eLetters

322 e-Letters

published between 2004 and 2007

  • Author's response
    Christof Kastner

    Dear Editor

    We fully agree with the remarks made as to the use of morphine rather than pethidine in patients with renal colic. During our investigations primary pethidine was used in our institution and excursions about the use of morphine were limited by the format of our publication. Therefore this eletter is an extremely welcome contribution.

    Thank you very much.

  • The value of ABGs
    Rachael Boddy

    Dear Editor

    We write in response to the paper by Cross et al. on the use of NIV.[1] We are encouraged to see research into such an important and under investigated area of emergency medicine.

    We do however have concerns regarding the study design, in particular the criteria on which NIV was initiated. The benefits of NIV have mainly been demonstrated in patients with a respiratory acidosis rather th...

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  • Re: Routine thrombolysis for all non-traumatic cardiac arrests?
    Andrew P Webster

    Dear Editor

    The issue of cardiac troponins is not an issue regarding the decision of whether to give thrombolysis in cardiac arrest, neither is echocardiography. Thrombolysis if to be given needs to be given early. Whether you feel it will be beneficial when administered to cardiac arrests depends on how you interpret the available evidence, which to be honest is of limited methodology.

  • Re: Vasopressin or adrenaline in cardiac resuscitation
    Andrew P Webster

    Dear Editor

    I agree with Dr Lockers concerns regarding the publication of BETS in a peer reviewed journal. BETS are useful for introducing people to the theory of literature searching, and appraisal of published evidence, ideal skills for SPR's working towards their clinical topic review. However this does not necessarily warrant their publication in a peer reviewed journal. They occupy valuable space within a journal...

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  • Is the Andrews Introducer BEST
    Michael S Molloy

    Dear Editor

    Placement of chest drains can be associated with serious complications such as penetration of intra-thoracic and upper abdominal organs. This should be a less common occurrence nowadays as trochar use is no longer advocated.[1]

    Chest tube malposition post insertion is also common[2] as it can be difficult to manoeuvre the drain with the standard equipment once it is in the chest cavity. Usin...

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  • Primum non nocere
    Zane Sherif

    Dear Editor

    Air Bags-Primum non nocere

    Since airbags were installed initially as a safety feature in automobiles in the early 1970s there has been a significant drop in severity of injuries arising out of motor vehicle collisions. Injuries to the eye in particular have reduced since the introduction of laminated glass. Modern airbags however have significant potential to cause serious permanent damage...

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  • Nurse initiated thrombolysis in the emergency department
    Rob G Taylor

    Dear Editor

    We read with interest the artlcle by Heath et al. in the Emergency Medicine Journal, looking at nurse initiated thrombolysis in the accident and emergency department.[1]

    Speed of thrombolysis (and hence the "door to needle" time) is well recognised as being important in reducing myocardial damage and decreasing mortality in acute myocardial infarction. In fact, "pain to needle" time is ev...

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  • Peak Flow is rarely important in the decision to admit
    Marcin A Sosnowski

    Dear Editor

    In my opinion, it is much more important in the decision to discharge a patient. It is relatively rare that I have not made a decision to admit a patient within the first 30 seconds of presentation of an asthma attack- the respiratory rate, the use of accessory muscles and the overall behaviour of the patient is much more important than a number on the peak flow meter. I find it much more worrying that t...

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  • Pethidine for renal colic
    Roderick Mackenzie

    Dear Editor

    Kastner and Tagg have produced a useful guideline for the emergency management of renal colic.[1] I would disagree however with their recommendation that Pethidine 50 to 100mg should be administered if pain is not relieved by combinations of NSAID and co-codamol or Tramadol. There is no evidence that Pethidine has any specific advantages over other opioids and the belief that it provides better analgesi...

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  • Bicarbonate in the treatment of diabetic ketoacidosis
    Richard D Hardern

    Dear Editor

    I thank Dr Rosival for his interest in the article about DKA and for his recent letter which mirrors a previous one.[1] This reply largely covers the same ground as the reply to that earlier letter.[2]

    Although the most recent American Diabetic Association guidance does state that prognosis in DKA is worse in patients with coma [3] this is not equivalent to the assertion that only comatose patie...

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