We present an unusual case of chlorobenzylidenemalonitrile (CS) tear-gas exposure from the unwitting discharge of a personal-protection handgun loaded with CS gas. The gun was in a bag of toys purchased from a local thrift store and was discharged by a child. The responding paramedic presumptively identified the substance as CS based solely on personal experience. This recognition led to suboptimal field management of the incident with the paramedic failing to follow the standard operating procedures for an unknown chemical exposure. As this was a benign agent, there were no serious consequences. This case highlights the pre-hospital and emergency department challenges associated with the management of an unknown chemical exposure and the potential consequences if the chemical is a toxic substance. A methodical approach following established protocols can reduce the potential for negative outcomes. Review of the literature found no other report of CS gas exposure from such a personal-protection weapon.

Objective: To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.

Methods: We reviewed an existing study database of patients with bronchiolitis. We defined a positive EDSS as urine with ≥10 WBC per high power field or cerebrospinal fluid (CSF) with ≥10 WBC per high power field (>25 WBC in neonates), or if organisms were identified on gram stain. We defined SBI as significant growth of an accepted pathogen in blood, urine or CSF. Our composite endpoint was positive if either of these was positive. The decision to perform testing was modeled using modified Poisson regression; the presence of the combined outcome was modeled using logistic regression modified for rare events.

Results: We studied 640 children. Testing was performed in 199/640 (31.1%). These tended to be younger than two months RR 2.69 (95% CI 2.11, 3.44), febrile RR 2.01 (95% CI 1.58, 2.55), more dehydrated RR 1.50 (95% CI 1.28, 1.75) and had more severe chest wall retractions RR 1.54 (95% CI 1.22, 1.94). Only 11/640(1.7%) had a positive EDSS or SBI. Younger age (OR 0.67 per month; 95% CI 0.45, 0.99) and a negative RSV antigen test (OR 6.22; 95% CI 1.30, 29.85) were associated with the composite endpoint.

Conclusion: Testing was more likely to be performed in children younger than two months of age, and in those who were febrile, dehydrated, and had more severe chest wall retractions. A positive EDSS or SBI was rare occurring in younger infants with non-RSV bronchiolitis. [West J Emerg Med. 2010; 11(1):60-67].