Fatal Sequence: The Killer Within / Edition 1

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Severe sepsis, a critical illness that most often afflicts victims of initially nonfatal illnesses or injuries, is the third-most-common killer in the United States. In Fatal Sequence, neurosurgeon, immunologist, and clinical investigator Kevin J. Tracey offers a chronicle both scientific and human, using cases he personally experienced to illustrate the clinical nightmare of organ failure that typifies the disease. 

In clear, accessible language, Tracey explains how the brain, which normally restrains the immune system and protects the patient, can fail during severe sepsis—allowing the immune system to indiscriminately kill normal cells along with foreign microbes. Fatal Sequence is a compelling documentation of an all-too-common situation: doctors fighting to prevent patients’ deaths at the hands of complications from injuries and illnesses that should never be fatal in the first place. 

“This book is a must for anyone interested in protecting the body from foreign organisms and, in many instances, itself.” —Jamie Talan, Newsday

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Editorial Reviews

Richard Selzer
"The powerful and gripping story of one doctor's battle to save the life of a severely burned child. . . . It is medicine practiced at its purest and most noble, and all told in a prose that is easily understood."—Richard Selzer, author of The Whistlers' Room
Jamie Talan
"This book is a must for anyone interested in protecting the body from foreign organisms and, in many instances, itself."—Jamie Talan, science writer, Newsday
Bruce S. McEwen
"Kevin Tracey tells a very compelling scientific detective story about how the body can destroy itself when an infection gets out of control and causes septic shock or sepsis. He describes with emotional intensity a path of discovery that is leading to new treatments based upon a new understanding of what goes wrong in the body."—Bruce S. McEwen, Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University
Christopher T. Walsh
"This book is one that everyone interested in both mind-body connection and the nature of medical discoveries should read and enjoy."—Christopher T. Walsh, Harvard Medical School
Ralph Steinman
"This is a book about the scientific process: how it unravels unknowns, often with totally unanticipated findings, and how it provides totally new and beautiful approaches to prevalent ills."—Ralph Steinman, The Rockefeller University
Shaw Warren
"Read it for an intimate glimpse into the thought patterns of a top-level physician researcher, for the brilliance of the science, for a better understanding of the mechanisms that affect all of us when we fall sick, or simply for the pleasure of the story."—Shaw Warren, Infectious Disease Unit, Massachusetts General Hospital
Journal of the American Medical Association
"I enjoyed reading Fatal Sequence very much; indeed, I had great difficulty putting it down. . . . Tracey is among the giants in sepsis research. . . . Tracey persuasively distinguishes between severe sepsis and septic shock . . . . I recommend Fatal Sequence to all involved in the care of patients with sepsis and to patients' families."—Robert F. Wilson, Journal of the American Medical Association



Critical Care Medicine - Jerry J. Zimmerman
"Here is the inside scoop on the discovery of tumor necrosis factor and high mobility group proteins, with an ever-convincing argument for the cytokine theory of disease."—Jerry J. Zimmerman, Critical Care Medicine
New Scientist
"The complete story of his unforgettable patient and the medical mystery surrounding severe sepsis."—New Scientist
Journal of Clinical Investigation - Peter A. Ward
"As a clinician and a highly regarded scientist, Tracey has done a beautiful job in helping us to understand the tremendous challenges of sepsis and the toll this condition exacts on patients, their families, and caregivers."—Journal of Clinical Investigation
Doody's Review Service
Reviewer: David J. Dries, MD (University of Minnesota Medical School)
Description: This is a case presentation intended to review advances and research issues in the care of patients with infection and organ failure.
Purpose: Readers are provided a series of telling anecdotes and insights into the ups and downs of shock and sepsis research as applied to the care of a severely injured patient.
Audience: Trainees, practitioners and, most important, the non-medical reader with interest in infection is an appropriate audience. The author is a noted sepsis researcher with involvement in much of the seminal work related to infection and its management.
Features: The reader begins with a hectic ambulance ride to a burn center. The course of a severely burned child is traced through resuscitation, operating room management, and postoperative care. During the course of the patient's month-long hospital stay, Dr. Tracey describes shock and infection manifest by the most severe complications including multiple organ failure. From this experience, Dr. Tracey places treatments available in the mid-1980s in the context of later work describing the patient response to infection, which sometimes complicates care of this problem. He ends with his own more recent work on nervous system control over immune response. While specific references to original work are not provided, detail is sufficient to allow the concerned reader to do database searches for additional information. A concluding subject index gives access to medical terms.
Assessment: This is a good read for the clinician and layperson with an interest in infection and shock. Dr. Tracey has been a central figure in this work for two decades. While his concluding statements regarding neurologic modulation of immune response await confirmation over time, Dr. Tracey provides insight into some of the work that frames the way clinicians think about and treat an important clinical problem.

3 Stars from Doody
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Product Details

  • ISBN-13: 9781932594096
  • Publisher: Dana Press
  • Publication date: 3/15/2006
  • Edition description: ANN
  • Edition number: 1
  • Pages: 225
  • Sales rank: 1,409,345
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.60 (d)

Meet the Author

Kevin J. Tracey, M.D., is chief executive officer of the Feinstein Institute at North Shore-LIJ Health System in Manhasset, New York. He is a leader in inflammation research and the study of the way the immune system responds to infection and injury.

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Table of Contents

1.  The ER
2.  The Burn Unit
3.  The OR
4.  Shock
5.  Pestilence
6.  False Hope
7.  Unraveling Shock
8.  Unraveling Sepsis
9.  Brain Control of the Fatal Sequence
10.  Legacy

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