eLetters

322 e-Letters

published between 2004 and 2007

  • A caution with semi-paramedics: the SAO Paulo case
    Celio Levyman MD, MSc

    Dear Editor

    This paper shows a good outcome of undiagnosed cervical spine trauma when the intubation was performed by a senior practioner, in an ED of a UK.

    In USA, for example, paramedics perform access to airway in the local of an accident, and they are members of the Fire Department of some city.

    In Sao Paulo, the largest city of Brazil, with 10 million habitants, this type of rescue is perfor...

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  • Ketamine sedation - safe and effective
    Ian Ayenga Sammy

    Dear Editor

    I read with great interest the article by MC Howes. It concerns me that much current practice in Emergency Medicine in the UK is still dictated by those outside the speciality, who have little or no idea of the needs of our patients, or the settings in which we work.

    I was not surprised to read that, while ketamine sedation has been accepted both in the US and Australia as a part of modern eme...

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  • Futility of Nalbuphine
    Aruni Sen

    Dear Editor

    Woollard and his colleagues' study on nalbuphine identifies the gap that can exist between research and clinical practice. I resent the claims in this paper that nalbuphine somehow is an effective analgesic.

    Since 1996, I have been receiving patients in my hospital who have been given nalbuphine pre hospital with very little benefit and lot of problem. These patients get grossly inadequate anal...

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  • Ketamine marches on regardless
    Philip Munro

    Dear Editor

    Neil Morton's points are concise and thought provoking as always.[1] The withdrawal and ongoing reevaluation of the SIGN guidelines on paediatric procedural sedation were rightly welcomed as a chance to address issues which many emergency physicians felt had been overlooked. Our colleagues from Australasia and the United States are somewhat puzzled by our hesitation in adopting what is viewed by them a...

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  • AMTS
    Richard D Hardern

    Dear Editor

    We do not want to detract from the overall value of the recent article by Wardrope and MacKenzie,[1] but we feel it important to point out our concerns over the proposed assessment of cognitive function.

    Cognitive impairment due to dementia and delirium is common in emergency situations but formal assessment of cognitive function is rare. This could explain why at least 67% of older people wi...

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  • Authors' response to Heywood and Fatovich
    Simon G. A. Brown

    Dear Editor

    Dr Fatovich asks about initial reaction severity in three participants who were prescribed steroids and antihistamines for large local reactions or persistent urticaria.[1]

    Two initially had severe (hypotensive) reactions whereas the other had no systemic reaction. Although frequently used, it is difficult to determine the benefit of steroids and antihistamines to manage large local reactions an...

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  • Minutes matter - Hours matter more!
    David K Pedley

    Dear Editor

    Leah et al’s interesting paper describes a 10.5-minute time saving based on preparation of thrombolytic therapy for acute myocardial infarction (AMI). They go on to demonstrate an improvement in performance against the door to needle standard.[1]

    While no cost – benefit examination is made, the authors make reference to Boersma’s work to illustrate the benefits of early thrombolysis.[2...

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  • Accurate assessment of skin viability in pretibial haematomas
    Beryl De Souza

    Dear Editor

    I agree with Karthikeyan et al.[1] regarding simple and safe evacuation of pretibial haematomas using a Yankauer sucker as a means to evacuate a haematoma and thereby reducing skin loss. However, the procedure described needs to be carried out under aseptic conditions which was not emphasized with care to avoid damage to underlying structures and to prevent further haematoma formation.

    ...

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  • Airway care in Ludwigs angina
    Malcolm Cameron

    Dear Editor

    There are two points we would like to raise in the management of the case described. We feel they are important "lessons learned" and have not been given emphasis by the authors.

    1. The patient’s symptoms were recorded in detail (noisy, gurgling breathing with drooling of saliva; dyspnoea; dysphagia; trismus; bilateral submandibular tense swellings; elevated, immobile tongue; tachycardia;...

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  • Domestic violence against women
    Rudy Crawford

    Dear Editor

    Sethi et al.[1] state that a lack of data on the prevalence of domestic violence is particularly true of A&E departments and that only two studies of prevalence were identified in the past ten years.

    In 1995 we published a combined prospective and retrospective study [2] of violence against women presenting to Glasgow Royal Infirmary over a six month period. The prevalence was 0.75%....

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