J Emerg Med
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Button batteries can cause local tissue necrosis within 2h of exposure due to hydrolysis of tissue fluid and generation of hydroxide ions. Tissue damage resulting from battery exposure has been associated with acute and chronic complications via several routes, however, previous experience with ocular battery exposures is predominantly limited to batteries that have exploded or penetrated the eye. ⋯ Prolonged ocular exposure to an intact battery can cause significant tissue necrosis, which may threaten sight. Early removal is critical to prevent significant ocular damage and visual compromise.
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Bell's palsy is the most common acute mononeuropathy, with an incidence of 20 to 30 cases per 100,000 people per year. ⋯ Although very rare, physicians should be aware of the existence of Bell's palsy associated with blepharospasm, as it may be under-reported.
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Controversy exists regarding the need for contrast agents for emergency abdominal computed tomography (CT). ⋯ Contrast practices for abdominal/pelvic CT vary nationally, according to a survey of US academic EDs. For multiple indications, the contrast practices of a substantial number of respondents deviated from those recommendations given the highest clinical appropriateness rating by the American College of Radiology.
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The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. MPDS is a computer-based EMD system that uses callers' responses to scripted questions to categorize cases into groups and subgroups, based on complaint and perceived acuity. ⋯ Medications were administered in 19% of all calls. There were higher rates of ALS interventions in higher-acuity categories that were not observed in many other categories.
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Chlorate poisoning as a cause of methemoglobinemia is regarded in current literature to be resistant to treatment by methylene blue due to the oxidizing and denaturing properties of the chlorate anion, and often leads to severe renal and hematological complications with a high mortality rate. Recent case studies suggest practitioners have eschewed the use of methylene blue in such situations. ⋯ The successful outcome in our case suggests that a window of opportunity as long as 6 h may exist during which treatment of chlorate poisoning with methylene blue may be of clinical value. We postulate that the absence of significant hemolysis and hematological alterations at the time of antidote administration may be a necessary prerequisite for treatment success.