular surgeon in St George's Hospital, London, and the Critical Care Tutor at the Royal College of Surgeons of England. He has gathered together a very experienced team of surgeons and anaesthetists. The course manual covers the main topics important in the management of the critically ill surgical patient. The layout is clear with bullet point boxes and realistic case scenarios. The objectives of this popular course remain, namely to develop an understanding of the theory of the management of critically ill patients, and to develop the practical skills to assess and manage these patients successfully. As is to be expected, there is an emphasis on communication, multidisciplinary and multi-professional management of these ill patients. The major topics covered include the assessment of the critically ill surgical patient, airway management, blood gases, cardiovascular problems, various types of shock including haemorrhage, monitoring, renal failure and detailed discussion on fluid, electrolyte balance and sepsis. Pain management, communication and organisational skills are also included. As is to be expected in a manual of this sort, it is written in a very didactic fashion. Relatively minor critiques would include the observation that some of the figures are small and the font size in some figures is a little too small for easy reading, such as figure 7.2 on page 92. Despite proof reading some typing errors have been included such as page 17 (CVP should be CNS). For a future edition the authors may want to discuss in some more detail the management of hypovolaemic shock, particularly, as it applies to trauma. While I appreciate some of these principles are covered in the equally popular ATLS course, nonetheless, some of the lessons learned from Afghanistan should be mentioned, such as in resuscitation and damage limitation surgery; permissive hypotension, …