236 e-Letters

published between 2007 and 2010

  • Re:'Unstable' buckle fractures
    Thomas W Hamilton

    In reply to Dr Kennedy's comments Salter Harris IV and displaced Salter Harris II fractures are seen in this population, these may be initially interpreted as stable fractures but may require manipulation or observation to avoid long term disability. Misdiagnosis may also occur where a fracture is diagnosed in the absence of any bony injury.

    Conflict of Interest:

    None declared...

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  • Trauma care in England: Londons Trauma System goes live
    Anna Vondy

    We were encouraged by Hughes editorial on Trauma Care in England (1), which highlighted the key points from the National Audit Office publication Major Trauma Care in England (2).

    As an update, the London Trauma System was launched on 6th April 2010. The system is composed of four trauma networks, each with a major trauma centre providing care for the most seriously injured patients, linked in with a number of l...

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  • To complete the question...
    Janos P Baombe

    I read with great interest the Best Evidence Topic by N. Naheed and R. Jenner about the place of rectal examination in paediatric constipation.

    The current NICE guidelines concur with the conclusions worded in the BET and do not advocate a digital examination unless one is a healthcare professional with experience in the specific aspect.

    Whilst I would not suggest that emergency physicians should under...

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  • Be wary of premature extrapolations!
    Janos P Baombe

    I read with great interest the Sophia section of the EMJ this month.

    A few lines draw our attention to a multi-centre prospective randomised study, which compared preoperative cleansing of the patients 'skin with chlorhexidine-alcohol to povidone-iodine for preventing surgical site infection (Darouiche et al).

    The EMJ editors wondered if there would be some useful implications for ED practice.


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  • 'Unstable' buckle fractures
    Dr J Julian A Kennedy

    Hamilton et al in commenting about use of removable splints in childhood wrist fractures mention that there may be misdiagnoses in these 'unstable' fractures. How on earth can a barely visible Taurus or greenstick fracture of a child's wrist be anything but stable??

    Conflict of Interest:

    None declared

  • generalists cannot afford the luxury of being ignorant
    oscar,m jolobe

    The luxury of being relatively ignorant of the latest developments outside the "comfort zone" of one's highly specialised field of expertise is one which can be indulged only by specialists in highly esteemed disciplines such as cardiology (the heart being a highly emotive organ), and neurology (neurology being the equivalent of "brainy"). Generalists, such as frontliners in emergency medicine, have to make do with ency...

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  • A systematic review or a review of the literature?
    Janos P Baombe

    I read with great interest the review regarding pre-procedural fasting in emergency sedation.

    Whilst the findings of it are re-assuring for the emergency physician, there are certain points that need to be highlighted about the methodology used.

    First of all, the validated procedure to conduct a systematic review is to use two authors to separately browse the relevant literature applying inclusion cri...

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  • Regarding the JRCALC Airway Managment Report and the subsequent College of Paramedics position paper.
    Scott Farmery

    Firstly may we welcome the many excellent points raised on all sides. As active Pre-hospital Care practitioners we agree that there are important, unresolved issues regarding intubation(1). As practising Anaesthetists, while we acknowledge that intubation is not the only technique, we would consider the proposed withdrawal of intubation and the reliance on supra-glottic devices(1) to be premature for two reasons. Firstly,...

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  • Pre-hospital assessment and management of chest pain needs improving
    Abhishek Chauhan

    We read with interest the article by Figgis et al highlighting the need for improvement in the pre-hospital management of chest pain. It is concerning that only 20% of patients had a 12-lead ECG and that 64% of paramedics surveyed felt that they had received insufficient training on ECG interpretation [1].

    Of particular concern is the inability of paramedics to identify ST elevation myocardial infarction (STEMI...

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  • Another cause of falsely high readings
    Mark A R Jadav

    Peritoneal dialysis patients can also have falsely high bedside glucose estimations. Icodextrin in the dialysate can pass into the blood where it is metabolised to maltose. Maltose reacts with glucose sticks utilising the glucose dehydrogenase with coenzyme pyrroloquinolinequinone (GDH PQQ) assay to give a falsely high reading. Kits using glucose oxidase or hexokinase are less affected. Again the blood gas analyser will r...

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