eLetters

322 e-Letters

published between 2004 and 2007

  • Double Jeopardy!
    Sahadu Saajid Kaleel

    Dear Editor

    In clinical practice most of us at some point have come across patients who are Jehovah’s Witness. According to their religious way of life they cannot take any form blood or blood related products, which includes immunoglobulin, but in the event of traumatic wound what are our options if patient also has hypersensitivity to tetanus toxoid?

    I was referred from casualty a right-handed male pat...

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  • RULES FOR HEADACHE IN AN ED
    CELIO LEVYMAN,MD,MSc

    Dear Editor

    Headache is a very common presentation in the neurology practice, and one of the most prevalent consultations in the office.Thus, headache clinics and/or sub-specialist neurologists with interest in the headache field become more and more common.

    However, in an Emergency Department, things are a lot different from the chronic headache-suffer patient. The guidelines of the International Headac...

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  • A design flaw revealed
    Phil Brewer

    Dear Editor

    The two cases of penetration of the skull by falling onto electrical plugs could have easily been prevented with a design which caused the prongs to be in a horizontal rather than verticle position when placed on a flat surface. A rounded or roof-shaped backing, instead of the usual flat backing, would do the trick nicely, forcing the prongs to a 45-90 degree angle not likely to cause any damage to fa...

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  • Kounis Syndrome, Insect Sting Anaphylaxis and Adrenaline treatment
    Nicholas G. Kounis

    Dear Editor

    In the elegant paper of Brown et al [1] concerning insect sting anaphylaxis and its treatment, two patients developed electrocardiographic changes suggesting acute inferior myocardial ischaemia with normal troponin and cardiac enzymes. These cases are characteristic examples of type II variant of Kounis syndrome [2].

    Kounis syndrome [3][4][5] is the concurrence of allergic or hypersensitivit...

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  • The impact of NICE guidelines for the management of head injury in children
    Phillip Debenham

    Dear Editor

    We were interested in the recent NICE guideline review by Dunning & Lecky [1], in particular the extrapolation of the Canadian head CT rule for adults to a paediatric population. We retrospectively audited children with head injury presenting to the emergency department of Birmingham Heartlands & Solihull hospital for the months of June 2003 and December 2003. Case notes were reviewed to dete...

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  • Are BETs best?
    Thomas Locker

    Dear Editor

    I would like to thank the editors of the EMJ for their replies to the points raised by myself and Dr Webster, however these replies have themselves highlighted further concerns [1][2].

    It is clear that considerable effort goes into producing the BETs but as Mr Mackway-Jones states, BETs do not represent the highest level of evidence. Might it not be better to coordinate this effort to produc...

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  • Authors response to Gori et al
    Simon G A Brown

    Dear Editor

    Dr Gori, Cinotti and Papagallo's concerns [1] reflect the inexperience of many medical staff in the use of adrenaline to treat anaphylaxis, a misunderstanding of the ethical issues relating to our trial, and perhaps over-reliance on invasive measures of severity that are a sign of sustained and untreated cardiorespiratory collapse. To deal with each comment in turn:

    - Even Mueller Grade I re...

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  • Primary Headache Disorder in the Emergency Department
    Andrew J Larner

    Dear Editor

    We read with interest the article by Locker et al [1] as we have recently commenced a study looking at the issue of headache in the emergency department from the perspective of the neurology outpatient clinic. Approximately 20% of patients seen in general neurology outpatient clinics have headache as their principal complaint [2], and the vast majority have primary headache disorders, amenable to dia...

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  • The who, where, and what of rapid sequence intubation
    Angela J Oglesby

    Dear Editor

    Reid and colleagues have produced an interesting observational study on rapid sequence intubation (RSI) [1].

    The authors comment on the lack of data on complications of RSI in the UK hospital setting. In 2003, we published complication data from a multi-centre prospective observational study of 735 patients undergoing RSI in seven Scottish urban emergency departments (ED) [2].

    The...

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  • Emergency Management of 'Tension Gastrothorax'
    Michael W Ardagh

    Dear Editor

    Dalton and colleagues describe a rare case of tension gastrothorax from a Bochdalek hernia. Their case was managed in the belief it was a tension pneumothorax, with subsequent perforation of the stomach and soiling of the chest cavity. They suggest that this diagnosis should be entertained in certain cases and that emergency management should be decompression with a nasogastric tube.

    We hav...

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