eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Hand Injury, High Pressure: Treatment & Medication
Updated: Oct 1, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Emergency Department Care
Emergency department care for high-pressure hand injuries includes the following:
- Obtain radiographs.
- Prescribe broad-spectrum prophylactic antibiotics.
- Update tetanus and administer parenteral analgesics.
- Splint the extremity and keep it elevated.
- Several authors report that steroids may be beneficial in selected cases, especially when an intense inflammatory response develops or treatment is delayed.
Consultations
Refer these patients emergently to an experienced hand or orthopedic surgeon. Prompt surgical debridement optimizes tissue salvage.
Medication
The goal of therapy is to prevent infections. Prophylactic broad-spectrum antibiotics are indicated.
Antibiotics
Therapy must cover all likely pathogens in the context of the clinical setting.
Cefazolin (Ancef, Kefzol, Zolicef)
DOC; first-generation semisynthetic cephalosporin which, by binding to one or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth. Primarily active against skin flora, including Staphylococcus aureus.
Adult
1 g IV/IM q6-8h for 5-7 d
Pediatric
25-50 mg/kg/d IV/IM divided tid/qid for 5-7 d
Probenecid prolongs effect; aminoglycosides may increase renal toxicity; may yield false-positive urine dip test for glucose
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS)
Inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid, inhibiting folic acid synthesis and thus bacterial growth. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens except Pseudomonas aeruginosa.
Adult
160 mg TMP or 800 mg SMZ PO q12h for 5-7 d
Pediatric
<2 months: Not recommended
Infants and children >2 months: 15-20 mg/kg/d (TMP dose) PO divided tid/qid for 5-7 d
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; diuretics increase incidence of thrombocytopenia purpura in elderly; may increase phenytoin levels; may potentiate effects of methotrexate in bone marrow depression; may increase hypoglycemic response to sulfonylureas; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Do not administer to infants <2 mo
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBCs frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholics, elderly, those receiving anticonvulsant therapy, or those with malabsorption syndrome); hemolysis may occur in G-6-PD-deficient individuals; AIDS patients may not tolerate or respond; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
Clindamycin (Cleocin)
Lincosamide useful as treatment against serious skin and soft-tissue infections caused by most staphylococci strains. Also effective against aerobic and anaerobic streptococci, except enterococci.
Adult
600-1200 mg/d IV/IM divided q6-8h for 5-7 d
Pediatric
20-40 mg/kg/d IV/IM divided tid/qid
Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption
Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis
Tetracycline (Sumycin)
Treats susceptible bacterial infections of both gram-positive and gram-negative organisms, as well as infections caused by Mycoplasma, Chlamydia, and Rickettsia species. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s) of susceptible bacteria.
Adult
250-500 mg PO q6h
Pediatric
25-50 mg/kg/d PO divided q6h
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; can increase hypoprothrombinemic effects of anticoagulants
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Amoxicillin (Amoxil, Biomox, Trimox)
Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Adult
250-500 mg PO q8h; not to exceed 3 g/d
Pediatric
20-50 mg/kg/d PO divided q8h
Reduces efficacy of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment
More on Hand Injury, High Pressure |
| Overview: Hand Injury, High Pressure |
| Differential Diagnoses & Workup: Hand Injury, High Pressure |
 Treatment & Medication: Hand Injury, High Pressure |
| Follow-up: Hand Injury, High Pressure |
| References |
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References
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Further Reading
Keywords
hand injury, injection injury, high-pressure injection injury, grease gun injury, paint sprayer injury, diesel fuel injector injury, oleogranulomas, chronic fistula formation, chemical inflammation, finger amputation, fingertip injury, high pressure hand injury
