855 e-Letters

  • 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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  • 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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