Introduction Overview High-pressure injection injuries are a traumatic condition characterized by extensive soft tissue damage associated with a benign high-pressure entry wound Treatment involves emergent surgical debridement Epidemiology incidence relatively rate, 1 in 600 hand traumas demographics most common in young male laborers in industry using paint, automotive grease, solvents and diesel oil location the non-dominant index finger is the most commonly affected digit >50% Pathophysiology mechanism of injury injection force delievered from 3,000 to 10,000 PSI and up to 400 MPH 100 PSI is enough force to break the skin pathophysiology 4 main components initial injury chemical irritation inflammation secondary infection pathoanatomy leads to dissection along planes of least resistance (along neurovascular bundles) vascular occlusion may lead to local soft tissue necrosis Prognosis Up to 50% amputation rate for organic solvents (paint, paint thinner, diesel fuel, jet fuel, oil) prognostic variables time from injury to treatment force of injection volume injected composition of material grease, latex, chloroflourocarbon & water based paints are less destructive industrial solvents & oil based paints cause more soft tissue necrosis Presentation History important to document duration since event time to physician evaluation averages nearly 9 hours material injected Symptoms minimal or no pain at injection site pain and paresthesias eventually occur Physical exam inspection entry wound often benign looking only 1 in 4 initially present to ED eventually finger becomes bloated, edematous, tense, pale, and cold Imaging Radiographs may be useful to detect spread of radio-opaque dyes or paint Treatment Nonoperative tetanus prophylaxis, parenteral antibiotics, limb elevation, early mobilization, monitoring for compartment syndrome indications for injection of air, water, or chicken vaccine outcomes 50% of injuries treated nonoperatively will ultimately require an operation delayed surgical management associated with higher reoperation rates and postoperative complications Operative irrigation & debridement, foreign body removal and broad-spectrum antibiotics indications most cases require immediate surgical debridement outcomes higher rates of amputation are seen when surgery is delayed greater than 10 hours after injury 48% of finger injuries require amputation Techniques Nonoperative considerations tetanus prophylaxis parenteral antibiotics gram-negative and gram-positive coverage limb elevation early mobilization pain control avoid digital blocks and ice to prevent decreased perfusion monitor for compartment syndrome Operative irrigation & debridement, foreign body removal and broad-spectrum antibiotics approach Bruner palmar digital incisions midaxial incision full exposure to zone of injury technique wide debridemeent of all involved tissues decompression of tissue compartments exploration and incision of tendon sheaths removal of all injected material saline irrigation repeat I&D at 24 to 72-hours complications postoperative infection 42% have positive cultures, most polymicrobial Complications Amputation amputation rates approach 50% with oil-based paint injection injuries Infection delayed treatment increases risk of postoperative infection necrotic tissue is a good culture medium for bacterial growth might be lower with organic solvent injections as they do not support bacterial growth
QUESTIONS 1 of 4 1 2 3 4 Previous Next (OBQ13.48) A 36-year-male was using a high-pressure paint gun when he suffered the injury shown in Figure A. Which of the following variables would have the worst impact on his prognosis? Review Topic | Tested Concept QID: 4683 FIGURES: A Type & Select Correct Answer 1 Delay in surgical treatment 77% (4828/6299) 2 Injected solvent was grease 19% (1193/6299) 3 Injected solvent was water-based paint 2% (152/6299) 4 An entry wound of greater than 3 cm 1% (94/6299) 5 Injected solvent was at room temperature 0% (8/6299) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.97) A 42-year-old male diesel mechanic presents to your clinic 3 days after he was power washing automotive parts with a high-pressure solvent and accidently hit the tip of his finger with the spray gun. A clinical photo is shown in Figure A. What is the most appropriate first line of treatment? Review Topic | Tested Concept QID: 3191 FIGURES: A Type & Select Correct Answer 1 Irrigation and debridement at the bedside using a digital block 1% (33/2320) 2 Immediate debridement in the operating room 96% (2219/2320) 3 A dose of IV antibiotics in the ER, followed by a 10 day oral course 1% (27/2320) 4 Immediate finger tip amputation 1% (23/2320) 5 Arrange for follow-up with a hand specialist 0% (6/2320) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept
All Videos (1) Podcasts (0) Upgrade to View Premium Videos Upgrade to View Premium Videos High Pressure Injection Injuries Amiethab Aiyer General - High-Pressure Injection Injuries 3/16/2013 2036 views (14)