J Emerg Med
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This case report illustrates an adult presenting with the simultaneous occurrence of both methemoglobinemia (MetHb) and systemic toxicity from the topical application of local anesthetics while undergoing laser epilation therapy of the legs. The concurrent development of both is considered uncommon in this setting and may have been related to several factors, including her recent previous treatment, increased absorption secondary to abraded skin with the addition of occlusive dressing, and possible alteration of protein binding and drug metabolism due to the use of medications. The clinical manifestations and mechanisms of MetHb and systemic local anesthetic toxicity are discussed.
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The objectives of the present study were to determine the behavioral and psychological risk factors associated with injury. The most widely investigated risk factor for injury is alcohol use. However, other behavioral and psychological risk factors may also contribute to injuries. ⋯ The results from a multivariate analysis controlling for age, gender, and ethnicity indicated that, in addition to alcohol consumption (OR = 2.2, 95% CI = 1.1-4.5), driving (OR = 2.4, 95% CI = 1.7-3.5) and violence-related risk behaviors (OR = 1.6, 95% CI = 1.0-2.2) are significantly associated with injury. In conclusion, the engagement in injury-related risk behaviors, including alcohol use, is strongly associated with injury status. Brief interventions that directly address these behavioral risk patterns in injured patients may reduce their risk of future injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training.
In a randomized, crossover study, we compared insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training. Ten registered nurses with no hands-on clinical experience of airway management and 100 anesthetized, paralyzed adults (ASA Status 1-2, aged 18-80 years) participated in the trial. Training comprised: 1) a 30-min didactic lecture; 2) a 3-min description of each of the insertion techniques; 3) a 3-min demonstration of each technique using a manikin; 4) 10 min of supervised training on the manikin with each technique. ⋯ There were no differences in performance among nurses. We conclude that insertion of the LMA-Unique is equally successful with or without digital intraoral manipulation by inexperienced personnel in paralyzed adults after manikin-only training. Successful insertion of the LMA-Unique does not require insertion of the finger into the patient's mouth.
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In 2000, a series of cases of necrotizing fasciitis (NF) among injection users of black tar heroin was observed in our Emergency Department (ED). The description of these cases characterizes the ED presentation of NF, focusing on the sensitivity of physical signs and ED diagnostic tests. All cases of pathologically determined NF in 2000 were prospectively and retrospectively identified and analyzed. ⋯ Thirty-seven percent of blood cultures and 75% of surgical wound cultures were positive, revealing a variety of organisms. Although tachycardia, leukocytosis, and elevated lactate levels are common in NF patients, fever and soft tissue gas are not. Tests and traditional teaching regarding the "classic" findings of NF should be amended to reflect differences seen in the setting of injection drug use with black tar heroin.