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Introduction Antidotes are available to treat some specific poisonings; however, the mainstay of treatment for the poisoned patient remains supportive care. Extracorporeal membrane oxygenation (ECMO) is one of the most aggressive supportive measures available to manage poisoned patients. Objective To characterize the recommendation and use of ECMO in cases reported to the California Poison Control System (CPCS). Methods This retrospective chart review queried the CPCS database from 1997 to 2016 for cases containing the American Association of Poison Control Centers (AAPCC) code for ECMO, and BECMO^and BECLS^free-text searches. The collected data included year, age, gender, substances involved, route of exposure, clinical effects, treatments, and medical outcome. Results A total of 94 cases discussed ECMO as a supportive option with 16 cases utilizing ECMO. Cases where ECMO was discussed rose from one case in 1997 to 13 cases in 2016. Of the 94 cases where ECMO was discussed, 38 cases (40%) involved toxicity from a cardiovascular agent(s) and 33 cases (35%) involved exposure to hydrocarbons. Of the 16 cases where ECMO was performed, 13 (81%) involved males. The median age was 17 years (range 1 month-54 years). Ten cases (63%) involve patients under the age of 18. In this series, 13 of 16 ECMO-supported patients survived (81%). Conclusions ECMO is being recommended more often for treatment of acute poisoning cases by the CPCS. All caregivers involved in the treatment of poisoning should gain a working knowledge of the potentially lifesaving technology of ECMO, its indications for use, adverse effects, and drug or poison interactions.

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Patients treated by open carpal tunnel decompression under local anaesthetic experience significant pain with the introduction of local anaesthetic before operation. A prospective double-blind randomized placebo controlled trial was carried out to assess whether this pain could be reduced with the pre-application of a topical lignocaine-prilocaine anaesthetic cream. Nineteen patients undergoing simultaneous bilateral operations were studied. Pain, measured with a visual analogue scale, was significantly reduced on the sides treated with anaesthetic cream. On a four point verbal scale the rating on the placebo side was "moderate" or "severe", compared to "mild" on the anaesthetic cream side. The reduction in pain was greater in women, possibly due to a relatively thinner dermis. There were no adverse effects.

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Pediatric levetiracetam exposures were associated with few transient clinical effects. Poison Control Centers may wish to consider acuity of ingestion when developing send-in protocols.

This paper reports on strategic developments to enhance student learner autonomy skills through the use of enquiry-based learning (EBL) in the design of higher education programmes. The UK's Sheffield Hallam University is a recognized Centre of Excellence in Teaching and Learning (CETL) in the field of developing learner autonomy. Central to the university's learning, teaching and assessment strategy is the conviction that students must become autonomous learners to acquire the skills and knowledge needed for employment, research and continuing professional development. In this context it is imperative that students are increasingly able to manage their own learning, formulate their own lines of enquiry and develop flexible approaches to their studies – the essence of acquiring learner autonomy. It is also important that they can work across discipline boundaries, often in teams, tackling problems that are essentially multidisciplinary. The central theme of this paper is the strategic use of EBL in areas that involve students working together in small groups.