831 e-Letters

  • How can one claim 'superiority' in a pilot study
    Tom Quinn

    I enjoyed reading the paper by Markus S?ren Roessler and colleagues, but wondered how a claim for superiority could be made on the basis of a pilot study?

    Conflict of Interest:

    None declared

  • Mental Health Care neglected in the Emergency Department
    Heather M Sowden

    I enjoyed reading the paper by Da Cruz et al. On starting my ED job I asked our consultants what our role is in terms of a good outcome for patients presenting in Mental Health Crisis. The overwhelming response was 'make sure they're medically fit' and let the psychiatric worker look after that side. These patients are a group with unmet needs in most ED's when the NICE guidelines are reviewed, a group who leave without be...

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  • Value of a rigid collar in- need to more research and better devices
    Matthew W Cooke
    The use of cervical collar, head blocks and tape on a stable surface (such as a long spine board or hospital trolley) has long been accepted as the standard of care for patients with potentially unstable spinal injury. holla raises important isues[1]. There is however scant evidence that supports their use and there are significant potential risks associated with their use, including aspiration of vomit, difficult airway access,...
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  • The general public is ready for transparency about organ donation at the end of life
    Mohamed Y Rady

    The general public is ready for transparency about organ donation at the end of life

    Bruce et al conducted an opinion survey using a convenience sample in the emergency department (ED) and concluded that patients and relatives are not averse to organ donation being "discussed shortly after ED death" and that "organ preservation procedures [prior to donation consent] are acceptable to many" [1]. We outline 3 mai...

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  • Re:Assessment of Respiratory Status in the Hot Zone
    Michael D Malpas

    I would like to thank N Abeysinghe, K Laver and F Mason for their e- letter response to my reflective article. One of the aims of the reflection was to stimulate debate around this difficult subject and indeed the proposal of using a piece of equipment that has a dual purpose of triaging and supplying oxygen therapy has its merits. I welcome the opportunity to explain why I favour the use of the disposable End Tidal Ca...

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  • Emergency Medicine Can!
    David W. Wright

    Letter to the Editor

    RE: Coats, Timothy J.: Future research in emergency medicine: explanation or pragmatism? Large or small? Simple or complex? Emerg Med J. 2011 Dec;28(12):1004-7.

    Coats highlights the potential role of emergency medicine in conducting large pragmatic trials and the shortcomings of the more traditional complex randomized controlled trials. He correctly points out that traditional pha...

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  • Migration of endotracheal tubes in children
    Adrian T Humphry

    We read with interest Dr Durge's suggestion with regards recognition of a migrating endotracheal tube (ETT). Whilst this simple idea looks like a very effective way of monitoring the position of an ETT in an adult, we would urge extreme caution when treating paediatric patients.

    It has long been recognised that ETTs in small children and infants are prone to migration, even when securely strapped(1,2). Whilst wor...

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  • Nose and vein, speed and pain: comparing the use of intranasal diamorphine and intravenous morphine in a Scottish paediatric emergency department
    Lisa Curatolo

    Re: Nose and vein, speed and pain: comparing the use of intranasal diamorphine and intravenous morphine in a Scottish paediatric emergency department

    The conclusions of the study by Regan et al 1, that intranasal diamorphine (IND) compares favourably over the use of intravenous morphine (IVM) would suggest a potential prehospital utility.

    There are however some concerns regarding the audit that produce...

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  • The iLMA vs the Airtraq for prehospital airway management
    Andrew M Mason

    I was interested to read the study by Grosomanidis et al., which compared intubation of a manikin using the intubating laryngeal mask airway (iLMA) and Airtraq optical laryngoscope in various non-conventional patient positions [1]. The authors report that those anaesthetists who participated in the study required a significantly greater number of attempts (and time) to achieve intubation via the iLMA when the operator wa...

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  • Assessment of Respiratory Status in the Hot Zone
    Neil Abeysinghe

    Editor, We read with interest the article by M.Malpas [1] which cites the difficulty of assessing respiratory status in triaging those involved in a mass casualty chemical incident resulting from the use of personal protective equipment. However, we are concerned that the use of a calorimetric device to aid this assessment in a mass casualty CBRN incident will prove impractical. It is often difficult to ascertain early ide...

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