eLetters

838 e-Letters

  • 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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  • The value of taking a history in patients with chest pain
    Allan D Cameron

    In introducing Goodacre et al's paper on low risk chest pain patients, the Primary Survey of the December 2009 issue prompts emergency physicians to reflect on "why [they] take histories at all in this patient group".(1,2) This is, in our opinion, an inappropriate reaction to the results of the study. The patients under investigation were those with a potential diagnosis of a cardiac cause of chest pain, and according t...

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  • Simple buckle fracture? Are you sure of the diagnosis before discharge with no follow up?
    Elizabeth C Jones

    I read with interest the Best Evidence Topic report by May G, Grayson A regarding the follow up of buckle fractures.[1] I agree that buckle fractures should not require routine follow up, however systems need to be robust to ensure that the correct diagnosis has been made. Diagnosis may not be as simple as often believed; several studies researching this topic have inadvertently included fractures other than buckle fracture...

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  • On the philosophy of diagnosis: Authors' response
    Richard Body
    Dear Editor,

    We welcome the thoughtful responses of Dr. Challen and Dr. Cattermole to our paper entitled: On the philosophy of diagnosis: is doing more good than harm better than primum non nocere? Dr. Challen makes two principle criticisms of our review to which we would like to respond.

    1. The existence of reality

    Dr. Challen correctly states that outside the medico-scientific realm, th...
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  • When the Good of the One outweighs the Good of the Many
    Jean Marc Benoit

    I would like to thank Body and Foex for their thought-provoking article, and also Cattermole and Challen for their replies. Too often in the culture of emergency medicine, the philosophical underpinnings of thought and action are neglected. When is there time to reflect?

    One highlight of their discussion of utilitarianism is the inclusion of emotional factors into the weighing of what actions can be counted as...

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  • Don't we have a service concept?
    suzanne mason

    The article by Higginson made me think about our specialty and whether we have got a missing link. However, it reminded me to look at the Way Ahead document produce by the UK College of Emergency Medicine in 2008. Surely this provides an excellent service concept for our specialty? The document provides clear guidance as to what our core and extended services should be and how we should consider delivering them. I wonder...

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  • Sensitivity or specificity?
    Shenaida R. Oemar

    With great interest we read the recent article by Bevan and colleagues reporting how predictive ALT is for liver injury in children with blunt abdominal trauma. In the result section the authors describe the following: "The presence or absence of liver injury can be predicted with a sensitivity of 96% and a specificity of 80%". In their conclusion they reported: "a threshold of >104 IU/L gave a 96% specificity for t...

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