839 e-Letters

  • 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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  • Paramedic V Physician
    Tom Mallinson

    Thankyou for your informative article investigating the use of ketamine in prehospital intubation.

    From your article it seems clear that data was collected identifying who undertook the intubations in each case; I was wondering if there was any significant difference in success rates, number of attempts and complication rates between paramedic and physician intubations?

    If this data is available I'm...

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  • Nebulising supine patients
    Tom Mallinson

    In their informative article, Fitzpatrick, Brady and Maguire (1) demonstrate an excellent method for delivering nebulised medication to a supine patient. The authors also state they are unaware of any commercially available devices able to nebulise a supine patient. Although I have no personal experience with the mask in question, the Aero Neb Go mask, produced by Romsons International, utilizes an elbow adapter, allowing neb...

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  • The importance of clinical details
    Caroline Leech

    Dear Editor

    I would be very grateful if the author of this clinical image could be given the opportunity to describe the clinical aspects of the case.

    Pelvic splints are applied in the pre-hospital environment for suspected pelvic fractures and should be removed by the emergency department when imaging has excluded an unstable fracture pattern and when the patient is haemodynamically stable.


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  • Kendrick Extracation Device in pulmonary compromise
    Daniel J Dodd

    Although the gold standard of immobilisation is in a prone position, with a C collar and a vaccum matress the use of a device such as the kendrick extraction device (KED) is one to be considered in patients such as this. It provides almoast complete immobilisation from the neck to the torso. (1) This allows the patient to be sat up at a 30-40 degree angle to allow for best ventilation.(2) This same method can be used with...

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  • The use of PAT in the emergency department
    Laura A. Backhouse

    Re: Systematic review of alcohol screening tools for use in the emergency department. Jones L, A. emj.2011;28:182-191 doi:10.1136/emj.2009.085324

    I read the article reviewing the accuracy of screening tools and recommending their use in the emergency department with interest. As a final year medical student, I recently piloted the Paddington Alcohol Test (PAT) in a district hospital emergency department to asses...

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