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• Comments: although IV antibiotics can be discussed as not all teams use it, otherwise I
agree with this MCQ
2ND MCQ: A 25 YR MALE PRESENTS 2 H AFTER A HIGH-PRESSURE
INJECTION INJURY TO HIS INDEX FINGER FROM A PAINT GUN
NOZZLE. HIS FINGER HAS A PUNCTURE SIGHT WITH SWELLING
DISTALLY. WHICH OF THE FOLLOWING IS A POTENTIAL
CONSEQUENCE OF THIS INJURY?
1. Tissue necrosis
2. Compartment syndrome
3. Functional loss of the involved part of the hand
4. Amputation
5. All of the above
From Welch J. High-pressure injection injury of the finger. Visual Journal of Emergency Medicine 10 (2018) 68–70
ANSWERS
• All of the above. Explanation: High-pressure injection injuries of the hand
typically results from wiping the top of a high-pressure nozzle with the
index finger. The foreign material is injected at high- pressures of 5000–
7000 psi into the finger and penetrates along the tendon sheaths and
facial planes causing tissue distention and local inflammatory response.
These injuries carry high risks of devastating consequences and can
cause tremendous damage including tissue necrosis, high compartment
pressures, compartment syndrome, ischemia, and thrombosis. Additional
complications and morbidity include infection, high rates of amputation
(range from 16% to 50%) chronic pain, stiffness, sensation loss, and loss
of function of the involved part of the hand
From Welch J. High-pressure injection injury of the finger. Visual Journal of Emergency Medicine 10 (2018) 68–70
TAKE HOME MESSAGE
• Rare injuries (1-4 cases per year in specialized centers
/ 1f 600 hand injuries in a emergency department)
• Hesse, 1925
Kaufman HD. The anatomy of experimentally produced high-pressure injection injuries of the hand. Br J Surg. 1968 May. 55(5):340-4.
THE INJECTED FLUID
• Water, air, veterinary vaccine
cause little damage
Paint HP injury
CLINICAL PRESENTATION
• Sometimes signes of
ischemia are present
Paint Injury
CLINICAL PRESENTATION
• Diminished sensibility
• Hypersensitivity
X-RAYS ARE MANDATORY
• You can see the extend of
the injury (air, paints,…)
From Welch J. High-pressure injection injury of the finger. Visual Journal of Emergency Medicine 10 (2018) 68–70
PROGNOSIS DEPENDS OF:
• The compression force
• Tissue distension caused by the fluid itself or by swelling and edema can
cause a compartment syndrome
• Contracture
• Stiffness
• Tetanus prophylaxis
• Steroids has been suggested for severe cases but it does not change the rate
of amputation nor increase the risk of infection
SURGICAL TREATMENT = EMERGENCY
• Plexus block (for vasodilatation) or general
anesthesia - not local (increase pressure)
• Neurolysis