eLetters

831 e-Letters

  • Increasing the use of the fascia iliaca compartment block for patients with a fractured neck of femur: a quality improvement project
    Andrew J. Tabner
    We read with interest the article by Rashid et al (1) documenting current UK practice with regards to hip fractures (HF) and regional analgesia (RA); only 44% of their respondents reported local use of RA for this indication. The two main reasons highlighted were lack of equipment availability and lack of staff training; they therefore suggest that an appropriate protocol, a "Hip Block Box", audit and staff training may i...
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  • The intubating laryngeal mask airway: What is there not to like?
    Andrew M. Mason

    I was interested to read the paper by Castle & Naguran describing use of the intubating laryngeal mask airway (iLMA) in an entrapped patient [1]. The authors might be interested to know that I have also used the iLMA in the treatment of trapped trauma patients [2][3], and their case bears striking similarities to the ones that I encountered. Their report provides further evidence of the efficacy of the iLMA in trapped...

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  • Thoracic ultrasound may be a solution
    Hsiangwen Liu

    I agree with the authors that using the guidelines may not avoid subdiaphragmatic viceral injuries. First, many underlying diseases could alter the thorax shape and the diaphragm position. Second, in patients using positive mechanical ventilation support, many different ventilatory strategies, such as lung recruitment strategy, can alter the diaphragm level. Moreover, among some special groups of patients, such as patie...

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  • Zero numerators and the illusion of safety
    Alistair Maddock
    Kaye and Govier's case series of propofol sedation for DC cardioversion 1 provides a useful contribution to the relatively evidence-light area of Emergency Department (ED) sedation. I would, however, urge caution in their conclusion that propofol is a "safe" drug for the uses they describe.

    Safety is obviously relative but, in the grand scheme of things, their series of 111 patients is small. The statistical "...
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  • Emergency Department ECMO and Echo - better together?
    Paul R Atkinson

    As highlighted by Chou et al[1] it is becoming more evident that extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) is feasible and compares well against conventional CPR. As technologies such as ECMO[2] and echocardiography (Echo),[3] previously limited to intensive care units and cardiology suites, become increasingly available in the Emergency Department (ED), it is important that w...

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  • Just to clarify
    Andrew Baillie

    A number of comments have been made to me regarding this article since it was published. I would like to take this opportunity to clarify that the experiences described did not occur whilst working at North Tees University Hospital. This is where I currently work as a higher trainee in Emergency Medicine. I am keen that the contents of the correspondence address do not overshadow the key message of the article.

    C...

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  • Lack of evidence to support use of D-dimer in pregnant women with a suspicion of pulmonary embolism
    Mathilde Nijkeuter

    The authors state that current evidence supports the use of a negative D-dimer to rule out a suspicion of pulmonary embolism (PE) in pregnancy. They show in Table 2 5 relevant studies to support their conclusion. However, the study of Damodaram was the only study that included patients with a clinical suspicion of venous thromboembolism, thus including pulmonary embolism. All other 4 studies included either healthy preg...

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  • The Psychological Effect of Ebola on ED Staff
    Gab Lantos

    Now 11+ years since SARS, it would be interesting to repeat this study post Ebola... Are staff any better prepared for a highly contagious, fatal disease?

    Conflict of Interest:

    None declared

  • Sepsis Six: Are we doing the right thing?
    FERGUS W HAMILTON

    Dear Editor,

    The "Sepsis Six" resuscitation bundle is now common in UK hospitals, and endorsed by the College of Emergency Medicine, SIGN guidelines, and the Royal College of Physicians.1-3 However, the evidence behind it remains limited and must be re-evaluated as new data emerges - especially since the results of the PRoCESS and ARiSE trials on Early Goal Directed Therapy (EGDT) were published this year.4,5...

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  • Different populations, overall cost increase
    Timothy RJ Parke

    Sir I find the methodology for this paper to contain a significant flaw in that the triage criteria used to determine suitability for the GP unit contain a requirement that the patient will need minimal additional resources for them to be processed. It is hardly surprising therefore that the post intervention analysis sees fewer additional resources subsequently spent on this group with the associated savings.

    ...

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