831 e-Letters

  • 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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  • Re:Spinal Boards Do NOT Work
    John Emil Palao Ramos

    Absolutely Correct. You can not immobilize a spine to a flat surface.

    Conflict of Interest:

    None declared

  • Rapid Sequence Induction of Anaesthesia? Really?
    Dilip DaCruz

    I found the term "Induction of Anaesthesia" somewhat uninspiring, especially as it was the header of a national survey.

    The term is outdated and was replaced some 10 years ago by "Rapid Sequence Intubation". "Intubation" and "Induction" of anaesthesia are not interchangeable terms. The latter stops at "Time zero*" the former only after mission is accomplished and the airway is secured. We intubate. RSI = Rapid S...

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  • Minimising Risk in Procedural Sedation
    Marten C Howes

    I welcome the opportunity to read this article and thank the authors for their work which adds considerably to the literature on the topic of Procedural Sedation and Analgesia (PSA) in Emergency Departments (EDs).

    My own experience is similar, and I concluded some time ago that complications, or situations where complications are more likely to occur, can be minimised by a system of training, education, and by ch...

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  • Difficulties in Requesting CT imaging in Head Injury: Another Role for Ultrasound?
    Luke T Iddon
    The National Audit Office (1) has evaluated delays when requesting Computed Tomography (CT) scans for patients with head injury and reveals that nationally, a quarter of patients may wait for more than two hours. This work also found, that in London alone the average delay in transfer from local hospital to specialist unit is typically six hours. In the West Midlands Workforce Deanery, a survey of senior (ST4 and above) Emergency...
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  • Cost effectiveness of GP's within an ED may not be generalisable everywhere
    Andrew P Webster

    The authors of the recent study looking at the addition of a GP within an Emergency Department are to be congratulated for their research into a difficult area [1]. I would have to challenge the authors conclusions that the addition of another body i.e. a GP would have only a limited effect on patient process time compared to usual care. From the staffing figures provided they are increasing clinician numbers from 3 to...

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  • Track and trigger - is it really a false trail?
    Kirsty Challen


    Dr Roland and Prof Coats raise some interesting reservations regarding the adoption of hospital-wide track and trigger systems (TTS), but I must take issue with some of their pessimism.

    They argue that the application of TTSs in the ED will be limited by the difference between the inpatient derivation sets of the TTS and the ED population. I am not convinced that our patient populations are so dif...

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  • RSIs in the Emergency Department
    Ian R Mowat

    Dear Editor,

    We read, with interest, the article by Benger and Hopkins,[1] published March 2011 describing the results of their national census of rapid sequence induction anaesthesia in UK emergency departments.

    The authors report an overall rate of RSI by unsupervised trainees as 45%, increasing to 71% out of hours. However, their conclusion that 57% of RSIs are carried out by senior anaesthetic traine...

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  • Early Warning scores do have a role to play in the ED
    Susan Dorrian

    Dear Sir

    The commentary on early warning scores in the ED presents an interesting viewpoint on their use. NCEPOD, NICE and CEMACH all recommend the use of track and trigger systems in acute hospital settings, a Department of Health review found that most NHS trusts were using aggregate weighting systems such as Modified Early Warning Scores (MEWS) (1). MEWS have been validated in the medical and surgical ward s...

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