844 e-Letters

  • Left-without-being-seen patients and nurse counselling
    Benoit Bailey

    Left-without-being-seen patients and nurse counselling

    It is with great interest that we acknowledge the recent publication concerning improvements that could prevent departures of patients that left-without-being seen (LWBS) (1). Children who LWBS are an important concern in our emergency department (ED) and we have previously reported a proportion of LWBS of 17% during the year 2008 (2). With the implementatio...

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  • Best BETS: A further call for scrutiny.
    Alistair Steel

    Dear Sirs,

    We have previously expressed concerns about the validity of the "clinical bottom line" published alongside the popular Best BETS. (1) Best BETS should be based on specific clinical scenarios and should aim to provide a clinical bottom line which indicates, in the light of the evidence, what the clinician would do if faced with the same scenario again. (2) The report by Olaussen and Williams serves to...

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  • Acute cyanide poisoning from apricot kernels
    Vikhyat S. Bebarta

    We congratulate Cigolini and colleagues on their case report of apparent cyanide poisoning from apricot kernels[1]. However, we have several concerns regarding the verifiability of cyanide as the poisoning agent. These concerns were not addressed in the case description or in a limitations section.

    First, while the patient was surrounded by apricot kernels, ingestion of the kernels was not verified visually (...

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  • Age-based paediatric weight estimation is imprecise
    Giles N Cattermole

    Dear Editor,

    Luscombe et al [1] are to be congratulated for developing a more accurate age-based paediatric weight estimation tool than that previously commonly used in the UK. Perhaps modesty prevented them mentioning that their formula has also been incorporated into the 5th edition of the Advanced Paediatric Life Support manual, for 6-12 year olds [2]. It is important for readers to realise that in their art...

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  • Insufficient detail sadly means that this case remains not proven
    Kit Byatt

    We read this intriguing case report with great interest. However, it contained two specific weaknesses which undermined its strength, leaving it inconclusive. The critical point is not whether caffeine excess might cause seizures (this is known), or the theoretical pathophysiology (comprehensively discussed in the article), but whether it was the definitive cause of seizures in this case.

    Firstly, without meas...

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  • The role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest - a lost opportunity?
    James T Gray
    Other authors: Dr S Rawstorne - Medical Director, Great Western Ambulance Service NHS Trust and Chair of the Directors of Clinical Care; Dr A Walker - Medical Director, Yorkshire Ambulance Service NHS Trust; Dr A Carson - Medical Director, West Midlands Ambulance Service; Dr John Black – Medical Director, South Central Ambulance Service NHS Trust; Dr Kyee Han – Medical Director, North East Ambulance Service NHS Trust ...
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  • Re:Kendrick Extracation Device in pulmonary compromise
    David Fitzpatrick

    Thank you for taking the time to read and respond to our paper and for usefully highlighting the possible application of the Kendrick Extrication Device (KED) in such circumstances.

    We can confirm that had nebulisation been required prior to extrication from the premises that the application of the KED would have been considered. In our case however the initial position of the patient enabled a simple rearwar...

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  • Re:Nebulising supine patients
    David Fitzpatrick

    Thank you for taking the time to read and respond to our paper. The authors are very grateful for your information on the 'Aero Neb Go Mask'. The Scottish Ambulance Service (SAS) currently use the Lifecare micro neb III)which does not enable nebulisation in the supine position. Having viewed the Aero Neb Go Mask it would appear that it would have been effective in our case. The authors would be interested to know whethe...

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  • Triage flowchart to rule out acute coronary syndrome: beware of generalization!
    Yonathan Freund

    We thank Dr. Lopez and colleagues for this large prospective study evaluating the benefit of a triage flowchart to rule out acute coronary syndrome (ACS) in the emergency department1. They apply a 5 steps flowchart to classify patients as "triage non-ACS": i.e. patients less than 40 years old, absence of diabetes, no previously known coronary artery disease, non-oppressive and non-retrosternal pain. In their sample of 4...

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  • Lessons learned from Left Bundle Branch Block: could inter-professional communication be part of the solution?
    David Fitzpatrick

    We were concerned to read the paper by Figgan et al (1) demonstrating the ambulance clinicians lack of compliance with prehospital guidance during assessment of chest pain presentations. Chauhan et al (2) also appropriately highlight the need for accurate assessment of posterior myocardial infarction (PMI) and that this particular presentation of Acute Coronary Syndrome (ACS) appears to have received little attention in p...

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