844 e-Letters

  • Propofol is not safe for sedation for hip relocation
    Keith J Anderson

    University Department of Anaesthetics Level 2, University Block Glasgow Royal Infirmary 10 Alexandra Parade Glasgow G31 2ER

    19 February 2009

    Dear Sir,

    We read with interest the clinically based study, on the use of propofol to sedate patients for relocation of hip prostheses in the emergency department.[1] The authors rightly point out that there are problems with the safety and efficacy of us...

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  • ToPDoG is in progress
    Colin M Parker

    Dear Sirs

    I commend the work of Geelhoed and MacDonald in their sentinel dose- finding studies regarding the minimum effective dose of dexamethasone for croup, it does seem to suggest a 'ceiling' effect. This work has been recently followed by a descriptive paper (accepted for publication, not yet published) outlining the experience over 27 years at their institution, clearly demonstrating the real-world effect...

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  • Basic Life Support should be kept basic.
    Andrew M. Mason

    Although the definition of Basic Life Support (BLS) does vary between sources, it is probably best regarded as, "a level of medical care that can be used to treat patients with life-threatening illness or injury without the use of any advanced or invasive medical procedures or intravenous access". It should be possible for any rescuer in any situation to render BLS simply by using hands and lungs, although simple improvi...

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  • A response from the International Academies of Emergency Dispatch
    Tracey E Barron
    In response to this article it is important to highlight that this system is not used by any ambulance services or EMS systems in the UK or the world - it is over 8 years old and has been replaced multiple times. Also, a later version of the system has demonstrated a sensitivity of 83% for Emergency Medical Dispatchers using MPDS stroke protocol (http://www.prioritydispatch.co.uk/uk/San_Diego_Accuracy_of_Stroke.pdf). A response...
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  • Thomas H McKinnell


    Whilst we feel that Lindford et al(1)’s work has many admirable points, we also feel it important to point out minor areas about the study which detract from its overall impact.

    Whilst details of the subgroups in the sample size of 50 assessors is given, unfortunately there is no similar breakdown in the information about their answer regarding size of burn requiring resuscitation in adults and chi...

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  • More questions than answers
    Andrew M. Mason

    One major shortcoming of this comparison of monophasic and biphasic defibrillators for the treatment of out-of-hospital cardiac arrest, which was not fully addressed by the authors, concerns the fact that the defibrillators used were programmed to analyse and deliver up to three stacked shocks in accordance with the AHA guidelines of 2000. Guidelines 2005 revolutionised the treatment of VF cardiac arrest by emphasising t...

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  • MCL calcification not described?
    Gautam Ray

    Is this not "Pelligrini-Stieda" disease?

  • It is correct priority, not diagnosis, that matters at telephone triage
    James T Gray

    I found the article by Deakin et al interesting but have to feel that the article seems to dwell on whether the Advanced Medical Priority Dispatch system (AMPDS) correctly identifies stroke when the emphasis should have been on whether it can correctly prioritise patients to a catagory A or B who are later found to have suffered a stroke.

    The authors themselves identify the fact that ambulance prioritisation is...

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  • CT Urography: Clarification
    Darra T Murphy

    Dear Sir/Madam,

    We read with great interest the excellent article in the September 2008 issue of the journal by Ulahannan et al entitled “Benefits of CT Urography in patients presenting to the emergency department with suspected ureteric colic”[1]. They employed a test designated a “non-contrast CT Urogram” and concluded that CT is the preferred test of choice for patients over 40 with suspected ureteric coli...

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  • A low GCS does not equate to a compromised airway reflex
    Dexter Y S Chan

    Sibbald and colleagues raise the important point that sedation often verges on the edge of general anaesthesia during emergency department sedation in response to Vardy et al’s audit of ED sedation practice(1,2). They do, however, make the false assumption that a GCS of 8 or less is equivalent to the loss of airway reflexes.

    Moulton et al(3,4), in two papers describing the relationship between the GCS and gag a...

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