Dental Emergencies.

Dental emergencies present frequently to the emergency department and urgent care centers. Trauma to the teeth includes fractures, luxations, and avulsions, which can be reduced in most cases. Avulsed primary teeth should never be replaced. Mouthguards should be worn in most youth sports to prevent many dental injuries. Dental caries can progress to worsening infection and should be diagnosed and promptly referred. More severe infections may require antibiotics, imaging, or incision and drainage. Dental blocks can assist with analgesia and patient comfort during other procedures.

The influence of environmental conditions on kinetics of arsenite oxidation by manganese-oxides.

BACKGROUND: Manganese-oxides are one of the most important minerals in soil due to their widespread distribution and high reactivity. Despite their invaluable role in cycling many redox sensitive elements, numerous unknowns remain about the reactivity of different manganese-oxide minerals under varying conditions in natural systems. By altering temperature, pH, and concentration of arsenite we were able to determine how manganese-oxide reactivity changes with simulated environmental conditions. The interaction between manganese-oxides and arsenic is particularly important because manganese can oxidize mobile and toxic arsenite into more easily sorbed and less toxic arsenate. This redox reaction is essential in understanding how to address the global issue of arsenic contamination in drinking water. RESULTS: The reactivity of manganese-oxides in ascending order is random stacked birnessite, hexagonal birnessite, biogenic manganese-oxide, acid birnessite, and δ-MnO2. Increasing temperature raised the rate of oxidation. pH had a variable effect on the production of arsenate and mainly impacted the sorption of arsenate on δ-MnO2, which decreased with increasing pH. Acid birnessite oxidized the most arsenic at alkaline and acidic pHs, with decreased reactivity towards neutral pH. The δ-MnO2 showed a decline in reactivity with increasing arsenite concentration, while the acid birnessite had greater oxidation capacity under higher concentrations of arsenite. The batch reactions used in this study quantify the impact of environmental variances on different manganese-oxides' reactivity and provide insight to their roles in governing chemical cycles in the Critical Zone. CONCLUSIONS: The reactivity of manganese-oxides investigated was closely linked to each mineral's crystallinity, surface area, and presence of vacancy sites. δ-MnO2 and acid birnessite are thought to be synthetic representatives of naturally occurring biogenic manganese-oxides; however, the biogenic manganese-oxide exhibited a lag time in oxidation compared to these two minerals. Reactivity was clearly linked to temperature, which provides important information on how these minerals react in the subsurface environment. The pH affected oxidation rate, which is essential in understanding how manganese-oxides react differently in the environment and their potential role in remediating contaminated areas. Moreover, the contrasting oxidative capacity of seemingly similar manganese-oxides under varying arsenite concentrations reinforces the importance of each manganese-oxide mineral's unique properties.

Recurrent respiratory depression associated with fentanyl transdermal patch gel reservoir ingestion.

BACKGROUND: Opioid abuse is common in the United States and is currently on the rise. Fentanyl transdermal patches (FTPs) have been on the market since 1991, and have recently become a popular source of opioids for abusers. There are currently two distinct FTP designs available on the market today; a gel reservoir system and a matrix construct. The gel reservoirs of FTPs contain massive amounts of fentanyl and are easily extractable for abuse. Ingesting the gel reservoir of an FTP is potentially lethal. CASE SERIES: In this case series, 4 patients ingested the gel reservoir of an FTP and experienced severe and recurrent respiratory depression necessitating continuous naloxone infusions. All patients responded adequately to initial prehospital doses of naloxone (0.8-2 mg intravenous) but developed recurrent respiratory depression within 2 h of presentation to the hospital. CONCLUSION: The gel reservoir of an FTP contains massive amounts of fentanyl. Ingestion of the gel may cause severe and recurrent respiratory depression necessitating repeated naloxone boluses, continuous naloxone infusion, and a prolonged observation period.

Quantification of rapid environmental redox processes with quick-scanning x-ray absorption spectroscopy (Q-XAS).

Quantification of the initial rates of environmental reactions at the mineral/water interface is a fundamental prerequisite to determining reaction mechanisms and contaminant transport modeling and predicting environmental risk. Until recently, experimental techniques with adequate time resolution and elemental sensitivity to measure initial rates of the wide variety of environmental reactions were quite limited. Techniques such as electron paramagnetic resonance and Fourier transform infrared spectroscopies suffer from limited elemental specificity and poor sensitivity to inorganic elements, respectively. Ex situ analysis of batch and stirred-flow systems provides high elemental sensitivity; however, their time resolution is inadequate to characterize rapid environmental reactions. Here we apply quick-scanning x-ray absorption spectroscopy (Q-XAS), at sub-second time-scales, to measure the initial oxidation rate of As(III) to As(V) by hydrous manganese(IV) oxide. Using Q-XAS, As(III) and As(V) concentrations were determined every 0.98 s in batch reactions. The initial apparent As(III) depletion rate constants (t < 30 s) measured with Q-XAS are nearly twice as large as rate constants measured with traditional analytical techniques. Our results demonstrate the importance of developing analytical techniques capable of analyzing environmental reactions on the same time scale as they occur. Given the high sensitivity, elemental specificity, and time resolution of Q-XAS, it has many potential applications. They could include measuring not only redox reactions but also dissolution/precipitation reactions, such as the formation and/or reductive dissolution of Fe(III) (hydr)oxides, solid-phase transformations (i.e., formation of layered-double hydroxide minerals), or almost any other reaction occurring in aqueous media that can be measured using x-ray absorption spectroscopy.