169 e-Letters

published between 2011 and 2014

  • 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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  • Just to clarify
    Andrew Baillie

    A number of comments have been made to me regarding this article since it was published. I would like to take this opportunity to clarify that the experiences described did not occur whilst working at North Tees University Hospital. This is where I currently work as a higher trainee in Emergency Medicine. I am keen that the contents of the correspondence address do not overshadow the key message of the article.


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  • Lack of evidence to support use of D-dimer in pregnant women with a suspicion of pulmonary embolism
    Mathilde Nijkeuter

    The authors state that current evidence supports the use of a negative D-dimer to rule out a suspicion of pulmonary embolism (PE) in pregnancy. They show in Table 2 5 relevant studies to support their conclusion. However, the study of Damodaram was the only study that included patients with a clinical suspicion of venous thromboembolism, thus including pulmonary embolism. All other 4 studies included either healthy preg...

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  • The Psychological Effect of Ebola on ED Staff
    Gab Lantos

    Now 11+ years since SARS, it would be interesting to repeat this study post Ebola... Are staff any better prepared for a highly contagious, fatal disease?

    Conflict of Interest:

    None declared

  • Sepsis Six: Are we doing the right thing?

    Dear Editor,

    The "Sepsis Six" resuscitation bundle is now common in UK hospitals, and endorsed by the College of Emergency Medicine, SIGN guidelines, and the Royal College of Physicians.1-3 However, the evidence behind it remains limited and must be re-evaluated as new data emerges - especially since the results of the PRoCESS and ARiSE trials on Early Goal Directed Therapy (EGDT) were published this year.4,5...

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  • Different populations, overall cost increase
    Timothy RJ Parke

    Sir I find the methodology for this paper to contain a significant flaw in that the triage criteria used to determine suitability for the GP unit contain a requirement that the patient will need minimal additional resources for them to be processed. It is hardly surprising therefore that the post intervention analysis sees fewer additional resources subsequently spent on this group with the associated savings.


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  • Towards a valid proxy measure for sepsis associated mortality
    Meghan L Bateson

    Wright and colleagues1 discuss some interesting issues around blood cultures and sepsis outcome measurement. We agree that evaluating and tracking sepsis associated mortality over time is important. It would facilitate assessment of the impact of changes in practice, both intended effects of sepsis improvement interventions and unintended consequences of other initiatives, e.g. restrictive antibiotic policies, as well a...

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  • Utility of a single early warning score in patients with sepsis in the emergency department
    Santiago Romero Brufau

    Santiago Romero-Brufau, MD1; Jeanne M. Huddleston, MD1,2

    1Healthcare Systems Engineering Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA 2Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Correspondence to: Santiago Romero-Brufau, MD, Mayo Clinic Robert D. and Patricia E. Kern C...

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