eLetters

193 e-Letters

published between 2001 and 2004

  • Are BETs best?
    Thomas Locker

    Dear Editor

    I would like to thank the editors of the EMJ for their replies to the points raised by myself and Dr Webster, however these replies have themselves highlighted further concerns [1][2].

    It is clear that considerable effort goes into producing the BETs but as Mr Mackway-Jones states, BETs do not represent the highest level of evidence. Might it not be better to coordinate this effort to produc...

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  • Authors response to Gori et al
    Simon G A Brown

    Dear Editor

    Dr Gori, Cinotti and Papagallo's concerns [1] reflect the inexperience of many medical staff in the use of adrenaline to treat anaphylaxis, a misunderstanding of the ethical issues relating to our trial, and perhaps over-reliance on invasive measures of severity that are a sign of sustained and untreated cardiorespiratory collapse. To deal with each comment in turn:

    - Even Mueller Grade I re...

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  • Primary Headache Disorder in the Emergency Department
    Andrew J Larner

    Dear Editor

    We read with interest the article by Locker et al [1] as we have recently commenced a study looking at the issue of headache in the emergency department from the perspective of the neurology outpatient clinic. Approximately 20% of patients seen in general neurology outpatient clinics have headache as their principal complaint [2], and the vast majority have primary headache disorders, amenable to dia...

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  • The who, where, and what of rapid sequence intubation
    Angela J Oglesby

    Dear Editor

    Reid and colleagues have produced an interesting observational study on rapid sequence intubation (RSI) [1].

    The authors comment on the lack of data on complications of RSI in the UK hospital setting. In 2003, we published complication data from a multi-centre prospective observational study of 735 patients undergoing RSI in seven Scottish urban emergency departments (ED) [2].

    The...

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  • Emergency Management of 'Tension Gastrothorax'
    Michael W Ardagh

    Dear Editor

    Dalton and colleagues describe a rare case of tension gastrothorax from a Bochdalek hernia. Their case was managed in the belief it was a tension pneumothorax, with subsequent perforation of the stomach and soiling of the chest cavity. They suggest that this diagnosis should be entertained in certain cases and that emergency management should be decompression with a nasogastric tube.

    We hav...

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  • eletter
    Ron Trussell

    Dear Editor

    Thought provoking as this paper is, it doesn't take account of any 'special awareness' of the problem as percieved by the coronial & reactive health service opinions upon which it is based.

    It might not be the case that Brighton's problems are any greater than any other similar conurbation - only that those reacting to your questions are more specifically looking for, and willing to ident...

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  • Topical anaesthesia in children
    Matt Baker

    Dear Editor

    I read kennedy et al's article regarding the use of topical cocaine and adrenaline with interest.

    I have also seen instillagel (2% lignocaine and 0.25% chlorhexidine)used with good effect when placed on childrens wounds to allow exploration and closure within the emergency department setting.

    The great advantages being that it is easily available within the department and when wo...

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  • Author’s response to ‘futility of nalbuphine’
    Malcolm Woollard

    Dear Editor

    Aruni Sen’s evident distaste for nalbuphine seems to have precipitated a somewhat hasty and inaccurate reading of our paper [1].

    Firstly, we did not claim that nalbuphine is an effective analgesic. We did, however, offer empirical evidence that it is effective for many patients –just under half of those treated had a pain score of three or less (‘mild’ pain) on arrival at hospital. Less tha...

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  • Assessment of cognitive functioning is important but some modification maybe required
    Andrew P Webster

    Dear Editor

    I agree with the comments by Dr Harden that assessment of cognitive function is important in the acutely confused patient.

    However maybe a slight modification is necessary. Knowledge of the start of the first world war is also partly dependent on level of education. As the war started 90 years ago, for the majority of our patients this was a long time before they were born. Perhaps asking when...

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  • LMA use by Warwicksire ambulance service
    Andrew M. Mason

    Dear Editor

    I was interested to read the letter by Pattinson et al [1] reviewing the use of the single-use laryngeal mask airway (LMA-Unique) over a two- year period in the ambulance service in Warwickshire. In their summary, the authors commented that their success rates for LMA insertion were similar to those reported in the literature and that the introduction of LMAs, ‘had achieved the aims that were intended’...

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