J Emerg Med
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Interstitial lung disease (ILD) is a group of restrictive pulmonary diseases associated with diffuse interstitial and parenchymal inflammation. Patients can present to the emergency department with severe exacerbation. ⋯ Emergency clinician knowledge of AE-ILD can improve the evaluation and management of these patients.
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Ethyl chloride is commercially available as a DVD/VCR cleaner, and can be found as a gasoline additive and topical anesthetic. There is an emerging trend of recreational huffing to enhance sexual relations. Neurotoxicity from repeated abuse is uncommon. ⋯ A 36-year-old man with a history of intermittent ethyl chloride use for 15 years presented to the Emergency Department with an inability to walk for 4 days after frequent use for 1 week. The patient reported a rapid titration of inhalation from zero to eight cans of 4.6 oz ethyl chloride aerosol per day over a 1-week period. Initial vital signs were heart rate 88 beats/min, blood pressure 147/60 mm Hg, temperature 37.2°C (99°F), and respiratory rate 16 breaths/min. Physical examination was notable for slurred speech, ptosis, a wide-based and ataxic gait with short strides, inability to stand without support, loss of toe/finger proprioception, horizontal and vertical nystagmus, and dysmetria on coordination testing. Strength and sensation were preserved. His work-up included computed tomography and magnetic resonance imaging of the brain, cervical, thoracic, and lumbar spine that demonstrated no acute abnormalities. On hospital day 9, the patient was able to ambulate with mild difficulty. WHY SHOULD AN EMERGENY PHYSICIAN BE AWARE OF THIS?: Toxicity from excessive ethyl chloride huffing has been rarely reported. The toxicity was characterized with cerebellar findings, no attributable laboratory abnormalities, and no radiographic abnormalities on computed tomography/magnetic resonance imaging. The neurotoxicity resolved with supportive care. This case of excessive huffing of ethyl chloride presenting with neurotoxicity and ataxia further characterizes a rare complication of ethyl chloride toxicity that is gaining popularity.
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Cold-water immersion is the gold standard for field treatment of an exertional heat stroke (EHS) casualty. Practical limitations may preclude this method and ice sheets (bed linens soaked in ice water) have emerged as a viable alternative. Laboratory studies suggest that this is an inferior method; however, the magnitude of hyperthermia is limited and may underestimate the cooling rate in EHS casualties. ⋯ The cooling rate in EHS casualties with initial Tc ≥ 39°C was approximately double that reported in laboratory studies. The observed mortality rate was comparable with casualties treated with cold-water immersion. Our data suggest that ice sheets provide a viable alternative when practical constraints preclude cold-water immersion.