key: cord-0009119-txc0s6ra
authors: Tan, Jennifer H.; Weber, Ellen J.
title: SARS decision rule: who's a suspect?
date: 2004-07-23
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2004.01.038
sha: ffd3606ed51d3129db5863b2246ec587e07323c8
doc_id: 9119
cord_uid: txc0s6ra

nan

In our patient, the defibrillator was automatically programmed to lead II. During the initial synchronized cardioversion, the device was synchronized to the T wave and this resulted in ventricular fibrillation ( Figure 3A ). This demonstrates the importance of careful lead selection.

The current guidelines for advanced cardiac life support recommend checking additional leads on the device monitor when there is difficulty in identifying the morphology of the rhythm. 5 In an emergency situation, the exact characteristic of the ECG tracing on the monitor screen of the defibrillator is commonly overlooked. If at all possible, a lead with a prominent R wave should always be selected. 

To the Editor:

We read the article by Wang et al 1 in the January 2004 issue of Annals with interest. However, we have concerns regarding the inclusion criteria used in the study. The Methods state that the population included was those who met the World Health Organization (WHO) definition for suspected severe acute respiratory syndrome (SARS) cases. The WHO criteria for suspected cases at the time of your study included fever, coughing or breathing difficulty, and one of the following: close contact, travel, or residing in an area with recent transmission of SARS within 10 days before the onset of symptoms. We understand that Taiwan became an endemic area just around the time of your study, and thus may not yet have been factored into your inclusion criteria. However, in Table 1 , 42% of the patients without SARS did not have a history of travel or exposure, and in Table 3 , 73% of the SARS patients and 40% of the non-SARS patients had no history of exposure or travel. Assuming that the inclusion criteria are patients who meet the WHO criteria for suspected cases, how could some of the patients in the study have no history of exposure? We would appreciate your clarification of this seeming incongruity. In reply:

We appreciate the comments by Dr. Tan and Dr. Weber. When the community outbreak occurred in Taiwan, it was difficult for us to clarify whether the patients had had 

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