816 e-Letters

  • Request for information
    Jim Wardrope

    It would be useful to know the Total number of traumatic cardiac arrests treated by the system during these three years. Hard to draw conclusions on effectiveness without this figure. Also note different results in the paper Chiang W-C et all on the next page of the journal. (Emerg Med J 2017; 34: 39-45).

    Conflict of Interest:

    None declared

  • high fentanyl doses - is this an error?
    Gael J Smits

    Dear authors,

    In your intersting RCT of propofol versus midazolam sedation, you describe giving a fentanyl dose of 3mcg/kg, in conjunction with a titrated dose of propofol or midazolam.

    This appears a pretty large dose, compared to the procedural sedation literature, where the usual dose is 1 mcg/kg (min-max 0.5-2.0).[1-2]

    From previous research with propofol and midazolam in the Emergency Depa...

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  • A timely health warning.
    Anisa J N Jafar

    We thank the authors Challen and Roland for their review (1) which highlights a very important issue faced daily in our Emergency Departments.

    The use of, and more importantly, reliance on the Early Warning Score (EWS) carries risk as up to 1:3 patients admitted to ICU from ED will not score highly on the EWS (2). Clinician opinion may prove a superior assessment tool; this is not adequately explored. Experien...

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  • The Golden Rule
    Thomas Benzoni

    Dr. Basu et al. make an interesting observation: if you kick the dog, eventually he will bite the mailman. How is it we think we can treat the workers without compassion or empathy while expecting them to treat the patients with these same virtues, ones we don't practice?

    This article and an ever-expanding body of literature make it clear: we must treat our staff in the same way we expect them to treat patients....

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  • The Critical Role of Medical Scribe Training
    Nicholas Rich

    Walker et al. report the first economic analysis of the cost of training medical scribes (1). The concept of the medical scribe has been around for at least 4 decades (2), but with the recent advent of the electronic medical record (EMR), especially in the US, there has been a rapid increase in the use of scribes, particularly in emergency departments (3). The ongoing exponential growth in the use of scribes has been re...

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  • Accurate diagnostic strategies for PE
    Philip D Kaye

    The reported algorithm for diagnosis and exclusion of PE using Wells score < 2 plus negative d-dimer to indicate the patient does not require further imaging is a validated pathway. However, d-dimer specificity is low resulting in large numbers of patients who are low-risk for PE still requiring CTPA or a ventilation-perfusion scan. The aim of recent diagnostic studies, including this study reported by Theunissen JMG e...

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  • Re:Letter to the Editor
    Dustin Smith

    Dear Editor,

    We agree with our colleagues at Erasmus Medical Centre that physician actions motivated by pure self-interest are antithetical to a physicians' responsibility to their patient. Fortunately, we have never encountered such a Machiavellian physician in our practices. It was perhaps na?ve on our part to assume all readers would approach our research with the foundational belief that physicians are bot...

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  • Letter to the Editor
    Elise L. Tierie

    Dear Editor, With amazement we have read the article of our colleagues from Loma Linda University Medical Center, recently published in your journal. This article is a call to use short empathic statements in our daily medical practice (on the Emergency Department), as this will reduce the thoughts of patients regarding litigation. Although we encourage the use of empathy in daily practice, we fiercely object to the call...

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  • Response to Obstacle Course runs: Review of Qcquired injries and illnessas at a series of Canadian events (RACE)
    Marna Greenberg

    As authors of a previous report about serious injuries that occurred during an extreme sports obstacle course in the U.S. (1), we read with interest the article by Alana Hawley, etal describing injury and illness outcomes in a series of Canadian obstacle course events. (2) In this Canadian study a small percentage of participants presented to onsite medial services; the majority of complaints were minor and musculoskele...

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  • In response to the e-letter "An interesting study of the wrong cohort"
    Carl Marincowitz

    Many thanks for your interest in our study.

    We agree that as a retrospective study that compares head injured patients presenting within and after 24 hours of injury that have undergone CT imaging our study does have limitations. However, there are currently few data to guide clinicians in this area. We found only 2 other retrospective cohort studies and an abstract that assessed such patients in a recently pu...

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