eLetters

322 e-Letters

published between 2004 and 2007

  • Pre-hospital use of cuffed tracheal tubes in children
    Roderick Mackenzie

    Dear Editor,

    In his letter entitled “Counting Angels”, Dr Mason dismisses our attempt to challenge the doctrine of always using an un-cuffed tracheal tube for emergency intubation of children as irrelevant and meaningless (1). His arguments are that we should instead challenge the perceived “gold standard” role of emergency tracheal intubation in the pre-hospital setting (for all patients) and consider using su...

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  • Response to death from paracetamol overdose despite appropriate treatment with N-Acetylcysteine
    Suzanne Doyon

    Dear Editor,

    This 55 yo man presented with a plasma paracetamol level of 534 mg/L at 4 hours post ingestion and was treated with adequate doses of intravenous acetylcysteine. Peak ALT was 145 U/L and peak INR was 2.5 both drawn 72 hours post ingestion. He met none of the King's College criteria for paracetamol-induced liver failure and transplant. The patient died of ARDS and a "deteriorating cardiovascular st...

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  • Reviw of the article "Tracheal Intubation in the Emergency Department"
    Heather L Gallie

    Dear Editor,

    As Anaesthetists we question the validity of the statement “rapid sequence induction (RSI) can be performed safely in the district general hospital (DGH) by both Anaesthetic and Emergency physicians, with comparable success rates and complication rates”.

    Firstly, we would consider the definition of successful intubation “in less than or equal to three attempts”. Some failed intubation al...

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  • LBBB with MI
    Mark T Lown

    Dear Editor,

    I don't think the sgarbossa criteria are that useful. In the example ECG, the 2 strikingly obvious criteria that would indicate acute MI are the hyperacute T waves laterally (the absolute height of the T wave being greater than that of the the QRS) and the high ST to T ratio laterally. It is only Anterior MIs that are difficult to diagnose in the presence of LBBB. The presence of hyperacute Ts is s...

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  • It's how you use it!
    Patrick Linehan

    Dear Editor,

    The problem is that patients (and untrained health workers) assume that the glue should be used on skin the same way it's used to glue a broken cup: put the glue in the middle and push the edges together. Used this way the outcome is poor with either medicinal-grade or ordinary cyano-acrylate glue.

    Conflicts of Interest:

    I've used superglue to cover my own minor hand laceration...

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  • Response to Welling's article on the efficacy of topical morphine on burn wounds
    Bhagteshwar Singh

    Dear Editor,

    The considerable pain caused by common partial thickness cutaneous burns is widely acknowledged to be a difficult therapeutic problem. Growing evidence has shown peripheral opioid receptors to be a potentially exploitable target for topical analgesic intervention. The efficacy of topical opioids at various time points following burns, and the relative effectiveness of their use for various burn dept...

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  • The Importance of Irrigation
    Daniel G Boden

    Dear Editor,

    I read with interest the article and discussion on human bite injuries by Henry et al (EMJ 2007; 24:455-458). I would like to make reference to the particular importance of irrigation and debridement of any such wound involving dental flora, as well as the high index of suspicion required in an often unreliable cohort of patients.

    We recently had a patient present to our department with a...

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  • Medical Training in the UK Fire Service
    Anil P Hormis

    Dear Editor,

    We applaud the short report by Lee and Porter 1 . We would agree with the need for a medical training model for the UK Fire and Rescue Service. Since the research was submitted for publication in 2006, a number of fundamental moves have already taken place. Most notably the publication of a trauma chapter,for the very first time, in the new Fire and Rescue Service Extrication manual. Additionall...

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  • Pre-hospital tracheal intubation in critically injured children by specialist practitioners
    Roderick Mackenzie

    Dear Editor,

    In his letter entitled ‘Counting Angels’, Dr Mason dismisses our attempt to challenge the doctrine of always using an un-cuffed tracheal tube for emergency intubation of children as irrelevant and meaningless (1). His arguments are that we should challenge the perceived ‘gold standard’ role of emergency tracheal intubation in the pre-hospital setting (for all patients) and consider using supra-glot...

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  • Acetylcysteine did not fail
    Kennon Heard

    Dear Editor,

    After reviewing Drs. Boudreaux and Bewley report entitled “Death from paracetamol overdose despite appropriate treatment with N-acetylcysteine “(1) we must disagree with their conclusions. The authors described a patient who was treated appropriately with N-acetylcysteine after a large acetaminophen overdose. The patient was initially stable, but decompensated after 8 hours, developed multi-system...

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