eLetters

193 e-Letters

published between 2001 and 2004

  • Back to the future-superspecialisation in ED
    Dilip Menon

    Dear Editor

    I think the model the Israeli medical services had adopted in the development of emergency medicine is brilliant and something we should deliberate adopting as modelling for the future of emergency medicine. It's not a new idea as the Casualty Surgeons in the UK and countries affiliated to this model in other parts of the world did way back in the 1960's develop as a group of specialist orthopaedic sur...

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  • EMERGENCY DEPARTMENT, WEEKENDS, AND TEMPORAL PATTERN OF OCCURRENCE OF ACUTE MEDICAL DISEASES.
    Roberto Manfredini

    Dear Editor

    We read the interesting paper by Mirò et al [1], who found that in the emergency department (ED) weekends are not characterized by a loss of effectiveness compared to workdays. The possible reduction in staff and loss of attention on weekends is a topic still under debate. A recent study [2] analyzed the six more common urgent procedures usually utilized in acute care hospitals, and found that only 5...

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  • Convincing senior doctors to train in EM
    Mohamed Gaber

    Dear Editor

    Dr Halpern's article about the development of EM training in Israel is quite informative and can be relevant to many other countries in the middle east.

    However, I would like to enquire about how senior physicians who are already trained in their respective specialties and run their own private clinics were persuaded to leave all that and enter another 2.5 years of EM specialist training - th...

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  • Jelly on the Belly
    Dilip Menon

    Dear Editor

    I read with interest Brooks audit of FAST in a 100 Blunt Abdominal Trauma and 10 penetrating abdominal injuries done by 3 non-radiologists members of of the emergency department. Ultrasound imaging as a diagnostic modality is unique for us in A&E as it requires skills in both image acquisition and interpretation where we have traditionally had only to deal with the latter for plain films or CT/MRI...

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  • Fast food medicine for thought
    Dilip Menon

    Dear Editor

    The paper by Terris [1] on reducing waiting times in the ED using consultant/Senior Nurse triage and subsequent papers by Subash on team triage and Mitchell on Senior House Officer time-motion study in this month's EMJ is giving me serious concerns we have missed the woods for the trees. Our core activity of giving high quality emergency care to those who truly need it is being diluted by the increasin...

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  • Double Jeopardy!
    Sahadu Saajid Kaleel

    Dear Editor

    In clinical practice most of us at some point have come across patients who are Jehovah’s Witness. According to their religious way of life they cannot take any form blood or blood related products, which includes immunoglobulin, but in the event of traumatic wound what are our options if patient also has hypersensitivity to tetanus toxoid?

    I was referred from casualty a right-handed male pat...

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  • RULES FOR HEADACHE IN AN ED
    CELIO LEVYMAN,MD,MSc

    Dear Editor

    Headache is a very common presentation in the neurology practice, and one of the most prevalent consultations in the office.Thus, headache clinics and/or sub-specialist neurologists with interest in the headache field become more and more common.

    However, in an Emergency Department, things are a lot different from the chronic headache-suffer patient. The guidelines of the International Headac...

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  • A design flaw revealed
    Phil Brewer

    Dear Editor

    The two cases of penetration of the skull by falling onto electrical plugs could have easily been prevented with a design which caused the prongs to be in a horizontal rather than verticle position when placed on a flat surface. A rounded or roof-shaped backing, instead of the usual flat backing, would do the trick nicely, forcing the prongs to a 45-90 degree angle not likely to cause any damage to fa...

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  • Kounis Syndrome, Insect Sting Anaphylaxis and Adrenaline treatment
    Nicholas G. Kounis

    Dear Editor

    In the elegant paper of Brown et al [1] concerning insect sting anaphylaxis and its treatment, two patients developed electrocardiographic changes suggesting acute inferior myocardial ischaemia with normal troponin and cardiac enzymes. These cases are characteristic examples of type II variant of Kounis syndrome [2].

    Kounis syndrome [3][4][5] is the concurrence of allergic or hypersensitivit...

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  • The impact of NICE guidelines for the management of head injury in children
    Phillip Debenham

    Dear Editor

    We were interested in the recent NICE guideline review by Dunning & Lecky [1], in particular the extrapolation of the Canadian head CT rule for adults to a paediatric population. We retrospectively audited children with head injury presenting to the emergency department of Birmingham Heartlands & Solihull hospital for the months of June 2003 and December 2003. Case notes were reviewed to dete...

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