American journal of hospital pharmacy
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The development and maintenance of an organized system of emergency care in isolated ambulatory health-care centers are described. A system of three community health centers, staffed chiefly by midlevel practitioners (i.e., physician's associates and nurse practitioners), had a need to provide occasional emergency care to patients. Emergency care needed to be provided (for up to one hour) until an ambulance arrived to transport the patient to a hospital. ⋯ Weekly checks of the supplies and medications are conducted. Lists of supplies and medications stocked, and a sample drug monograph, are included in the paper. The program has resulted in more efficient emergency care, including less confusion in executing and documenting treatment.
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A case of methemoglobinemia secondary to topical local anesthetic agents is reported. A 28-year-old, 80-kg white man was admitted to a hospital for respiratory distress two days after an accident. During intubation, Cetacaine (benzocaine, butamben, and tetracaine) spray and Americaine (benzocaine) ointment were used topically for local anesthesia. ⋯ Abnormal hemoglobin variants and NADH-methemoglobin reductase deficiency were ruled out as sources of methemoglobinemia. A discussion of methemoglobinemia, including biochemistry, pathogenesis, symptomatology, and management, is presented. If cyanosis occurs following application of local anesthetics, methemoglobinemia secondary to these drugs should be considered in the differential diagnosis.