eLetters

322 e-Letters

published between 2004 and 2007

  • Re: Death from paracetamol overdose despite appropriate treatment with N-acetylcysteine
    ruben hk thanacoody

    Dear Editor,

    The authors describe a case of fatal paracetamol overdose (4 hour paracetamol concentration 534 mg/L) despite initiation of N-acetylcysteine within 8 hours of ingestion.

    Although the cause of death was ascribed to paracetamol, several aspects of this case are not typical of paracetamol toxicity: 1) The early development of neurological symptoms (agitation, confusion and falling conscious l...

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  • Suspension Trauma in UK Climbers?
    David Hillebrandt

    Dear Editor,

    Although I do not have any experience of the industrial rope access industry I do have considerable personal experience of rock climbing, general mountaineering and ski mountaineering and a long term interest in mountain medicine over the last 35 years, so it was with interest that I read the paper by Lee and Porter (1) in the EMJ. They suggest that they have never seen a case of suspension trauma...

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  • GTN ingestion and autonomic balance
    Kaushik Sanyal K Sabanathan

    Dear Editor,

    Lowering of blood pressure is a reflex phenomenon after GTN ingestion.GTN is a nitric oxide donor The response is due to increase in cGMP level. The metabolic consequence of this bio activation depends on the chemical structure. This is a systemic arterial response, with some effect on the platelet aggregation but no expression of the adhesion molecule. The other hypothesis is that it activates ATP...

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  • Effective treatment of ACPO
    Dominic Williamson

    Dear Editor,

    I welcome Matthew Reed's article emphasising the role of nitrates in the emergency management of severe acute cardiogenic pulmonary oedema (ACPO). I also welcome his appreciation of the dead space involved in the use of any cannula, which so often seems to be ignored.

    ACPO occurs as a result of decompensation of the left ventricle initiating a circle of increasing preload, often with incr...

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  • Does separte sub-unit matter?
    Dhananjay Kumar

    Dear Editor,

    I agree with the findings of the study. My common sense says that If we have a reservoir having a capacity of 10 litres, even if we divide it into two compartments by a shelf, its capacity will remain 10 litres. Unless we increase the size of the reservoir we can not store more than 10 litres in to it.

  • upgauging of peripheral venous cannulae
    Dr Winston F de Mello

    Dear Editor,

    We would like to congratulate Harvey and colleagues on their study of upgauging peripheral venous cannulae in volume resuscitation.

    In late 1980's a similar technique was brought to our attention(WDM) by an obstetrician (Ian Page,MRCOG) who learned it from a senior obstretrician.For a major obstetric haemorrhage -gentle manual pressure was applied proximal to the intravenous peripheral can...

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  • The effects of altitude on endotracheal tube cuff pressures
    Philip D Kaye

    Dear Editor,

    Re: Mann C, Parkinson N, Bleetman A. Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport. Emerg Med J 2007;24:165-167

    The issue of endotracheal tube (ETT) cuff inflation in response to reduced barometric pressure at altitude has been recognised for a long time. The most recent study published in 2004 used pressure trans...

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  • response to Dr. Yasin's letter
    Siu Fai Li

    Dear Editor,

    We agree with Dr. Yasin's comment concerning clinical judgment in septic arthritis; it is most important in the assessment of a potentially septic joint, and should not be discounted in the light of "negative" ancillary tests. However, we would like to caution against the use of numerical cut-offs for "positive" and "negative" jWBC. There is considerable overlap in jWBC counts between patients with se...

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  • Will it change your management?
    Matthew Babirecki

    Dear Editor,

    As a paediatrician I have learnt that auscultation often adds little to my assessment of children with possible pneumonia. If the patient (adult or child) has other clinical features of pneumonia e.g hypoxia, pleuritic pain, tachypnoea, then a chest radiograph will probably be requested anyway.

    Interestingly the British Thoracic Society guidelines on Community Aquired Pneumonia in Adult...

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  • Suspension Trauma
    David S Whitmore

    Dear Editor,

    Thank you for your article which I found very interesting. I have undertaken some work in this area with a colleague of mine from the, now, South Western Ambulance Service NHS Trust, (Mr. David Halliwell). I was also asked to advise the National Scaffolding and Access Confederation (UK)(NASC) on the formulation of a "Rescue Plan" as required under the Working at Height Regulations. Having researche...

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