SLAM Book Review by Michael A.E. Ramsey MD

SLAM: Street Level Airway Management, by James Michael Rich and 24 contributorsUpper Saddle River, NJ: Pearson Education Inc, 2008. Paperback, 400 pp., $40.00.Reviewed by Michael A. E. Ramsay, MDThis first-edition book on emer-gency and difficult airway manage-ment arose from a series of courses presented by the author. Jim Rich used his training as a certified nurse anesthetist and his extensive experience in airway management to coordinate this text. He worked with 24 collaborators: 23 with extensive airway management experience plus an expert in scientific com-munication. Two of the coauthors hold patents on airway device inventions used extensively in securing difficult airways: Michael Frass, professor of medicine at the Medical University of Vienna, designed the Combitube, an esophageal-tracheal double-lumen airway for combined endotracheal and esophageal obturator ventilation, and George Beck designed an airflow indicator, or “whistle,” for facilitating blind intubations. Another con-tributor, Andrew Mason, is an anesthesiologist who travels with paramedics in a helicopter to motor vehicle collision sites; he has extensive experience in gaining control of trauma victims’ airways. I also coauthored parts of two chapters and strongly encouraged Jim Rich to complete this endeavor. Among the other contributors are several international peers as well as many national experts. The outcome of this work is a first-class text on airway management.What sets this text apart from many other texts on airway management is the hands-on practicality that pervades the book. It emphasizes the concept that if your patient can’t breathe, nothing else matters. Patients die or get severely injured from failure to ventilate and oxygenate, not failure to intubate. The SLAM concept explains alternative techniques for managing the patient with the difficult airway, including use of the latest technology. The title of this book might suggest that it helps a man or woman on the street deal with an emergency airway situation.

broad group of practitioners, from paramedics to medical residents, respiratory therapists, intensivists, emergency medicine physicians, nurse anesthetists, anesthesiologists, and trauma surgeons. The 19 chapters cover airway anatomy, airway assessment and evaluation, numerous airway management techniques, air-way devices, monitoring techniques, pharmacology, and legal implications. The first chapter describes the SLAM Universal Adult Airway Flowchart. This algorithm was designed to be used by all airway practitioners, regardless of location. It received the prize for best scientific exhibit for clinical application at the 57th Postgraduate Assembly of the New York State Society of Anes-thesiologists in December 2003. Although the book focuses on adults, one chapter is devoted to pediatric airway management. This chapter reviews the anatomical differences in children, gives the readers guides to recognize the difficult airway, and includes some basic pharmacology of commonly used pediatric airway drugs. Other chapters address burns to the airway, inhalational injuries, and sedation and analgesia protocols for postintuba-tion management. Nosocomial infection management is also addressed. Many of the chapters use the case study format to bring home the value of a particular algorithm. Although the content is very detailed, a number of format-ting features aid readability and application. The text is enhanced by excellent figures, photographs, and drawings that simplify and reinforce the concepts. “Pearls” and “On Target” sidebars are used throughout to highlight main points, and review ques-tions are provided at the end of each chapter. The references appear at the back of the book under chapter headings, allowing the text to flow better. The text is full of acronyms—perhaps to be expected, as the title itself is an acronym!—and that can be distracting. Fortunately, a glossary at the end of the book explains not only medical terms but also the acronyms. Baylor can be proud that “one of its own” produced this comprehensive and readable text that will be helpful to so many practitioners and may be instrumental in saving lives. It is also a bargain, priced at $40, which is much less expensive than similar texts. This could perhaps be called a “SLAM”-dunk book for anyone who might be involved in airway management!

The reviewer, Michael A. E. Ramsay, MD, is chief of the Department of Anesthesiology and Pain Management at Baylor University Medical Center and president of the Baylor Research Institute.

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