Annals of emergency medicine
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We describe the case of an adolescent girl who received high-dose metoclopramide in combination with oral N-acetylcysteine therapy for acute acetaminophen toxicity. Whole blood-sample analysis for abnormal hemoglobin pigments established the diagnosis of sulfhemoglobinemia. ⋯ Although N-acetylcysteine alone has not been associated as the cause, we suggest that sulfhemoglobinemia is a potential complication in patients treated with metoclopramide for the nausea that often accompanies oral N-acetylcysteine therapy for acetaminophen toxicity. Cyanosis without respiratory distress should suggest this diagnosis.
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To conduct an economic analysis of the implementation of the Ottawa Knee Rule. ⋯ Implementation of the Ottawa Knee Rule Would be associated with meaningful reductions in societal health care costs both in the United States and Canada without a reduction in quality of care.