844 e-Letters

  • prevalence of sudden death in asthma
    Rex Harrison

    The case Dr. Alzetta describes is similar to the ones I described. Although these cases are rare in any one location and undocumented especially after death I believe that taken nationally they are of significant numbers. The evidence lies in a paper written to discover the cause of the dramatic increase in asthma deaths in the sixties by Speizer, Doll et al. They studied all the deaths in England and Wales for six cons...

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  • Over-bedding or de-bunking
    Nick Harrop

    The paper by Harris and Sharma [1] confirms what many emergency physicians think they know : no beds means no admissions. An automatic plea for more beds needs to be regarded sceptically.

    The authors rightly conclude that "the availability of fully staffed beds is a major determinant of ED overcrowding".

    It is crucial for clinicians as well as planners to realise that availability does not equate simpl...

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  • diagnosis of swine flu: wieghting between false positive and false negative
    professor viroj wiwanitkit

    Editor, I read the recent publication by Mann et al. with a great interest. Mann et al. concluded that " There is a significant risk of harm with false-positive diagnoses and potential delays in appropriate treatment [1]." I agree that there are several problem in diagnosis of swine flu. Several problems can lead to the failure of using any scoring system or algorithm for diagnosis [2-3]. On the other hands, although sev...

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  • The benefit of intravenous magnesium sulphate is not proven in adults with acute severe asthma
    Steve Goodacre

    The correct answer to question 2a in the EMQs on magnesium is false, at least with regard to adults. For children it is probably true. The evidence cited to support the answer provided is ten years old [1]. Avid EMJ readers will know that a more recent meta-analysis [2] showed that in adults there was only weak evidence that intravenous magnesium sulphate had an effect upon respiratory function (standardised mean differe...

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  • Re:'Unstable' buckle fractures
    Thomas W Hamilton

    In reply to Dr Kennedy's comments Salter Harris IV and displaced Salter Harris II fractures are seen in this population, these may be initially interpreted as stable fractures but may require manipulation or observation to avoid long term disability. Misdiagnosis may also occur where a fracture is diagnosed in the absence of any bony injury.

    Conflict of Interest:

    None declared...

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  • Trauma care in England: Londons Trauma System goes live
    Anna Vondy

    We were encouraged by Hughes editorial on Trauma Care in England (1), which highlighted the key points from the National Audit Office publication Major Trauma Care in England (2).

    As an update, the London Trauma System was launched on 6th April 2010. The system is composed of four trauma networks, each with a major trauma centre providing care for the most seriously injured patients, linked in with a number of l...

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  • To complete the question...
    Janos P Baombe

    I read with great interest the Best Evidence Topic by N. Naheed and R. Jenner about the place of rectal examination in paediatric constipation.

    The current NICE guidelines concur with the conclusions worded in the BET and do not advocate a digital examination unless one is a healthcare professional with experience in the specific aspect.

    Whilst I would not suggest that emergency physicians should under...

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  • Be wary of premature extrapolations!
    Janos P Baombe

    I read with great interest the Sophia section of the EMJ this month.

    A few lines draw our attention to a multi-centre prospective randomised study, which compared preoperative cleansing of the patients 'skin with chlorhexidine-alcohol to povidone-iodine for preventing surgical site infection (Darouiche et al).

    The EMJ editors wondered if there would be some useful implications for ED practice.


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  • 'Unstable' buckle fractures
    Dr J Julian A Kennedy

    Hamilton et al in commenting about use of removable splints in childhood wrist fractures mention that there may be misdiagnoses in these 'unstable' fractures. How on earth can a barely visible Taurus or greenstick fracture of a child's wrist be anything but stable??

    Conflict of Interest:

    None declared

  • generalists cannot afford the luxury of being ignorant
    oscar,m jolobe

    The luxury of being relatively ignorant of the latest developments outside the "comfort zone" of one's highly specialised field of expertise is one which can be indulged only by specialists in highly esteemed disciplines such as cardiology (the heart being a highly emotive organ), and neurology (neurology being the equivalent of "brainy"). Generalists, such as frontliners in emergency medicine, have to make do with ency...

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