833 e-Letters

  • 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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  • Performance of the C-MAC videolaryngoscope for emergent tracheal intubation in prehospital setting
    Fu-Shan Xue

    By a preliminary prospective, multicentre, observational study, Cavus et al.1 concluded that the C-MAC videolaryngoscope was suitable for prehospital emergency intubations with complicated airway conditions. Although they may have provided valuable information, several aspects of their study should be clarified and discussed.

    First, in results, the authors stated that it was possible to obtain a view of the glotti...

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  • Response to : Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department
    Pascal Dang-Minh

    1. Service Médical d'Urgence de la Brigade des Sapeurs Pompiers de Paris - France
    2. Pôle Anesthesie - Réanimation - SAMU - Urgences Centre Hospitalo-Universitaire de Brest - France
    3. Inserm U1018, Centre for research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
    4. Université de Versailles St-Quentin AP-HP, Poincaré...

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  • Re: An evaluation of echo in life support (ELS): is it feasible? What does it add? Hayhurst et al. Emerg. Med. J. 2011 28:119-121; doi:10.1136/emj.2009.084202
    Michael J. Stewart

    We note the experience of Dr Hayhurst and colleagues in the use of echo in life support (ELS) with interest.[1] Our own anecdotal experience agrees that focused ELS scans can be performed within the 10 second pause in CPR for a pulse check, and provide additional diagnostic information that can guide further resuscitative measures.

    Moreover we have found that it is usually practical to extend the ELS protocol to...

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  • Table 6 Calculation Error
    John Fralick

    Dear Dr. Jones and colleagues,

    I recently came across your paper as I was in need of a power calculation for diagnostic studies and have found your work to be very helpful. I noted, however, a minor but important error in Table 6, that outlines how to calculate sensitivity and specificity. The formula for sensitivity is incorrectly stated as the true positives divided by true positives plus false positives. Thi...

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  • The use of chaperones for intimate examinations is often impractical in primary care
    Deen M Mirza

    I found this article which showed suboptimal use of chaperones in emergency departments to be of great interest. In my clinical work in primary care in the UK, I often struggle with providing a chaperone for intimate examinations. The two main issues I have are who we should bring in, and what should they see.

    Firstly I feel that the person brought in should be someone who is allowed to examine patients themsel...

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  • Methoxy-what?!
    David G.E. Caldicott


    I presume that Dr Fairhurst is referring to a substance used ubiquitously in the Antipodes and more commonly spelled 'methoxyflurANE'.

    It is estimated that over three million doses have been used over the last 25 years in Australia (Jacobs, 2010). It is used by state ambulance services in the pre-hospital environment in most states of Australia, by the Australian Defence Forces, within emergency de...

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  • Comparison of tracheal intubation through intubating laryngeal mask airway and Airtraq? laryngoscope in different non-conventional positions
    Fu Shan Xue

    We read with interest the recent article of Grosomanidis et al.1, who compared applicability and efficacy of the tracheal intubation using an intubating laryngeal mask airway (ILMA) or an Airtraq? laryngoscope (Airtraq) in four non-conventional positions in a manikin study. Their findings that success rates of tracheal intubation using both techniques in an acceptable time period (up to 120 s) are up to 100% appear very...

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  • Reply to: Modelling the effects of the weather on admissions to UK trauma units: a cross-sectional study
    Wouter Stomp

    With great interest we read the report by Parsons et al. regarding the effects of the weather on trauma unit admissions.[1] We would like to bring to the authors attention our study, in which we studied the same effects in an area in the Netherlands geographically and metereologically similar to the United Kingdom over a total period of 36 years, including over 350,000 patients.[2] Although the authors of the present stu...

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