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 | ||
== | ==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 | ||
* | **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]] | ||
* | *[[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