High-pressure injection injury: Difference between revisions

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**Grease causes small inflammatory response w/ lower rate of amputation
**Grease causes small inflammatory response w/ lower rate of amputation


==Diagnosis==
==Clinical Features==
*Benign appearance of small injection site in immediate post-injection period is misleading
*Benign appearance of small injection site in immediate post-injection period is misleading
**With time digit becomes edematous, pale, and severely tender to palpation
**With time digit becomes edematous, pale, and severely tender to palpation
*X-ray
 
==Differential Diagnosis==
==Diagnosis==
*Usually clinical
*Consider X-ray
**May show extent of injection of radiopaque substances
**May show extent of injection of radiopaque substances


==Management==
==Management==
*Splint and Elevate
*[[Splint]] and Elevate
*Emergent ortho/hand surgeon consult
*Emergent ortho/hand surgeon consult
**Admission
**Early surgical decompression and debridement
*Early surgical decompression and debridement
**>10hours to OR with increased amp rates
**>10hours to OR with increased amp rates
*Tetanus
*[[Tetanus]]
*Abx
*[[Antibiotics]]
*Analgesia
*Analgesia
**Digital blocks are contraindicated
**Digital blocks are contraindicated
==Disposition==
*Admission


==See Also==
==See Also==

Revision as of 21:31, 3 December 2015

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

See Also

References