844 e-Letters

  • Seniors for minors, juniors for majors: an unbalanced and dangerous equation
    M Sakr
    Dear Editor,

    I read the article titled "The management of minor injuries- a personal view" and while I agree with the author on the title, I believe that the contents are very biased and unrealistic. Of course the author is entitled to give his views but in the era of evidence-based medicine nobody can deny the evidence and antagonise all the research results because simply he "does not like it".

    Throughout the arti...

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  • The care of minor injuries
    S C Brooks

    Dear Editor,

    I write in support of the article by Alan Leaman in the EMJ Supplement January 2001

    I agree with him completely that the care of minor injuries is one of the skills of the A&E department and one in which Consultants should and do have a considerable expertise. The focus has for a long time been on improving the care of the major injuries which present to our department. Although obvio...

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  • Indicators of mortality from meningococcal disease
    Sérgio de Andrade Nishioka

    Dear Editor,

    Dr Riordam's study on promptness of antibiotic treatment for meningococcal disease revealed that "door to needle" time to administration of appropriate antibiotic for children decreased clearly from before to after a teaching intervention was given to nurses and doctors.[1] That this decrease occurred only for the children who had typical rash on arrival is not a surprise, given that the interventi...

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  • Re: Methodological problems in the study on deprivation and attendance at an A&E department
    T F Beattie
    Dear Editor

    Dr. Leung's first comment relates to our method of calculating the proportions of child attenders in each deprivation category. The numerator we use to calculate each proportion is based on the number of first-time attenders, while the denominator represents the total population in each category. Dr. Leung argues that the proportion of children who were 'at risk' of being first attenders will be lower in the de...

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  • Earlier examples of intraosseous drug and fluid administration
    Eskil Dalenius

    Dear Editor,

    In his article, Dr Foëx sketched the history of intraosseous drug and fluid administration, citing Tocantins and co-workers as the pioneers of this technique. In all fairness, however, it should be pointed out that this method was indeed described, and used clinically, even earlier than that. In fact, one of the pioneers in this field, Henry Turkel, traces the experimental studies of the bone marrow...

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  • A valuable lesson is reiterated
    Nick W Emms
    Dear Editor,

    Further to the case report presented by Carter and Wilby (Emerg Med J 2000 17:387) where a valuable lesson is demonstrated regarding overlooking lisfranc fractures in the presence of polytrauma, we would like to add to this a patient we encountered in order to emphasize the point.

    A 27-year-old male was admitted following a road traffic accident where the patient riding a motorcycle collided with a car...

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  • Re: Use 10mg of naloxone before abandoning resuscitation of cardio-respiratory arrest caused by opia
    Alison Walker
    Dear Editor,

    While it is reasonable to use large doses of Naloxone as described in the BNF (the maximum dose recommended is 10mg), the National poisons information service recommend that dose is titrated to response. Naloxone however, has also been attributed to improving GCS in gamma-hydroxybutyrate and alcohol overdoses.

    Large doses of opiate antagonists may be used in simple opiate overdose, however it was not cle...

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  • Use 10mg of naloxone before abandoning resuscitation of cardio-respiratory arrest caused by opiate
    David Wise
    Dear Editor,

    We read with interest and some sympathy the recent case report by Walker et al of an apparent 'Lazarus' phenomenon in which spontaneous circulation unexpectedly returned after abandoning resuscitation of a patient believed to have taken an opiate overdose [1]. In common with inner-city Emergency Departments the world over, heroin overdoses make up a significant proportion of our workload. It is establis...

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  • Is fasting necessary for ESR estimation ?
    Saroj K Mishra

    Dear Sir,

    I read with interest the article by Drs Boyd and Martin (Emerg Med J 2001; 18:212-213). This article needs to be read by all doctors working in hospitals of developing countries. ESR as a single test is advised in many conditions and the importance attached to it is well known. In emergency as well as outpatient practice, the test is ordered very often.

    Another point of concern is the strictness...

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  • Management article
    Geoff Hughes

    Some responses to the in tray problems at St Judes

    (1) Dear Chief Executive,

    Thank you for welcoming me to the trust. I look forward to working with you in solving the many problems challenging the Emergency Dept (a term I refer to as Casualty). I'd be grateful if your PA can arrange our meeting urgently. I'd like to know from you where the ED and its service fit in with the strategic direction of the Tr...

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