title: Application of topical analgesia in triage: a potential for harm.
abstract: To reduce the overall time spent in the ED, triage nurses are encouraged to treat patients with a topical anesthetic cream, eutectic mixture of local anesthetics (EMLA). We present a case in which a 28-day-old neonate who was treated with EMLA cream in triage developed severe methemoglobinemia 18 hours post admission to the pediatric ward. This case demonstrates that there may be some risks associated with this approach, and that protocols for the use of EMLA at triage should include not only the indications for its use, but also need to ensure that there is a process to have the EMLA removed before patient discharge or transfer.
authors.affiliation: Pediatric Department A, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Shachor-Meyouhas
authors.forename: Roger
authors.initials: R
authors.lastname: Galbraith
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D016529:Emergency Nursing; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D000077442:Lidocaine, Prilocaine Drug Combination; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D008751:Methylene Blue / Q000627:therapeutic use; D011318:Prilocaine / Q000008:administration & dosage / Q000009:adverse effects*; D014218:Triage / Q000379:methods
chemical_list: D000779:Anesthetics, Local; D004791:Enzyme Inhibitors; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine; D008751:Methylene Blue