View source for Medicine:High pressure injection injury

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| name            = High pressure injection injury
| synonyms        = Grease gun injury, injection injury
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| field           = [[Medicine:Emergency medicine|Emergency medicine]], [[Engineering:Plastic surgery|plastic surgery]]
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A '''high pressure injection injury''' is an injury caused by high-pressure injection of [[Chemistry:Oil|oil]], [[Chemistry:Petroleum|grease]], [[Engineering:Unit injector|diesel fuel]], [[Engineering:Gasoline direct injection|gasoline]], solvents, water, or even air, into the body.<ref name="verhoeven">{{cite journal|last1=Verhoeven|first1=N|last2=Hierner|first2=R|title=High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature.|journal=Strategies in Trauma and Limb Reconstruction (Online)|date=April 2008|volume=3|issue=1|pages=27–33|pmid=18427921|pmc=2291478|doi=10.1007/s11751-008-0029-9}}</ref> The most common causes are accidents with [[Engineering:Grease gun (tool)|grease guns]], paint sprayers, and pressure washers, but working on diesel and gasoline engine fuel injection systems as well as pinhole leaks in pressurized hydraulic lines can also cause this injury.  Additionally, there is at least one known case of deliberate self-injection with a [[Engineering:Grease gun|grease gun]].<ref>{{cite journal|last1=Kalsi|first1=JS|last2=Arya|first2=M|last3=Peters|first3=J|last4=Minhas|first4=S|last5=Ralph|first5=DJ|title=Grease-gun injury to the penis.|journal=Journal of the Royal Society of Medicine|date=May 2002|volume=95|issue=5|pages=254|pmid=11983770|pmc=1279682|doi=10.1177/014107680209500512}}</ref>

Although the initial wound often seems minor, the unseen, internal damage can be severe.  With [[Physics:Hydraulic fluid|hydraulic fluid]]s, paint, and detergents, these injuries are extremely serious as most hydraulic fluids and [[Physics:Solvent|organic solvents]] are highly toxic.  Delay in surgical treatment often leads to [[Medicine:Amputation|amputations]] or death.<ref name="verhoeven" />  But even with pure water or air, these injuries cause [[Medicine:Compartment syndrome|compartment syndrome]], which leads to cell death if surgical intervention is delayed.

==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.<ref name="High-pressure Injection Injuries to the Hand">{{cite journal | last1=Rosenwasser | first1=Melvin P. | last2=Wei | first2=David H. | title=High-pressure Injection Injuries to the Hand | journal=Journal of the American Academy of Orthopaedic Surgeons | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=22 | issue=1 | year=2014 | issn=1067-151X | doi=10.5435/jaaos-22-01-38 | pages=38–45}}</ref> But as the [[Medicine:Swelling (medical)|swelling]] increases, loss of perfusion causes pain and [[Unsolved:Paresthesia|paresthesia]], and the finger becomes bloated, pale, [[Medicine:Edema|edematous]], tense, and cold.<ref name="Long-Term Follow-Up">{{cite journal | last1=Wieder | first1=Anat | last2=Lapid | first2=Oren | last3=Plakht | first3=Ygal | last4=Sagi | first4=Amiram | title=Long-Term Follow-Up of High-Pressure Injection Injuries to the Hand | journal=Plastic and Reconstructive Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=117 | issue=1 | year=2006 | issn=0032-1052 | doi=10.1097/01.prs.0000185668.67855.63 | pages=186–189| pmid=16404265 | s2cid=21070884 }}</ref>

==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.<ref name="Circumstances, management, and outcome">{{cite journal | last1=Valentino | first1=Matteo | last2=Rapisarda | first2=Venerando | last3=Fenga | first3=Concettina | title=Hand injuries due to high-pressure injection devices for painting in shipyards: Circumstances, management, and outcome in twelve patients | journal=American Journal of Industrial Medicine | publisher=Wiley | volume=43 | issue=5 | date=April 14, 2003 | issn=0271-3586 | doi=10.1002/ajim.10218 | pages=539–542}}</ref><ref name="Prevention">{{cite journal | last1=Hart | first1=Raymond G. | last2=Smith | first2=Gillian D. | last3=Haq | first3=Adeel | title=Prevention of high-pressure injection injuries to the hand | journal=The American Journal of Emergency Medicine | publisher=Elsevier BV | volume=24 | issue=1 | year=2006 | issn=0735-6757 | doi=10.1016/j.ajem.2005.08.001 | pages=73–76}}</ref> 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 [[Biology:Vaccine|vaccines]] have also been made.<ref name="A 10-Year Review">{{cite journal | last1=LEWIS | first1=H. G. | last2=CLARKE | first2=P. | last3=KNEAFSEY | first3=B. | last4=BRENNEN | first4=M. D. | title=A 10-Year Review of High-Pressure Injection Injuries to the Hand | journal=Journal of Hand Surgery | publisher=SAGE Publications | volume=23 | issue=4 | year=1998 | issn=0266-7681 | doi=10.1016/s0266-7681(98)80126-5 | pages=479–481| pmid=9726548 | s2cid=34690645 }}</ref><ref name="Chinese Population">{{cite journal | last1=WONG | first1=T. C. | last2=IP | first2=F. K. | last3=WU | first3=W. C. | title=High-Pressure Injection Injuries of the Hand in a Chinese Population | journal=Journal of Hand Surgery | publisher=SAGE Publications | volume=30 | issue=6 | year=2005 | issn=0266-7681 | doi=10.1016/j.jhsb.2005.07.009 | pages=588–592| s2cid=20308620 }}</ref>

The majority of high-pressure guns and injectors reach pressures of 2000 to 12000 pounds per square inch (psi),<ref name="Prevention"/> but the ejection pressure must be at least 100 psi to penetrate human skin.<ref name="Neal Burke 1991 pp. 467–470">{{cite journal | last1=Neal | first1=N.C. | last2=Burke | first2=F.D. | title=High-pressure injection injuries | journal=Injury | publisher=Elsevier BV | volume=22 | issue=6 | year=1991 | issn=0020-1383 | doi=10.1016/0020-1383(91)90131-w | pages=467–470}}</ref>

==Treatment==
Analgesia, systemic prophylactic [[Chemistry:Antibiotic|antibiotics]], elevation of the affected limb, and [[Medicine:Tetanus|tetanus]] prophylaxis if necessary are all part of the initial management. Avoiding digital blocks is advised because they could exacerbate [[Medicine:Vasospasm|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.<ref name="High-pressure Injection Injuries to the Hand"/> Ice is also discouraged because the goal is to maximize the hand's perfusion after injection.<ref name="verhoeven" />

Only injections of the chicken, water, or air vaccine qualify for nonsurgical treatment; expectant management of these injuries is an option.<ref name="Veterinary High Pressure Injection">{{cite journal | last1=COUZENS | first1=G. | last2=BURKE | first2=F. D. | title=Veterinary High Pressure Injection Injuries with Inoculations for Larger Animals | journal=Journal of Hand Surgery | publisher=SAGE Publications | volume=20 | issue=4 | year=1995 | issn=0266-7681 | doi=10.1016/s0266-7681(05)80162-7 | pages=497–499| pmid=7594992 | s2cid=6212742 }}</ref> Surgical decompression is only necessary for high-pressure water injuries in cases where compartment syndrome symptoms are present.<ref name="Curka Chisholm 1989 pp. 165–167">{{cite journal | last1=Curka | first1=Peter A. | last2=Chisholm | first2=Carey D. | title=High-pressure water injection injury to the hand | journal=The American Journal of Emergency Medicine | publisher=Elsevier BV | volume=7 | issue=2 | year=1989 | issn=0735-6757 | doi=10.1016/0735-6757(89)90130-7 | pages=165–167| pmid=2920077 }}</ref><ref name="A report of six cases">{{cite journal | last1=JB | first1=Weltmer | last2=LL | first2=Pack | title=High-pressure water-gun injection injuries to the extremities. A report of six cases | journal=The Journal of Bone and Joint Surgery. American Volume | date=1988 | publisher=J Bone Joint Surg Am | volume=70 | issue=8 | pages=1221–1223 | doi=10.2106/00004623-198870080-00014 | issn=0021-9355 | pmid=2901420 |url=https://pubmed.ncbi.nlm.nih.gov/2901420/ | access-date=January 8, 2024 }}</ref>

==Epidemiology==
With an estimated frequency of one in 600 injuries presenting to a hospital, these injuries are rare.<ref name="SCHOO SCOTT BOSWICK 1980 pp. 229–238">{{cite journal | last1=SCHOO | first1=MICHAEL J. | last2=SCOTT | first2=FRANK A. | last3=BOSWICK | first3=JOHN A. | title=High-pressure Injection Injuries of the Hand | journal=The Journal of Trauma: Injury, Infection, and Critical Care | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=20 | issue=3 | year=1980 | issn=0022-5282 | doi=10.1097/00005373-198003000-00007 | pages=229–238}}</ref> These injuries mostly affect young men and are related to the workplace.<ref name="Prevention"/>

==See also==
*{{slink|Jet injector|History}}

==References==
{{reflist}}

==Further reading==
* {{cite journal | last1=Dailiana | first1=HZ | last2=Kotsaki | first2=D | last3=Varitimidis | first3=S | last4=Moka | first4=S | last5=Bakarozi | first5=M | last6=Oikonomou | first6=K | last7=Malizos | first7=NK | title=Injection injuries: seemingly minor injuries with major consequences | journal=Hippokratia | date=2008 | publisher=Hippokratio General Hospital of Thessaloniki | volume=12 | issue=1 | pages=33–36 | pmid=18923762 | pmc=2532970 | ref=none}}
* {{cite journal | last1=Fialkov | first1=Jeffery A. | last2=Freiberg | first2=Arnis | title=High pressure injection injuries: An overview | journal=The Journal of Emergency Medicine | publisher=Elsevier BV | volume=9 | issue=5 | year=1991 | issn=0736-4679 | doi=10.1016/0736-4679(91)90381-o | pages=367–371 | pmid=1940241 | ref=none}}

==External links==
* [https://www.ncbi.nlm.nih.gov/books/NBK542210/ StatPearls]

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[[Category:Injuries]]

{{Sourceattribution|High pressure injection injury}}