eLetters

126 e-Letters

published between 2000 and 2003

  • The time old RSI debate
    Mark R Nash

    Dear Editor

    It is interesting to once again read an article comparing the abilities of anaesthetic vs. emergency department staff to perform RSI. Unfortunately, I feel this article has been tarnished by two areas of bias.

    The first area is considered under 'time to RSI'. The emergency physicians intubated 94% of patients within 15 mins of arrival vs 86.1% by anaesthetics. However, anaesthetics only become inv...

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  • Mad as a Hatter
    A Fraser-Moodie

    Dear Editor

    I read with interest the case report “Mercury: Is it elemental my dear Watson” by M Poulden. [1] In 1993, Dr Roden and I reported a case of deliberate self injection of mercury resulting in abscess formation and mercuric emboli to the lungs.[2]

    In our case a 27-year-old doorman of a local casino presented with a swelling of the arm. (He was a keen body builder 1.90m in height and weighed 107Kgm). O...

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  • Measuring the distance between trials and reality
    William MC Rosenberg

    Dear Editor

    “Trials are nothing like real life” is a complaint that defines a common problem in the practice of evidence-based medicine. Differences between patient populations or the circumstances of trials and real life often leave us bewildered when trying to determine the applicability of clinical research to the care of our own patients. Sometimes inclusion and exclusion criteria for subjects in trials mean t...

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  • Pronation is overwhelmingly superior to supination
    David Alao

    Dear Editor

    I read with interest the Best bet on the reduction of pulled elbow by David Lewis in Emergency Medical Journal January 2003.[1]

    While I agree with the author’s conclusion he failed to state the fact that pronation technique was overwhelmingly superior to supination technique on second attempt (p=0.009).[2] In addition on the third attempt when the two techniques were crossed over, pronation tec...

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  • Senior Cover in the ED
    Fiona E Lecky

    Dear Editor

    I read the response from Wallis et al. with interest. From the study they describe it is clearly possible that the level of senior doctor involvement is underestimated on the TARN database due to a failure of notekeeping. However there is no reason to suspect that failing to record senior doctor involvement would be more prevalent in 2000 than in 1989 therefore there should be no systematic b...

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  • Are sterile gloves needed when treating simple wounds
    G.N. Malavige

    Dear Ediotr

    Whether or not a simple wound will get infected depends on the source of injury, the site of injury, age of the patient and the immune status of the patient. If the patient is at extremes of age or is immune suppressed then the chances of infection of the wound is quite higher. Moreover, simple wound infections in such patients may result in cellulitis, nectrotising facsitis, abcsess formation and chron...

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  • Re: Lack of change in trauma care in England and Wales since 1994
    Lee A Wallis

    Dear Editor

    We read with interest the article and accompanying editorial by Lecky et al. in this month's Emergency Medicine Journal.[1] Of note, between 1989 and 1994 there was an increase in the proportion of trauma patients (ISS>15) in whom a consultant was involved in their care: at the same time, trauma related mortality fell. Since then, both the level of documented consultant involvement and the mortali...

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  • Testicular microlithiasis: a urologist's dilemma
    Stephen J Gordon

    Dear Editor

    I agree with the authors’ conclusion that a clinical diagnosis of epididymitis without urology follow up is potentially hazardous. However, the importance of testicular microlithiasis(TM) is difficult to understand.

    Retrospective evidence has revealed an association between TM and testicular tumours to be as great as 40%. However, recent prospective evidence in one study of 1504 asymptomatic men...

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  • Response to Dr Duby letter
    Charles A Maxwell-Armstrong

    Dear Editor

    We thank Dr Duby for his interest in our paper and comments.

    We think he misses its fundamental points - the majority of haematology technicians cannot analyse DPL specimens, and the paucity of experience with the procedure. Similarly this paper is not a review of the efficacy of ultrasound.

    Dr Duby comments on our asking technicians on how DPL samples are analysed, even though they f...

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  • DPL vs. Ultrasound
    Alon Duby

    Dear Editor

    Maxwell-Armstrong et al[1] have apparently done a significant amount of work in sampling the current state of knowledge among haematology technicians on the performance of Diagnostic Peritoneal Lavage (DPL) analysis. They also report on surgeons’ experience of the procedure. Their analysis and conclusions, however, seem not to be supported by this data. Indeed, their paper climaxes with propos...

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