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High-Pressure Hand Injury Treatment & Management

  • Author: Stewart O Sanford, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Oct 17, 2015
 

Approach Considerations

Initial treatment of high-pressure injection injury includes tetanus prophylaxis, broad-spectrum antibiotics, and consultation with a hand surgeon. Injections with air, gas, or small amounts of veterinary vaccines can usually be managed with observation and serial examinations if there is no concern about compartment syndrome. Injections with other liquid materials may require emergent surgical débridement, with the best results when the injury is treated within 6 hours. Wide surgical irrigation and debridement of necrotic tissues should be performed under general or regional anesthesia. Organic and caustic materials are associated with a higher amputation rate, and decreasing the time from injury to surgery improves the prognosis.

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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.
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Consultations

Emergent consultation with an experienced hand surgeon is required. Prompt surgical debridement optimizes tissue salvage.

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Contributor Information and Disclosures
Author

Stewart O Sanford, MD Clinical Faculty, Department of Emergency Medicine, Albert Einstein Medical Center

Stewart O Sanford, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Glen Vaughn, MD Director, Department of Emergency Medicine, Defiance Hospital

Disclosure: Nothing to disclose.

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