A patient presented after ingesting the contents of a lava lamp that he believed to contain alcohol. It was later discovered that this product was comprised of 76% calcium nitrate, leading to his subsequent development of methemoglobinemia. This disease is a medical emergency secondary to poor transportation of oxygen and resultant tissue hypoxic effects. Therefore, having high suspicion for this disease process in patients with toxic ingestions, understanding the proper diagnosis, and promptly starting treatment are all critical actions for emergency physicians.

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increase topical anesthetic use for peripheral intravenous line (PIV) placement for hospitalized pediatric patients from a mean of 11% to 40% by June 2019. Methods The project utilized the Model for Improvement. An institutional clinical pathway and PIV order set were developed. Pre-checked orders for anesthetics were added to order sets. Visual reminders for anesthetic and pathway use were placed on IV carts. Run charts were posted weekly on daily management system boards on each medical-surgical floor, and this data was shared at daily nursing huddles, to increase awareness of performance. Nurse managers provided individual feedback to nurses. Nursing scripting examples of how to discuss PIV placement and anesthetics with patients and families were placed on IV carts. Results Topical anesthetic use for PIV placement increased from a mean of 11% to 34%. Comfort measures during PIV placement increased from a mean of 6% to 13%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 60%. Conclusions This project has highlighted the importance of pain prevention for needle procedures and initiated culture change. We have nearly reached our goal and PDSA cycles are ongoing to further increase topical anesthetic use.