Kelsey Angell McEwen* and Elizabeth Van Opstal
University of California San Francisco, CA, United States
Received date: October 26, 2014; Accepted date: December 18, 2014; Published date: December 23, 2014
Citation: McEwen KA (2014) Huffer’s Hand. J Clin Toxicol 4:221. doi: 10.4172/2161-0495.1000221
Copyright: © 2014, McEwen KA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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A 46 year-old man was brought to the emergency department after being found lying in an alley with bleeding hands. The patient reported frequent inhalation of ‘Dust-Off’ (difluoroethane), a refrigerant-based propellant cleaner, spraying the can for repetitive short intervals throughout the day. This practice is also known as ‘huffing’ or ‘dusting’. The propellant cans become very cold when sprayed and the patient reported initial numbness and tingling of his hands. This progressed to blistering and frank bleeding after prolonged, repetitive use.
Open, bleeding wounds with peripheral eschar were noted on examination, involving the volar aspect of the 3rd, 4th and 5th fingers of his right hand, consistent with third-degree frostbite. Neurovascular status of the hand was intact and there were no signs of superimposed bacterial infection. Radiograph showed no evidence of osteomyelitis and CBC and chemistry panel were within normal ranges. Poison control was contacted and recommended cardiac monitoring as difluoroethane sensitizes myocardium to catecholamine effects and can precipitate ventricular tachycardias. ECG demonstrated sinus tachycardia which resolved without intervention. The patient required no acute surgical therapies. He was discharged with appropriate wound care instructions and prophylactic antibiotics. He was scheduled to follow up with orthopedic surgery as an outpatient.