322 e-Letters

published between 2004 and 2007

  • Practical Procedures in A&E
    Evan A Bayton

    Sir, a number of other considerations may be helpful here. First, the most recent graduates to pass through ED are products of the new style undergraduate curriculum which emphasises critical self learning and omits a lot of the practical work involved in dissection or laboratory work. I recently asked a group of a dozen SHOs on the NW regional induction course how many had felt or held the pericardium. The answer was none...

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  • A method to measure validity of triage systems in paediatric emergency care
    Mirjam van Veen

    With interest we read the review by Twomey et al (1). They describe that, although four triage systems are widely used and studied, the validity of the systems is sparsely evaluated. (2) In order to evaluate triage systems, different aspects must be considered. First, the reliability of the system has to be studied, measured by interrater agreement. Secondly, the internal validity must be assessed, using a ‘golden standa...

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  • Gold Standard
    William Sargent

    Are 'operative findings' a gold standard for diagnosis of a septic joint? Discussion of interpretation of synovial fluid in Roberts: Clinical Procedures in Emergency Medicine, 4th ed, suggests that gout, pseudogout and other arthritides can give turbid fluid. This clearly has a major impact on interpretation of the data.

  • They're all superglues
    Dilip J DaCruz

    I've visited this issue before (ref 1) and still remain to be convinced that long-chain superglues are less 'toxic' than short-chain DIY superglues, given that no superglue should ever be placed in a wound. The exothermic and the cyanate components of the argument are also completely overstated; millions get superglue on their fingers everyday and dont feel the heat or keel over with cyanide toxicity!

    I'm afraid...

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  • Peripheral Blood Cultures in the Emergency Department
    Edward Smith

    We read with interest the study by Howie et al showing that a total of only 4 out of 2213 blood cultures taken in their department influenced patient management (0.18%). These results are in keeping with other similar studies that have been published.

    In our department the experience has been different, however. A recently conducted audit into blood cultures revealed that 17 out of 77 (22%) produced positive re...

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  • Re: There are other clinicians involved in expediting reperfusion
    Jason M Kendall

    Dear Editor,

    Professor Quinn makes a very good point and the absence of nurses from the list of "decison-making clinicians" in my paper is an oversight for which I apologise. Nurses have been instrumental over the last decade, along with doctors and paramedics, in developing strategy and implementing change in the management of patients with ST-elevation acute mycocardial infarction.

  • Administering a glyceryl trinitrate infusion: faster is better than slower
    Alistair Steel

    Dear Editor,

    Matthew Reed highlights the importance of practical issues in his article promoting the use of small-diameter cannulae for glyceryl trinitrate infusions.(1) However, there are several other issues that should be considered when administering drugs at low infusion rates.

    Firstly, mechanical slack within an infusion device may mean an infusion set at 1ml/hr will take many minutes for the dri...

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  • Dolasetron and QT Interval
    Colin B Page

    Dear Editor

    We read with interest the case report by Rochford et al. However, we are concerned that the title associates dolasetron overdose with a prolonged QTc despite electrocardiogram (ECG) and clinical features that are more consistent with sodium channel blockade and QRS widening.

    1.The ECG presented in the figure demonstrates the characteristic features of sodium channel blockade with a markedly...

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  • Confusion over rupture and dissection
    Matt J Reed

    The authors of the above paper, whilst admirably attempting to highlight the well recognised presentation of a dissecting aorta with neurological symptoms, have unfortunately confused two very distinct diseases with two very different distinct pathologies; those of a ruptured abdominal aneurysm and a dissecting thoracic aorta.

    The abdominal aorta is prone to aneurysmal dilatation, which can rupture spontaneously...

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  • Cutoff values for B-type Natriuretic Peptides in the Korean Population
    Justin A Woods

    Dear Sirs,

    We would like to thank the authors for their contribution to the debate concerning the diagnostic use of natriuretic peptides. As a component of an integrated diagnostic scheme1 their further insight into variations in levels is helpful however some clarification is required and that the results should be interpreted with a degree of circumspection. Choi et al have separated their patients into two c...

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