High Pressure Injection Injury Occurs when fluid is expelled at least 100 pounds per square inch. The fluid punctures skin and can dissect up along facial plains, neurovascular bundles, and tendons. This can easily cause compartment syndrome, deep infections, and debilitating fibrosis. Extremity necrosis can develop within 12 hours. Even with expeditious OR debridement and washout there is a 38% risk of amputation and with caustics or higher pressure the risk is up to 80%. Those that keep their limb lose a great deal of functionality.
Demographic:
Young adult typically male injured non-dominant hand
Inexperienced operator of equipment
exposure material is paint, grease, water, oil, diesel, paint thinner,
Acute phase
onset within 4-6 hours
paresthesias, pain, swelling,
vascular compromise
compartment syndrome
injury site may have no skin perforation or small subtle pinhole
ED steps:
Recognize this minuscule puncture site is a huge life changing problem
Broad spectrum antibiotics
Tetanus
Hand consultation for OR wash out/debridement
X-ray--> lead base paint is radio opaque but may appear like calcifications. Other paints will show sub-cutaneous emphysema. Grease will appear as a lucency.
analgesia
council patient of detriment to extremity function