eLetters

829 e-Letters

  • Positive Ottawa ankle rules with normal radiographs in children: what next?
    Gurpreet Singh-Ranger

    Dear Editor,

    In their best evidence report, Yuen et al conclude that the Ottawa Ankle Rules will become applicable to pre-school children [1]. From the studies mentioned it is indeed likely that they will become a useful addition to the clinician’s diagnostic armamentarium for ankle injury in this age group.

    It is of note however, that despite positive Ottawa Ankle Rules, subsequent ankle radiographs...

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  • Lack of use of anaesthetic in arterial blood sampling
    Sam Waddy

    Dear Editor

    I performed a similar literature search two years ago and came to the same conclusion that in the semi-elective setting (rather than time critical emergencies) the use of local anaesthetic with an appropriately small needle should make the procedure less painful and no more difficult – particularly relevant in COPD and asthma when patients may be subjected to multiple punctures during an admission. I fo...

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  • Improving waiting times.
    Angela C Dancocks

    Dear Editor

    I was interested to read the article on the effect of separate streaming for minor injuries by Cooke et al as we have recently introduced a similar system with similar results. In our department all ambulatory attendees are seen on arrival by a doctor and a nurse or a nurse and a nurse practitioner together. Patients who need simple advise or treatment are seen, treated and discharged from two room...

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  • Flumazenil is contraindicated in mixed tricyclic and benzodiazepine overdose
    Richard M Lynch

    Dear Editor

    I read with interest Kerr et al’s highly informative article, Tricyclic antidepressant overdose: a review.[1] However, I would like to highlight an important point which the authors have not mentioned. In cases of mixed overdose, of tricyclic antidepressants and benzodiazepines, flumazenil (Anexate) is contraindicated. It has produced convulsions and ventricular arrhythmias in the presence of tricyclics....

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  • Tricyclic antidepressant overdose
    Cathy Kelly

    Dear Editor,

    Kerr et al[1] point out in their review that despite the introduction of newer antidepressant agents in recent years, a large number of prescriptions for tricyclic antidepressants are still issued. Data from our unit suggests that overdose with selective serotonin re-uptake inhibitors (SSRIs) has now become more common than with tricyclic antidepressants. Despite this, there were 4981 accesses to i...

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  • Mark Simpson

    Dear Editor

    The excellent editorial written by Carl Gwinnut raises important issues regarding airway care of critically ill patients at the interface between anaesthetics and emergency care medicine.[1] The conclusion of the editorial suggested airway management in an emergency department is dependant on the available personnel and resources present, and that a co-ordinated approach is beneficial. As General Prac...

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  • Critical care in the Emergency Department
    John M Butler

    Dear Editor,

    I was encouraged by reading the excellent articles by Gwinnutt [1], Nightingale [2] and Shelley [3] in the Critical Care edition of the EMJ. Emergency Departments routinely receive critically ill/injured patients, a proportion of which will ultimately require admission to an intensive care unit. Effective interfacing between A&E departments and critical care units is essential to achieve the optimal...

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  • Homelessness adds another dimension
    Pamela Logan

    Dear Editor

    I read with interest the paper on repeated use of the emergency department by some patients. Like the authors I carried out a qualitative study looking at use of the emergency department, focusing however on the use made by homeless families for minor illnesses within the UK. To explore the reasons underlying the reason to attend, I interviewed 10 families living in temporary accommodation (mainly...

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  • The Spaso technique: is it an improvement ?
    Kelvin D Wright

    Dear Editor,

    I read with interest the article by Yuen et al[1]. Anterior shoulder dislocation accounts for a significant proportion of joint injury in emergency medicine and any technique that improves our care for these patients is to be welcomed. The authors state that the technique is easily learned by senior house officers and this certainly is important. Often the patient is seen by a junior doctor when se...

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  • John Ryan

    Dear Editor

    It seems that the authors of this paper were surprised to find such an elevated phenytoin level. A few questions sprung to mind:

    1) Did they repeat the level ?
    2) Are they sure this level was before the phosphenytoin was commenced?
    3) Was the patient symptomatic of phenytoin toxicity prior to being found seizing? One would have suspected ataxia and nystagmus e...

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