169 e-Letters

published between 2011 and 2014

  • Re:Prehospital care is not for amateurs
    John H G Antrum

    The authors thank Dr Clayton for her comments.

    However, they point out that her critique of their paper is largely inconsistent with what was actually written and can only assume a misunderstanding of the article.

    The article does not state, nor even imply, that the GMC require students to provide expert or definitive care as she asserted in her response. Indeed the article talks about basic skills an...

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  • High level disinfection reduces HPV contamination of transvaginal sonography probes in the emergency department
    Shuk Ting Christine Ma

    Our previous study reported in your journal in 2012 found that 7.5% of the transvaginal sonography (TVS) probe samples were human papillomavirus (HPV) DNA positive in our Emergency Department, when a barrier was applied along with low level disinfection using a quaternary ammonia based agent. (1)

    M'Zali et al also demonstrated that TVS probes remained substantially contaminated by HPV, C. trachomatis, mycoplasma...

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  • Oxygen Alert Cards: Are they working? Our Local Experience at Yeovil District Hospital
    Adam Hughes

    In Yeovil District Hospital (YDH), o2 alert cards are currently issued by the respiratory nurse specialist. Patients are usually referred by a doctor or the ward nurses for a respiratory nurse review to optimise management of a respiratory disorder and arrange appropriate follow up in the community. If a patient has a documented episode of type II respiratory failure the respiratory nurse will issue an o2 alert card as...

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  • Prehospital care is not for amateurs
    Kate Clayton

    The very fact that the author has written this article at all demonstrates to me a profound lack of understanding on his part of the complexities of prehospital care.

    Firstly, the obligation mentioned by the GMC to help victims of accidents is not a requirement to provide expert or definitive care - it is simply a moral duty to provide what help one can given ones own skill set and available resources. As the...

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  • Emergency medicine: the job we're all waiting for?
    Emma D Butterfield

    Much has been written about the current difficulties of recruiting and retaining doctors in key specialities: most recently psychiatry (1) and emergency medicine (2).

    Concurrently there has been a year-on-year decline in the number of doctors choosing to enter speciality training immediately upon finishing their FY2 year: in 2013 only 64% of FY2's chose to enter speciality training (3). Instead, many FY2's opt...

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  • Clinical Examination in place of end-tidal CO2
    Jecko Thachil

    Hunter and colleagues gives a good method to distinguish COPD and heart failure in a dyspnoeic patient. May i politely suggest an easier, clinical marker which can help in this distinction?

    This is based on the observation that patient who has prominent, bulging veins has COPD as the predominant cause for the breathlessness compared to the patient with heart failure who has collapsed, thready veins. The therapy...

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  • Re: Clinical navigation for beginners: the clinical utility and safety of the Paramedic Pathfinder
    James Goulding
    We applaud Newton et al[1] in their efforts developing the Paramedic Pathfinder tools. We feel that supporting paramedics in decision making regarding non-conveyance and use of alternative referral pathways is vital in meeting the challenges facing modern pre-hospital care, and appreciate their efforts in empowering pre-hospital staff to safely make decisions regarding such patients. However we remained unconvinced that protocolis...
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  • Access to a helipad and the impact to the hospital
    Samira S Fatehi

    We read with interest the article written by Freshwater et. al. (1) 'Extending access to specialist services: the impact of an onsite helipad and analysis of the first 100 flights' and were very impressed with the findings and at the outset we would like to congratulate the authors on this innovative analysis. This paper demonstrates the great impact retrievals and transfers can have on the referred hospital, however we...

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  • Don't ignore the ASA grade.
    Gavin Lloyd

    We welcome our Edinburgh colleagues' further contribution1 to the emergency medicine literature regarding procedural sedation for relocating hip prostheses. Their work raises a number of points worthy of debate.

    The number of patients in their study is unlikely to accurately determine a relationship between ASA grade and complication rates. This is particularly so for (meaningful) sentinel adverse events and outc...

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  • Re:AP pelvis and frog lateral for a limping child
    Jawad Sultan

    Many thanks for your letter. With the benefit of hindsight, the radiographs do show signs suggestive of SUFE. However, the original radiographs were reviewed by a senior A&E doctor in a peripheral hospital, and reported by a consultant radiologist as possible Perthes. This was also the working diagnosis of a consultant paediatric orthopaedic surgeon who reviewed the chid in clinic. SUFE was not suspected possibly beca...

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