Application of topical analgesia in triage: a potential for harm.
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.
Shachor-Meyouhas
Yael
Y
Pediatric Department A, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel.
Galbraith
Roger
R
Shavit
Itai
I
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
D000779:Anesthetics, Local; D004791:Enzyme Inhibitors; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine; D008751:Methylene Blue