How safe is acetaminophen? Some practical cautions with this widely used agent

Local Anesthetic-Induced Methemoglobinemia During Transesophageal Echocardiography

We report a case of methemoglobinemia that occurred following topical benzocaine spray to the throat, leading to cancellation of the transesophageal echocardiography (TEE) procedure. Since the condition is potentially fatal, increased awareness of this disorder should result in its early recognition and treatment.

Poisoning in children: an approach for the primary physician

Poisoning continues to be one of the major causes of mortality and morbidity in young children. The Product Safety Packaging Act needs to be expanded to cover toxic agents and drugs known to be involved in the majority of ingestions. Those agents that are particularly toxic will require more stringent measures than safety packaging. The primary physician is in the position to institute rapid and appropriate therapy for most poisoning. Consideration of poisoning in making a presumptive diagnosis and early institution of general supportive measures are critical. Familiarity with techniques of gastric emptying and with use of activated charcoal and naloxone as antidotes is essential, as is s knowledge of when to refer patients for specialized care. By educating parents about poison proofing the home and about appropriate first aid measures, the primary physician can play an important role in poison prevention.

Hyperpyrexia (temperature greater than 40 C) in children

A total of 516 charts of children who presented to the Oklahoma Children's Memorial Hospital Emergency Department or Walk-In Clinic with a temperature of 40 C(104 F) or more were reviewed. The findings were consistent with the concept that high fever in children is most often associated with common illnesses such as upper respiratory tract infections, otitis media, pneumonia, acute gastroenteritis, urinary tract infection, etc. There were only 22 (4%) admissions from the entire group and one death, actually due to delay in seeking medical help. The incidence and recurrence of febrile seizures (24 cases) was related to the use and compliance with anticonvulsant drugs rather than antipyretic measures. Appropriate laboratory work, x-rays and cultures should be done only when consistent with clinical findings. Follow-up can be done without hospitalization or antibiotics, as most children have a benign illness. The need for treatment of the underlying cause of the fever should, of course, remain the paramount goal. With proper parental guidance and education, the use of traditional methods of lowering fever can be discouraged.