844 e-Letters

  • A systematic review or a review of the literature?
    Janos P Baombe

    I read with great interest the review regarding pre-procedural fasting in emergency sedation.

    Whilst the findings of it are re-assuring for the emergency physician, there are certain points that need to be highlighted about the methodology used.

    First of all, the validated procedure to conduct a systematic review is to use two authors to separately browse the relevant literature applying inclusion cri...

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  • Regarding the JRCALC Airway Managment Report and the subsequent College of Paramedics position paper.
    Scott Farmery

    Firstly may we welcome the many excellent points raised on all sides. As active Pre-hospital Care practitioners we agree that there are important, unresolved issues regarding intubation(1). As practising Anaesthetists, while we acknowledge that intubation is not the only technique, we would consider the proposed withdrawal of intubation and the reliance on supra-glottic devices(1) to be premature for two reasons. Firstly,...

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  • Pre-hospital assessment and management of chest pain needs improving
    Abhishek Chauhan

    We read with interest the article by Figgis et al highlighting the need for improvement in the pre-hospital management of chest pain. It is concerning that only 20% of patients had a 12-lead ECG and that 64% of paramedics surveyed felt that they had received insufficient training on ECG interpretation [1].

    Of particular concern is the inability of paramedics to identify ST elevation myocardial infarction (STEMI...

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  • Another cause of falsely high readings
    Mark A R Jadav

    Peritoneal dialysis patients can also have falsely high bedside glucose estimations. Icodextrin in the dialysate can pass into the blood where it is metabolised to maltose. Maltose reacts with glucose sticks utilising the glucose dehydrogenase with coenzyme pyrroloquinolinequinone (GDH PQQ) assay to give a falsely high reading. Kits using glucose oxidase or hexokinase are less affected. Again the blood gas analyser will r...

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  • Paramedic Airway Skills
    Alan G Jones

    Dear Editor

    I was extremely interested in these papers in this months EMJ. [Joint Royal College Ambulance Liaison Committee Airway Working Group commentary The College of Paramedics (British Paramedic Association) position paper regarding the Joint Royal Colleges Ambulance Liaison Committee recommendations on paramedic intubation (Prehospital airway management)].

    I wonder if anyone could tell me what are the...

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  • Effects of bed height on the performance of chest compressions- Clinical application of results
    PB Sherren

    Editor- I would like to start by congratulating Cho and colleagues (1) on undertaking a study that addresses an area of cardiopulmonary resuscitation (CPR) which potentially, could for such a simple intervention have such a dramatic impact on the quality of CPR delivered. There are surprisingly few papers published on this area, and the 2005 ILCOR guidelines (2) were based largely on expert opinion with little evidence...

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  • Blended learning in the ED, and national guidance.
    David.C. Robinson

    I read the article by Roe et al with great interest, particularly because as a trainer of junior doctors in the Emergency Department I recognise many of the barriers to effective teaching as described in the article.

    Locally we have appreciated the poor attendance by Foundation trainees at weekly teaching sessions, mainly as a consequence of increasingly anti-social rotas. The delivery of high quality work-plac...

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  • Re:A Seventy-Five Year Old Mistake
    jeff w hayes

    I read your letter and understand that you say r22 cant cause phosgene gas. It would be easier to believe this statement if almost everyone that has been soldering in the hvac field weren't overcome with some type of toxin in the process. I just today was soldering in a freezer that uses hp-80 refrigerant and all of the sudden could not breathe. It felt like my lungs weren't working for a half hour or so and I felt dizzy...

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  • Another case of asthma near death averted by chest compression
    Michele Alzetta

    The article by Dr. Harrison reminds me of a similar case I treated years ago. A young adult with no prior history of asthma had the first, violent attack of asthma at home and went into respiratory arrest during transport to the emergency service of the small hospital I was working in at the time. The patient arrived unconscious but with carotid pulse still present. The thorax was obviously hyperexpanded and immediate intubati...

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  • recognition of non-diagnostic nature of the electrocardiogram in circumflex artery occlusion
    osacr,m jolobe

    Even though the electrocardiogram(ECG) may be entirely non- diagnostic, and entirely innocent of any ST segment deviation in as many as 38% of patients with myocardial infarction attributable to left circumflex artery occlusion(1), clinical features that simply help to confirm the diagnosis of acute coronary syndrome(ACS(2))will have greater practical value, in this context, than in patients who have diagnostic ECG. The...

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