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Hi Steve:

Read your article with interest in the NEJM. Well done!! It will serve as an
excellent resource for all PEM practioners.

BTW, read your response to Dr. Bell on the pediatric anesthesia list server.
I fully support your stance. I suspect you will have an opportunity to
respond formally with a letter to the editor in the near future.

In my hospital, our group performs around 400 procedural sedations annually,
with an impeccable safety & efficacy record, that we are proud of. This is
reflective of the "sedation record" across the nation [ refer to your
"ketamine" data and the recent data by Pena & Krauss in the Annals of EM on
adverse events with PED sedation]. In fact, our orthopedists and surgeons
prefer performing sedations in the ED for brief emergency procedures!!

It in no way diminishes the role of our subspecialty colleagues. However,
the fact is, we manage clinical emergencies, as well, if not better, with
excellent patient satisfaction.

Folks need to recall, that our specialty evolved because there was a
tremendous need for higher quality patient care in the "frontline", than was
being provided by "fly by night" sub specialists/general practitioners.

Thanks again

Jay
Jay Pershad, MD
Asst. Professor
PEM
LeBonheur Children's Medical Center

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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html