High pressure injection injury

Signs and symptoms

Small punctate lesions may be the only skin lesions visible at first, and there may not be any discomfort. Such a benign presentation of painless wounds may cause the patient to postpone getting medical attention. But as the swelling increases, loss of perfusion causes pain and paresthesia, and the finger becomes bloated, pale, edematous, tense, and cold.

Causes

Most injuries are caused by inexperience using high-pressure equipment, improper use, inadequate training, negligence, exhaustion at the end of the shift, or equipment rupture. Paints, paint solvents, grease, and fuel oils (diesel, paraffin, and gasoline) are the substances that are injected the most frequently, but reports of injecting water, air, cement, and animal vaccines have also been made.

The majority of high-pressure guns and injectors reach pressures of 2000 to 12000 pounds per square inch (psi), but ejection pressures of only 100 psi are sufficient to penetrate human skin.

Treatment

Analgesia, systemic prophylactic antibiotics, elevation of the affected limb, and tetanus prophylaxis if necessary are all part of the initial management. Avoiding digital blocks is advised because they could exacerbate vasospasm and swelling in a digit that is already at risk. In the emergency department, wounds should be left open without any attempt at primary closure. Ice is also discouraged because the goal is to maximize the hand's perfusion after injection.

Only injections of chicken vaccine, air, or water qualify for nonsurgical treatment; expectant management of these injuries is an option. Surgical decompression is only necessary for high-pressure water injuries in cases where compartment syndrome symptoms are present.

Epidemiology

With an estimated frequency of one in 600 injuries presenting to a hospital, these injuries are rare. These injuries mostly affect young men and are related to the workplace.

References

References

1. (April 2008). "High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature.". Strategies in Trauma and Limb Reconstruction (Online).
2. (May 2002). "Grease-gun injury to the penis.". Journal of the Royal Society of Medicine.
3. (2014). "High-pressure Injection Injuries to the Hand". Ovid Technologies (Wolters Kluwer Health).
4. (2006). "Long-Term Follow-Up of High-Pressure Injection Injuries to the Hand". Ovid Technologies (Wolters Kluwer Health).
5. (April 14, 2003). "Hand injuries due to high-pressure injection devices for painting in shipyards: Circumstances, management, and outcome in twelve patients". Wiley.
6. (2006). "Prevention of high-pressure injection injuries to the hand". Elsevier BV.
7. (1998). "A 10-Year Review of High-Pressure Injection Injuries to the Hand". SAGE Publications.
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9. (1991). "High-pressure injection injuries". Elsevier BV.
10. (1995). "Veterinary High Pressure Injection Injuries with Inoculations for Larger Animals". SAGE Publications.
11. (1989). "High-pressure water injection injury to the hand". Elsevier BV.
12. (1988). "High-pressure water-gun injection injuries to the extremities. A report of six cases". J Bone Joint Surg Am.
13. (1980). "High-pressure Injection Injuries of the Hand". Ovid Technologies (Wolters Kluwer Health).