831 e-Letters

  • Dissociation of mortality at high levels of overcrowding (the death plateau)
    David Mountain

    I read Gilligans et als article with interest but was very surprised initially at their lack of association of "boarding" with increased mortality (1). I note in the discussion that they compared their findings with Richardsons and stated that they did not find a similar outcome (2). I would suggest that there are a number of reasons why this study did not find similar findings to Richardson or Sprivulis who found strong...

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  • Not Cas, not A&E but Emergency Medicine
    John M Ryan

    Nearly 20 years ago I was fortunate enough to be present in the Isle of Man when Tom Hamilton gave his prestigious Maurice Ellis lecture entitled Not Cas, not A&E but Emergency Medicine.

    Some years ago myself and one John Heyworth, now president elect of the College of Emergency Medicine, castigated the British Medical Journal for publishing a paper referring to 'casualty'. [1] How disappointing this month...

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  • In Support of Observational Pain Tools for Emergency Medicine Triage in Children
    Briar Stewart

    We read with interest this article by Shavit et al comparing the Alder Hey Triage Pain Score with a subjective scoring tool. The finding of a discrepancy in scoring between the tools, with the AHTPS scoring lower, is entirely consistent with the similar finding we reported in our paper (Archdischild.2004;89;625-630). The conclusion drawn by the authors that this indicates that observational scoring should not be recommend...

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  • Ethics and analgesia
    Giles N Cattermole

    We were interested to read the article by Amoli et at [1] confirming that morphine reduces pain in patients with acute appendicitis without affecting diagnostic accuracy. Although the trial was said to be carried out according to the Declaration of Helsinki [2], we were concerned that emergency department patients with a clinically convincing presentation of acute appendicitis sufficient to warrant booking for appendicect...

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  • productivity
    Benjamin Dean

    I read the study with interest but felt that there was no way of knowing what type of patient cases the productivity was being based on. By this I mean that it is very possible that the SHOs and FY2s saw different cases mixes, ie one saw more simple minor injuries than the other. Also I could not see a mention as to the varying experiences of the FY2s and SHOs, were the SHOs all first year SHOs and had some of them no...

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  • ''Productivity''
    Uma Selvarajah

    This is an interesting paper. I have wondered about the implication of FY2 doctors being in the emergency setting myself.

    As a FY2, I have ran most of the patients that i have clerked by a senior when I first started work. However at the end of the day there were no difference between the no. of patients that I saw and the no. that a ST2 saw.

    I also agree that on a busy day (in EAU), the registrars do p...

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  • Casualty Surgeons
    David Menzies

    Dear Sir,

    It is disappointing, in 2008, to still see our departments described as "casualty' in the journal of our new college.1 As a speciality, we have long since discarded this terminology. More recently, "Accident & Emergency" has also fallen out of use in favour of the more appropriate "Emergency Department".

    It is interesting that the case report in question is from a surgical departmen...

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  • How Deep Is Your Sedation?
    Natalie M Sibbald

    Dear Editor,

    We read with interest Vardy et al's “Audit of the safety and effectiveness of ketamine for procedural sedation in the emergency department” [1]. A point of concern was that 77% of patients in their sample received propofol, midazolam or ketamine at a dose that depressed their conscious level such that they were unresponsive to verbal stimulus (scoring "P" or "U" on the AVPU scale). Furthermore, 15....

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  • Look again! Delayed traumatic rupture of the diaphragm

    Dear Sir,

    Please find enclosed our article submitted to European Journal of Anaesthesia, which was presented as a poster in Euro anaesthesia conference in Copenhagen on 31 May 2008 and also published in their May supplement, including the images.( A.Arora, K.Kada, A.Ferguson; Look again! Delayed traumatic rupture of diaphragm radiologically simulating a pneumothorax; Eur J Anaesthesiology 2008; 25 (suppl 44): 1...

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  • A Seventy-Five Year Old Mistake
    Kent B. Seitzinger

    Since the early 1930's there has been a mistaken belief concerning what happens when the refrigerant gas, R-22, also known as chlorodifluoromethane, is exposed to high temperature heat sources. Admittedly, several compounds, including hydrogen fluoride (which then forms hydrofluoric acid when it comes into contact with water vapor in the air), hydrogen chloride (which then forms hydrochloric acid when it comes into conta...

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