eLetters

835 e-Letters

  • 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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  • The Subjective Nature of BETs
    David Geggie

    Dear Editor,

    I am an avid reader of your Best Evidence Topic reports (BETS) section. In your November issue I was particularly interested to read the BET by Andrew Munroe on skull fractures and intracranial injury – particularly as I had recently presented a BET on the same subject in October.

    There were several striking differences between my BET and the one published in November. In particular I fin...

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  • Efficacy of magnesium sulphate
    Russell Boyd
    Dear Editor

    I was interested to read the published article concerning the use of IV magnesium in refractory VF [1]. However I am puzzled about the possible inclusion of episodes of torsades de point in the VF study group. The differentiation of torsades from VF in an ambulance must be extremely difficult and the text does not elucidate on the accuracy of monitor reading. Neither is mention made of any verification system for...

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  • 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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