816 e-Letters

  • Serious about change
    Eva F Howard

    I agree with Antrum and Ho (EMJ 2015;32:171-172) that formal Pre- Hospital Training should be included in all Undergraduate Medical Curriculums. They will be pleased to hear that a nationwide Faculty of Pre -Hospital Care Undergraduate Committee has been set-up, aiming to springboard ideas and information about events, funding and training in pre-hospital care, to all healthcare students. Antrum and Ho quite rightly realis...

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  • ANTRUM AND HO (EMJ 2015;32:171-172)
    Colville Laird

    Dear Editor

    ANTRUM AND HO (EMJ 2015;32:171-172)

    Antrum and Ho (EMJ 2015;32:171-172) identify an important issue in identifying the deficiency in medical education due to the lack of formal training in pre-hospital medical care at most medical schools in the UK.

    There are obvious benefits of increasing the number of trained professionals able to provide pre-hospital care it is important that all medical gradua...

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  • Dear Mr. Brody (correct salutation?)
    Steven L. Joffe, M.D.

    Your article on ED patients' suffering came to me only this week through Medscape.com. I would like to thank you for your analysis and for bringing this topic to the surface.

    I have been waiting thirty years for this concept to be treated in the scientific literature. When I started practice in 1983 in a busy urban academic Emergency Department in Baltimore, Maryland, and for the next twenty-five years, THIS was...

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  • Alternative to the use of an LMA bite guard
    Andrew Mason

    An alternative to the use of a bite guard in conjunction with the LMA would be to employ the intubating laryngeal mask airway (iLMA), since the single-use version of the iLMA has a rigid plastic airway tube which resists occlusion by biting, as does the silicone-coated stainless steel tube with the reusable version. Additional benefits would be that the iLMA can facilitate seamless progression to blind tracheal intubation...

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  • Precision of paediatric weight estimates
    Giles N Cattermole


    Skrobo and Kelleher rightly stress the importance of accurate, rapid weight estimation in children when the situation precludes actual measurement of their weight.[1] They also rightly emphasise the need for estimation tools to be validated locally.

    The CORKSCREW study convincingly demonstrates that the mean bias of weight estimates using the Luscombe formula (3xage+7) is much smaller than that...

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  • Increasing the use of the fascia iliaca compartment block for patients with a fractured neck of femur: a quality improvement project
    Andrew J. Tabner
    We read with interest the article by Rashid et al (1) documenting current UK practice with regards to hip fractures (HF) and regional analgesia (RA); only 44% of their respondents reported local use of RA for this indication. The two main reasons highlighted were lack of equipment availability and lack of staff training; they therefore suggest that an appropriate protocol, a "Hip Block Box", audit and staff training may i...
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  • The intubating laryngeal mask airway: What is there not to like?
    Andrew M. Mason

    I was interested to read the paper by Castle & Naguran describing use of the intubating laryngeal mask airway (iLMA) in an entrapped patient [1]. The authors might be interested to know that I have also used the iLMA in the treatment of trapped trauma patients [2][3], and their case bears striking similarities to the ones that I encountered. Their report provides further evidence of the efficacy of the iLMA in trapped...

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  • Thoracic ultrasound may be a solution
    Hsiangwen Liu

    I agree with the authors that using the guidelines may not avoid subdiaphragmatic viceral injuries. First, many underlying diseases could alter the thorax shape and the diaphragm position. Second, in patients using positive mechanical ventilation support, many different ventilatory strategies, such as lung recruitment strategy, can alter the diaphragm level. Moreover, among some special groups of patients, such as patie...

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  • Zero numerators and the illusion of safety
    Alistair Maddock
    Kaye and Govier's case series of propofol sedation for DC cardioversion 1 provides a useful contribution to the relatively evidence-light area of Emergency Department (ED) sedation. I would, however, urge caution in their conclusion that propofol is a "safe" drug for the uses they describe.

    Safety is obviously relative but, in the grand scheme of things, their series of 111 patients is small. The statistical "...
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  • Emergency Department ECMO and Echo - better together?
    Paul R Atkinson

    As highlighted by Chou et al[1] it is becoming more evident that extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) is feasible and compares well against conventional CPR. As technologies such as ECMO[2] and echocardiography (Echo),[3] previously limited to intensive care units and cardiology suites, become increasingly available in the Emergency Department (ED), it is important that w...

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