eLetters

126 e-Letters

published between 2000 and 2003

  • Nitrous oxide in emergency medicine
    Dr Moothedath Hariprasad

    Dear Editor

    Whilst we broadly agree with the authors use of nitrous oxide as an adjunct analgesic in emergency medicine,[1] we feel that there are better alternatives to nitrous oxide in some cases. For example, we would suggest the use of intravenous opioids and anti-emetics in myocardial and acute sickle cell pain, non-steroidals in renal colic, and triptans in migraine.

    Secondly, in the United Kingdom we...

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  • What to do about psychological distress in Emergency Department Senior House Officers
    Ian M Higginson

    Dear Editor

    McPherson et al’s article [1] generates some interesting questions concerning disproportionately high levels of psychological distress amongst Emergency Department (ED) Senior House Officers (SHOs). The combination of shiftwork, a challenging working environment, broad case mix, and newly acquired decision latitude may explain the findings.

    We did have some reservations about the article...

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  • Is it the call that needs refinement of the system? NHS Direct
    Andy Heward

    Dear Editor

    Regarding the article by O’Cathain et al. [1] it was interesting to note the conflicting statements made towards the end of the paper.

    The systems of NHS Direct were identified as having poor sensitivity and specificity when dealing with the studied calls, yet at the end the paper it states that the types of low priority calls referred need refinement due to at least one-fifth may be pass...

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  • "non-serious" 999 ambulance service callers
    Helen A Snooks

    Dear Editor

    Management of non-serious 999 calls by nurse-led telephone triage and advice or referral: building on initial research

    The Editors’ response to Dale et al.’s paper [1] rightly highlights the need for further research to evaluate the safety, appropriateness and effectiveness of the management of some non-serious 999 calls with telephone advice only.

    At the time of the ‘Telephone Ad...

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  • Climbie Inquiry sets new standards
    Jason L Louis

    Dear Editor

    King and Reid [1] highlight a number of standards relating to child protection procedures within emergency departments. In January 2003, Lord Laming published his report of the Victoria Climbie Inquiry which contains further recommendations regarding healthcare arrangements for children and procedures for investigation of possible deliberate harm. Those relevant to emergency department practice mainly conc...

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  • Radiology in Paediatric Cervical Spine Injury
    Bruce W Martin

    Dear Editor

    I read with interest Smart et al's letter [1] regarding the assessment of paediatric cervical spine injuries.

    It would certainly appear that many children in their cohort were Xrayed unnecessarily according to current guidelines. However, I would hope that the practice in their institution has changed dramatically in the 6 years since the group attended.

    Current guidelines on sel...

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  • 'See and treat' is great - if your'e a General Practitioner
    Daniel Ellis

    Dear Editor

    In today’s society people want everything instantly, including their medical care. See and treat provides that instant access to ‘primary care’ with no need to wait. Do Castille and Cooke[1] really think that anyone will wait 3 days to see their General Practitioner (GP) when they can pop in to the emergency department and see a doctor instantly 24 hours a day?

    The public perception of see and...

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  • See and treat
    Nicola Jakeman

    Dear Editor

    Thank goodness, monitoring week is over. We've reached our 90% and retained our stars. Nobody is going to loose their job and the department has pulled through intact. All the extra experienced locum staff can go home, and we can get back to normal.

    It felt bizzare not to have a waiting room full of frustrated patients. To have patients thanking us for seeing them so quickly. A happy feeling tha...

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  • A pulled elbow needs pushing back
    Bernie P Greenwood

    Dear Editor

    It is not surprising that pronation is better than supination to reduce a pulled elbow.[1] The principle of any reduction is to apply force in the opposite direction to the causal force.

    When a toddler is pulled up by the arm it usually swings inwards, causing a traction/supination force that can sublux the radial head. But whichever way the arm was twisted it was also pulled, and the radial...

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  • The physiotherapist practitioner: extending the role of the physiotherapist
    Stephen H. Boyce

    Dear Editor

    We read with interest the article by Jibuike et al. regarding the introduction of an experienced physiotherapist attached to the Accident & Emergency (A&E) department dealing specifically with acute knee injuries.[1] Their paper appears to show, that if properly trained, an experienced physiotherapist can provide a clinically competent service comparable too, if not better, than that of a...

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