eLetters

831 e-Letters

  • Weaknesses in the flowchart
    Andrew B Rowlands

    Dear Sir,

    The flowchart to guide management in paracetamol overdose, by Wallace, Dargan and Jones (EMJ Vol 19 No.3 p202) was presented at our weekly Journal Club and generated some thoughts and observations.

    Along the "Single" overdose pathway for "Low risk" patients the guideline suggests that if the ingested dose of "< 150mg paracetamol per kg or UNKNOWN" the patient can be discharged. Presumab...

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  • Airway management in the emergency department
    Matthew Williams

    Dear Editor

    We would like to congratulate Nolan and Clancy on their editorial addressing a controversial area.[1] We would like to comment on some of their points and add a few thoughts of our own.

    Notwithstanding our experience that there is rarely a significant delay in attendance to the emergency department (ED) by anaesthetists/intensivists, we agree that there is likely to be an increase in emer...

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  • Failed intubation drill: a necessity
    Fiona J Macfarlane

    Dear Editor

    As an anaesthetist, I read with interest the article by Carley and colleagues regarding the necessity of having a drill for failed intubation in the Emergency Department. A drill is essential and should be actively taught and practised.

    The algorithm you have developed is very similar to those used in anaesthetic practice, but I wish to highlight a few points. The use of the gum-elastic bougie...

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  • Re: Indications for CT head in minor head injury in children
    Andrew R Munro

    Dear Editor

    The Emergency Department management of minor head injury in children is an area of intense debate. It is encouraging that the BET (Best Evidence Topic) on indications for Computerised Tomography (HCT) in minor head injury in children published in November’s issue has stimulated further discussion.

    In his letter of criticism, Dr McCann expresses concern over the omission of a review article on...

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  • Re: The subjective nature of BETs
    Andrew R Munro

    Dear Editor

    The Best Evidence Topic published in November 2001 on absence of skull fracture failing to predict intra-cranial injury (ICI) as determined by head CT (HCT)[1] has provoked criticism on the methods used to find a clinical bottom line.

    Dr Geggie states that he produced a BET on the topic that appears not to contradict the findings of the published result, but that there is perhaps an unaccept...

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  • Psychiatric evaluation in acute poisoning
    Alan E O'Connor

    Dear Editor

    I would like to complement Wallace et al. for there production of a useful and user friendly algorithm for the management of paracetamol poisoning.[1] However, I would like to suggest that the addition of an acute psychiatric evaluation in patients who present with intentional overdose would greatly enhance the usefulness of the algorithm in the emergency department environment. This evaluation sh...

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  • RSI by non-anaesthetists in the UK - lower incidence of cricothyrotomy than in the US
    Cliff Reid

    Dear Editor

    Dr Carley and colleagues have produced invaluable and highly practical failed intubation guidelines for emergency physicians using RSI. They highlight the emergency department cricothyrotomy rate in the United States of 0.5-1.2%, and the lack of comparative United Kingdom rates, which are thought to be lower.

    As part of a prospective study of emergency airway management by intensive care doctors...

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  • PHEC course
    Daniel J Campion

    Dear Editor

    I look forward to taking a look at this book as I suspect it is much needed! I would also agree that the ALS course is not tailored particularly well to the pre-hospital environment. The proposed "prehospital ALS" does already exist, however, in the form of the Pre Hospital Emergency Care course run by the faculty of pre-hospital care of the RCS Edinburgh (check...

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  • Indications for CT Head in minor head injury in children.
    Brendan D McCann

    Dear Editor

    In "best BETs" of november 2001, regarding indications for head CT in children with mild head injury [1], Dr Munro makes no mention of the labours of Schutzman et al who sought to address this issue in the younger than 2 years age group. An expert panel drew evidence from 404 articles in total and presented their findings as "guidelines for the evaluation and management of children less than 2 with appa...

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  • Fast Track streams may worsen workload.
    Garry M Clearwater

    Dear Editor

    The authors have done well to show that allocating staff resources to a Fast Track stream can shorten waiting times without adversely affecting higher-acuity care. However, the duration of the study may have been too short to detect a secondary effect of worsening workload in the medium and long term.

    Emergency Departments (EDs) provide a highly attractive option for patients in the community:...

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