Objective: Methanol poisoning by ingestion is well represented in current emergency medicine literature. Much less described, however, is poisoning via intentional inhalation of methanol-containing products such as carburetor cleaner. This study intends to explore the exposure routes and treatment patterns of methanol cases reported to Texas Poison Centers.

Methods: All cases of methanol exposures from January 2003 to May 2005 were collected from the Texas Poison Center Network database “Toxicall.” Inclusion criteria were 1) methanol as primary exposure, and 2) documented route of exposure. Exclusion criteria were unknown, dermal, and eye exposures. Data was extracted from documented calls to Texas Poison Centers and analyzed using descriptive statistics.

Results: A total of 203 cases were collected from 6 regional Poison Centers. Eighty seven cases had inhalation as the route of exposure, while 81 were methanol ingestions. Carburetor cleaner was responsible for nearly all the inhalational cases (79/87) while ingestions involved mostly windshield washer fluid (39/81) and carburetor cleaner (20/81). Seventy-eight percent of the inhalational exposures were intentional while most of the ingestions were accidental (49/75) and suicidal (18/75). An anion gap was documented in 31 of the inhalational cases and in 10 of the ingestions. Dialysis, use of fomepizole, and vision loss were documented for both types of exposure. Fifty-six percent of the inhalational group was admitted compared to 46% of the ingestion group.

Conclusion: We propose that the results obtained from our review show inhalational exposure involving methanol (e.g., “huffing”) represents a significant source of toxicity in the studied population. This is in contrast to previous literature that proposed inhalational toxicity was rare and aggressive treatment usually not necessary in cases of inhalation of methanol-containing carburetor cleaners.[WestJEM. 2008;9:150-153.]

Study Objective: Laryngeal mask airways (LMAs) are often used as airway rescue devices where laryngoscopy is difficult. The LMA does not protect the airway and is preferably replaced with a cuffed endotracheal tube. There are reports of cases where an Eschmann tracheal tube introducer (ETTI) was successfully used to bridge between a standard LMA and an endotracheal tube. This project was designed to determine whether an Eschmann stylet can reliably be passed through an LMA into the trachea as a means of rescue intubation.

Methods: Nineteen emergency medicine residents and attending physicians, who were participants in a cadaveric airway course, placed and inflated a size 4 LMA (The Laryngeal Mask Company Ltd., San Diego, CA) on each of six unembalmed human cadavers in the usual fashion. They then attempted to pass a lubricated, 15 Fr, reusable, coude-tipped ETTI (Portex, Smiths Medical, Keene, NH)) through the airspace/handle of the inflated LMA. The LMA was then deflated and removed while the ETTI was held in place. Investigators then determined the location of the ETTI by laryngoscopy.

Results: Of 114 attempts at the rescue procedure, 59 resulted in placement of the bougie into the trachea, yielding an overall success rate of 52% (95% CI 48%-56%). There were no significant differences in performance based on level of training of residents or years of experience of attending physicians.

Conclusions: While not a primary difficult airway option, the use of a ETTI as a bridge device between LMA and endotracheal tube was successful about 50% of the time. [West J Emerg Med. 2010;11:16-19.]

Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military’s health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.