High-pressure injection injury
Revision as of 21:31, 3 December 2015 by Rossdonaldson1 (talk | contribs)
Background
- Surgical emergency
- Amputation rates are as high as 30%
- Occurs with grease, paint, and fuel guns; usually injected into non-dominant hand
- Most important factor is type of injected material
- Paint produces large, early inflammatory response w/ high rate of amputation
- Grease causes small inflammatory response w/ lower rate of amputation
Clinical Features
- Benign appearance of small injection site in immediate post-injection period is misleading
- With time digit becomes edematous, pale, and severely tender to palpation
Differential Diagnosis
Diagnosis
- Usually clinical
- Consider X-ray
- May show extent of injection of radiopaque substances
Management
- Splint and Elevate
- Emergent ortho/hand surgeon consult
- Early surgical decompression and debridement
- >10hours to OR with increased amp rates
- Tetanus
- Antibiotics
- Analgesia
- Digital blocks are contraindicated
Disposition
- Admission