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Alcohols and Aldehydes
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Isopropanol (isopropyl alcohol) is a colorless and volatile alcohol with a fruity odor and a slightly bitter taste. It is present in rubbing alcohol, industrial solvents, paints, disinfectants, and parenteral drugs. It may be ingested accidentally by nonalcoholics and intentionally by alcoholics.
Microdermabrasion and Dermabrasion
Published in Antonella Tosti, Maria Pia De Padova, Gabriella Fabbrocini, Kenneth R. Beer, Acne Scars, 2018
Annie Chiu, Deirdre Hooper, Katherine O. Brag
On the day of treatment, patients should present without makeup or jewelry on the intended treatment area. The patient should lie in the supine position. The treatment area should be cleansed, and then degreased using rubbing alcohol to remove any oil, residual makeup, or sunscreen from the skin. Both the patient and provider should wear eye protection. Anesthesia can be achieved with nerve block, local injection, tumescent anesthesia, or cryoanesthesia techniques. The skin should then be sterilized with chlorhexidine, being sure to avoid contact with the eyes and ears. Finally, the area can be covered with sterile drapes. With the motorized technique, pre-treatment of the area with a refrigerant spray provides a hard, consistent surface upon which to work [3,26].
Ostomy, Fistula, and Skin Management
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Christine T. Berke, Cathi Brown
Minor complications are reported in 13–40% of patients with a percutaneous gastrostomy tube [19]. The most common complications of the stoma site include peristomal skin irritation/breakdown, leaking, bleeding, hypergranulation tissue growth, and infection at the stoma site. General care of the tube site includes daily assessment for skin problems and gentle washing under the retention bumper with mild soap and water using cotton-tipped applicators. Hydrogen peroxide, rubbing alcohol, and/or routine/prophylactic use of topical antibiotic ointments/creams is not recommended as these can contribute to peristomal skin problems. The skin should be examined for excess moisture, denudation from leakage, rashes, nonblanchable erythema from too much pressure applied by the external bolster (i.e., too tight against the skin), skin stripping from adhesives and/or increased warmth, redness, or purulent drainage from infection. The retention bumper and flange should not be moved or “slid up and down” the tube during care as this can contribute to bumper failure over time. During examination, the edges of the retention bumper should be gently lifted on all sides to access and assess the tube insertion site. The site will be at increased risk for complications if it is located in a skin crease, fold, or scar and when the patient is obese or immunocompromised (e.g., diabetes mellitus, posttransplant, immunosuppressant medications) [19–21].
Death by hand sanitizer: syndemic methanol poisoning in the age of COVID-19
Published in Clinical Toxicology, 2021
Sarah Denise Holzman, Jaiva Larsen, Ramandeep Kaur, Geoffrey Smelski, Steven Dudley, Farshad Mazda Shirazi
In June 2020, a 47-year-old female was found in her home unconscious and unresponsive. She was last seen awake the night before. Near her was an empty bottle of insect repellent (active ingredient N, N-Diethyl-meta-toluamide 7.0%), and a bottle of hand sanitizer was missing. Per family report, she periodically drank hand sanitizer and rubbing alcohol when ethanol was not available. On arrival to the ED, her vital signs were BP 147/82 mm Hg, HR 92 bpm, RR 6 br/min, O2 saturation 90%, temperature 36.1 °C. Laboratory investigations revealed a severe metabolic acidosis (pH 6.70) and an osmolal gap of 132 mOsm/kg H2O. Ethanol was undetected. She was intubated, empirically started on fomepizole, and hemodialyzed. She also received folic acid, thiamine, pyridoxine, and NaHCO3. During the placement of the dialysis catheter, she experienced a generalized tonic-clonic seizure. Head CT, eight hours after arrival to the HCF, showed diffuse anoxic injury with cerebral edema, herniation, and hemorrhage. On Day 2, nuclear medicine imaging revealed lack of cerebral blood flow. She was transitioned to DNR status, and she died. Her serum methanol concentration, 278 mg/dL, was drawn when she presented to the ED. The result became available after her death.
Sustained low-efficiency dialysis (SLED) therapy following ingestion of isopropanol in a pediatric patient
Published in Clinical Toxicology, 2020
Kristie L. Edelen, Alex Barton, William Banner
Isopropanol is a colorless liquid with a fruity odor most commonly found as rubbing alcohol. It is also found in commercial products including cleaners, disinfectants, and antifreeze. Manifestations including brain stem depression, peripheral vasodilation, and decreased cardiac contractility are uncommon, but can occur after a massive overdose leading to significant CNS, respiratory and cardiovascular depression. These critically ill patients may require renal replacement therapy or hemodialysis, but due to the patient’s hemodynamic instability, hemodialysis may not be a viable option. In the acutely unstable patient with acute renal failure (ARF), blood flow often cannot be maintained that would allow adequate drug/toxin clearance.
Comparison of the effects of general, spinal and epidural anesthesia on ureter access and surgical outcomes during flexible ureterorenoscopy for transurethral single stone removal surgeries: a monocentric retrospective study
Published in Annals of Medicine, 2021
Haoliang Cai, Xiaohui Wu, Xi Chen, Wenting Chen
After routine monitoring in the preparation room, the skin was cleaned in the sitting position with rubbing alcohol. Using an 18 G needle (Becton Dickinson and Company, Franklin Lakes, NJ, USA), puncture was made at T11 to T12 range. The epidural range was obtained by the negative pressure method and an epidural catheter (Rosch Medical Systems Private Limited, Tucson, Arizona, USA) was placed. After applying 3 mL of prilocaine (Citanest® 2% 20 mg, Densply Pharmaceuticals, USA) as a test dose, 1.5 mL of prilocaine was added to each segment. The surgery was started when the sensory block reached the T6 level.