eLetters

322 e-Letters

published between 2004 and 2007

  • Questions raised by this study
    Matt Heywood

    Dear Editor

    Brown et al's [1] study provoked lively debate amongst the staff at Ipswich Hospital.

    I would like to pose two questions:

    1) What was the interval between sting challenge and onset of symptoms? Was this related to severity of reaction?

    2) What were the details of ethical approval, and what was the consent process and documentation?

    I wonder if such a stu...

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  • Limited use of corticosteroids for insect sting anaphylaxis
    Daniel M Fatovich

    Dear Editor

    I congratulate Dr Brown and his colleagues on conducting the first prospective trial of a management protocol for anaphylaxis.[1]

    Perhaps one of the most telling results was that corticosteroids and antihistamines were prescribed for only three of the 21 patients. In my experience, corticosteroids and antihistamines are frequently overprescribed and overemphasised for the management of allergic...

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  • Prevalence of domestic violence
    Adrian A Boyle

    Dear Editor

    I read with great interest the cross-sectional study about the prevalence of domestic violence conducted by Sethi et al.[1]

    I experienced a moment of deja vu having published a study with almost identical methods and conclusions in the EMJ in 2003.[2] It is reassuring to see that they came to similar conclusions in a different department! This perhaps shows the problems of a long submissio...

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  • Consensus on the prehospital approach to burns patient management. February 2004
    Keith P Allison

    Dear Editor

    We thank Allison Walker for her letter and helpful comments.[1] With respect to mention of the fire service with this patient group; care was taken to generically include all pre-hospital carers and there were two representatives from the fire service present at the consensus meeting. The fire services nationally are looking to use these guidelines as a standard of care and interface with their ambulanc...

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  • Acute General Medicine
    Mark L Mallet

    Dear Editor

    Whilst I share Terry Brown's concern that some trainee physicians may not receive adequate exposure to acutely ill adults, the role of the acute general physician can not therefore be said to be in demise. The recent emergence of acute medicine as a subspecialty in its own right, and the recognition of this by the Royal Colleges of Physicians, has paralleled a large expansion in the number of acute physi...

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  • Ludwig's Angina and airway obstruction
    Marten C Howes

    Dear Editor

    It would be interesting to know if the airway obstruction occured during the transfer of the patient from the A&E bed/trolley onto the operating table, and whether the patient was maintained in an upright sitting posture

    Most texts deeling with the management of acute upper airway problems such as this recommend that the patient is not moved from the A&E resuscitation room. Awake nasal fib...

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  • Bioterrorism- time to get organised
    Debasish Debnath

    Dear Editor

    Authors had focused on the modus operandi rather than the features that would help to identify the nature of bioterrorism. Current understanding is that infections like anthrax, botuilism, plague, small pox, tularaemia and viral haemorrhagic fever are most likely to be implicated in bioterrorism. Important aspects of these conditions are summarized below-

    [A] Anthrax, caused by Bacillus ant...

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  • A case of extreme hypercapnia
    Richard M Wright

    Dear Editor

    I read with interest the case report by Urwin et al. but wonder if there is another explanation for the patients’ deterioration, other than the administration of oxygen by the ambulance crew. The case presented involved a 64 year-old woman with undiagnosed chronic obstructive pulmonary disease. She was referred by her GP with a four-day history of increased shortness of breath. On arrival of...

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  • No opportunity for anaesthetic training.
    Victoria A Mottram

    Dear Editor

    I note with interest Graham's review of suggested desirable levels of anaesthetic and critical care experience for emergency medicine trainees and consultants. I entirely agree that RSI and endotracheal intubation are the gold standard for airway management in any seriously unwell patient, and as such, it is entirely appropriate and to be expected that emergency physicians are able to provide this. Ho...

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  • More than just maintaining one's own skills
    Andrew P Webster

    Dear Editor

    Mr Graham has written an excellent article reviewing the latest evidence on minimum competencies required to manage the emergency airway.

    In current emergency medicine practice there are many hurdles to overcome not just developing and maintaining skills. Most departments have not enough experienced practioners to offer this service more than sporadically. There are also other aspects other than...

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