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OBJECTIVE: To investigate the characteristics of tricycle-related injuries in children presenting to US emergency departments (EDs). METHODS: Data regarding tricycle injuries in children younger than 18 years of age were obtained from the National Electronic Injury Surveillance System for calendar years 2012 and 2013. Data included body regions injured, ED disposition, and demographics. RESULTS: There were an estimated 9340 tricycle-related injuries treated in US EDs from 2012 to 2013. The average age was 3 years. Children 2 years of age had the highest frequency of injuries. Boys accounted for 63.6% of all injuries. Children 1 to 2 years of age represented 51.9% of all injuries. Lacerations were the most common type of injury. Internal organ damage was the most common type of injury in 3- and 5-year-olds. Contusions were the most common type of injury in 1- and 7-year-olds. The head was the most commonly injured region of the body and the most common region to endure internal damage. The elbows were the most commonly fractured body part. The upper extremity was more frequently fractured than the lower extremity. Approximately 2.4% of all injured children were admitted to the hospital. CONCLUSIONS: The upper extremity of children, particularly the elbow, was more frequently fractured than the lower extremity. The head was the most common body part to endure internal damage. By elucidating the characteristics of tricycle-related injuries, preventive measures can be implemented to decrease the incidence of tricycle-related injuries and ED visits.

EMLA (eutectic mixture of local anesthetics) is a eutectic mixture of lidocaine and prilocaine used to provide topical anesthesia for various procedures. When used properly, EMLA can provide anesthesia to a depth of 5 mm in intact skin, allowing for better pain control during superficial procedures (eg, venipuncture and lumbar puncture).1 Its use has grown widely over the past few years. The adverse effects most commonly related to the use of EMLA are mild local reactions such as edema, erythema, and transient pallor. More-severe reactions, however, have been reported, including methemoglobinemia and seizures.1–6 Only 2 prior reports have described the association between the use of EMLA and the development of seizures.2 This case stands out from prior reports in that a proper amount of EMLA was used but applied to a large area of diseased skin. A healthy 3-year-old white female with a history of eczema was referred to an allergist because of seasonal and environmental allergy symptoms. She was scheduled for allergy skin testing. Her parents were given a prescription for a 5-g tube of EMLA to be applied to the patient’s back, which then was to be covered with plastic wrap, before arriving at the allergist’s office on the day of skin testing. On the morning of the scheduled visit, the parents … Address correspondence to James F. Parker, MD, Children’s Healthcare of Atlanta, 1645 Tullie Cir, Atlanta, GA 30329. E-mail: jparke4{at}emory.edu