eLetters

831 e-Letters

  • Stroke: Spread the word to save lives
    Surinder K. Sharma

    The article by Mellon et al highlights one of the lesser researched areas in stroke.[1] Only 27% of the patients presenting for stroke services at a tertiary level hospital in India were aware they had a stroke.[2] Lack of awareness about stroke among general masses is often an underestimated cause of prehospital delays. Less dramatic nature of symptoms in acute ischemic stroke as compared to myocardial infarction or sta...

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  • The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?
    Nayer Jamshed

    We read with great interest the article by A. Ross Naylor et al ; the face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? This study helps in generating awareness of the early stroke symptoms in the population. Similar studies were done in the past like Cincinnati prehospital stroke scale (CPSS) which had a positive predictive value between 72%-85%.1 Los Angeles Prehospital stro...

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  • Mnemonic for SSC resuscitation bundle or Sepsis Six
    Scott A Bradburn

    I have used the pneumonic F.O.C.A.L when discussing the treatment of septic patients with foundation doctors.

    F- Fluids, (Give and measure). O- Give Oxygen (If not contraindicated) C- Culture A- Antibiotics L- Lactate

    It's similar to 'MONA' used to remember ACS treatment. Junior doctors and nurses have found this a useful aid memoir when treating septic patients, I have also used it in a teaching proj...

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  • A way ahead or just a fork in the road?
    James J. Bethel

    A commentary is, by its nature just that but I feel compelled to rebut some of the conjecture and lack of evidence apparent in Alan Leaman's recent piece 'an alternative way ahead'. [1] We are aware as the author suggests that we are all struggling 'a little' to achieve the four hour standard even at it's 95% threshold; and much publicity has centred upon this in the general media of late. Reasons for this are multi-fac...

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  • Letter in response to 'Symptom-triggered benzodiazepine therapy for alcohol withdrawal syndrome in the emergency department: a comparison with the standard fixed dose benzodiazepine regimen'
    Anna S. Messmer

    We read with interest the study by Cassidy et al. [1] addressing the therapy for alcohol withdrawal syndrome; a very important and common problem in the emercency department. The authors raised the question which drug scheme for benzodiazepines (fixed-dose versus symptom-triggered) regimen is superior. Although benzodiazepine treatment is recommended, there are no data about respiratory depression in patients with alcohol...

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  • Chest pain - what question are we answering?
    Susan Dorrian

    Use of cardiac troponins in combination with ECG findings is well regarded as a standard way of diagnosing Acute Coronary Syndromes (ACS). As this study illustrates the inclusion of risk stratification scoring systems may also assist EM physicians in determining whether a short stay clinical decision unit or full cardiology assessment via an acute medical unit is required. However, whilst we as EM clinicians are focused...

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  • Obesity and risk of motor vehicle fatal injury
    Ediriweera Desapriya

    We recently read Rice and Zhu's [1] widely circulated article on risk of fatal injury and driver obesity. Presently, there is no consensus on the relationship between obesity and motor vehicle-related injuries and fatalities [2, 3, 4]. Indeed, some researchers have argued that obesity is a protective factor in motor vehicle-related injuries and fatalities [2, 3, 4]. The focus of Rice and Zhu study [1], therefore, was to de...

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  • Response to Arkell et al, regarding TOXBASE guidance
    Michael Eddleston

    We note the concerns of Arkell et al [1] about the National Poisons Information Service's TOXBASE guidance for management of paracetamol poisoning. However, the NPIS must provide advice that is consistent with recent guidance from the Commission on Human Medicines (CHM) [2] and the new marketing authorisation (licence) for acetylcysteine, especially as the CHM guidance was endorsed by the UK's Chief Medical Officers. The...

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  • Re:Early warning score evaluated was not ViEWS
    Jae Baek Lee

    We reported the predictive value of modified VitalPAC Early Warning Score(ViEWS) with lactate level, which named ViEWS-L score[1]. However, queries are raised about the ViEWS using in the present manuscript. First, the weightings for the four SpO2 ranges. Second, the weightings for the five temperature ranges. And third, ambiguities in the cut-off points between the weighting bands for the respiratory rate values. We che...

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  • A comment on the conclusion
    Christoph Schroth

    I sincerely enjoyed reading the study by Mache et al. as it provides an insight into the daily division of duties in a German emergency unit. I fully agree that further, larger studies are required to create a more accurate data pool that represents the entire industry but it is a start and could be utilized as a guideline for further research. One point I would like to raise however, in the conclusion of the article it s...

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