860 e-Letters

  • 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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  • Back to Basics
    Macduff Ogwido

    Dear Editor,

    I would like to comment on the excellent article on use of abdominal ultrasonography in paediatric trauma. Much as I concur with the authors on the use of routine sonography and computed tomography,in the third world where I practise, clinical decisions have to be made in a different way - do we operate on this child or not? Hence, the greater reliance on clinical signs and 24hr expectant observation - wi...

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  • It was an accident - is it an Emergency?
    Patrick K Plunkett


    I think readers will be interested in the fact that the Medical Council (Ireland) recently approved a petition from the practitioners to change the name of the specialty from Accident & Emergency Medicine to Emergency Medicine, in line with international practice.

    All the consultants in the specialty in this country are FFAEM.

    You might wish to know that there were misgivings from t...

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  • Methodological problems in the study on deprivation and attendance at an A&E department
    Wai-Ching Leung


    Beattie et al found a trend towards increased attendance for the more deprived categories of children attending a children’s accident and emergency department. However, there are weaknesses in their study methodology.

    First, in calculating the proportion of population in each deprivation category, they included only true "first attenders" in the numerator but all children in the appropriate dep...

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  • Treatment of status epilepticus
    Dirk Ulbricht


    I agree with the conclusion that Lorazepam might be more effcient as first-line therapy for status epilepticus (SE) than diazepam but the case is not proven. The study by Leppik et al compares a commonly used strategy for the swift termination of SE. The study by Treiman et al. sets out to investigate a number of treatments but I am not aware of any European neurologist using phenytoin i.v. or phenobarbitone i.v...

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