High-Pressure Hand Injury Treatment & Management
- Author: Stewart O Sanford, MD; Chief Editor: Trevor John Mills, MD, MPH more...
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.
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.
Emergent consultation with an experienced hand surgeon is required. Prompt surgical debridement optimizes tissue salvage.
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