Clinical Presentation and Outcome of Multiple Rare Earth Magnet Ingestions in Children of Qatar. A Single-Center Experience.

INTRODUCTION: Rare earth magnets are powerful magnets that can have several negative effects if ingested. The goal of our study is to describe the result of multiple rare earth magnets ingested by children in Qatar. MATERIALS AND METHODS: This is observational research. We conducted a retrospective chart review and descriptive analysis of all cases of multiple rare earth magnetic ingestion that werepresented to the Emergency Department of Sidra Medicine between January 2018 and July 2022. We obtained an exemption for this study from our institutional review board (IRB). RESULTS: In our research, we identified 21 children having multiple rare earth magnetic ingestions. The predominant symptoms were abdominal pain and vomiting which were observed in 57% (n = 12) and 48% (n = 10) of the patients respectively. The most common sign was abdominal tenderness,observed in 14% (n = 3) of the patients. In our sample, 38% (n = 8) of the patients were managed conservatively whereas 62% (n = 13) needed intervention. In our study, 48% (n = 10) of the patients sustained complications. The frequent complications were intestinal perforation appreciated in 24% (n = 5) and intestinal perforation with fistula formation in 19% (n = 4) of the patients. The median age of these patients was two years while the median number of magnets ingested was six. The ingestions were unwitnessed, and the duration of ingestions was unknowninthemajorityofpatientswhoexperiencedcomplications (n = 8/10). CONCLUSION: If numerous rare earth magnetis ingested, children are in high danger of harm. It can be difficult to pinpoint the cases in younger children due to poor communication skills, especially if the intake is unreported. Although Qatar has established restrictions banning the import of rare earth magnets, there are reported cases of children with rare earth magnets ingestions.

Acquired Methemoglobinemia in an Infant: Consequence of Prolonged Application of Eutectic Mixture of Local Anesthetics (EMLA) Cream for Spontaneous Abscess Drainage.

Topical anesthetics are commonly used in emergency departments. One of the side effects can be methemoglobinemia if not appropriately used. We present a case of a six-week-old baby who developed methemoglobinemia with levels of 30.6% after prolonged (15 hours) application of Eutectic Mixture of Local Anesthetics (EMLA) cream. The cream was applied for spontaneous drainage of a perianal abscess. The patient received IV methylene blue with a resolution of methemoglobinemia.

Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature.

BACKGROUND: Extremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown. OBJECTIVE: The aim of this review was to establish an evidence-based consensus for the management of extremity ischemia after jellyfish envenomation. METHODS: A systematic review of cases of extremity ischemia and necrosis after envenomation by marine cnidarians was performed to clarify what is and what is not known about management and outcomes, to draw conclusions about how best to manage these rare presentations, and to establish an evidence-based algorithm. RESULTS: The ischemic sequelae of envenomation typically evolves over a few days. Close medical supervision is necessary to react promptly to the evolving clinical scenario. In the literature, 15 different pharmacologic classes have been used to manage these presentations. Only IV infusions of prostaglandin derivatives and intra-arterial thrombolytics have been found to improve the clinical picture and avoid the need for surgical fasciotomy and debridement in some cases. Anticoagulants, antiplatelet agents, steroids, antibiotics, and nitrates, which are among the most commonly prescribed pharmacologic agents, have not been observed to alter the clinical picture. CONCLUSIONS: Surgery for compartment syndrome and necrosis are common sequelae of extremity envenomation by marine cnidarians. Only prompt use of IV prostaglandins or intra-arterial thrombolytics can halt ischemic progression and avoid the need for surgery. An algorithm is proposed to guide management of these rare and mutilative presentations.

Developing Adult Sepsis Protocol to Reduce the Time to Initial Antibiotic Dose and Improve Outcomes among Patients with Cancer in Emergency Department.

OBJECTIVE: Sepsis is a common cause of noncancer-related deaths among oncology patients. Delay in the initiation of efficient antimicrobial therapy will decrease the survival rate. This study aims to develop a sepsis protocol for adult oncology patients to decrease the time needed to receive the initial dose of antibiotic in an emergency department (ED), improve the early recognition of sepsis, and decrease the in-hospital mortality rate due to sepsis. METHODS: A quasi-experimental research design was used. A total of 168 participants were assigned into pre- and post-intervention groups (n = 85) and (n = 83), respectively. The quick Sequential Organ Failure Assessment screening tool was used to screen patients in the triage room. RESULTS: There was a significant difference in the proportions of receiving the initial antibiotic dose whether ≤1 h or >1 h between pre- and post-intervention groups. The results also showed that 89.4% of the postintervention group received their initial antibiotic dose in <1 h compared with 10.8% of the preintervention group. The median time needed for administering the initial antibiotic dose was decreased from 95 min to 45 min. The results of the changes in mortality rates are promising as it decreased 11.7% after applying the adult sepsis protocol. CONCLUSIONS: Applying an adult sepsis protocol in the ED significantly decreased the time needed to initiate antibiotic treatment. It is recommended to utilize a multidisciplinary and systematic approach in screening and treating sepsis.