Medicine:High pressure injection injury

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High pressure injection injury
Other namesGrease gun injury, injection injury
SpecialtyEmergency medicine, plastic surgery

A high pressure injection injury is an injury caused by high-pressure injection of oil, grease, diesel fuel, gasoline, solvents, water, or even air, into the body.[1] The most common causes are accidents with 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 grease gun.[2]

Although the initial wound often seems minor, the unseen, internal damage can be severe. With hydraulic fluids, paint, and detergents, these injuries are extremely serious as most hydraulic fluids and organic solvents are highly toxic. Delay in surgical treatment often leads to amputations or death.[1] But even with pure water or air, these injuries cause 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.[3] But as the swelling increases, loss of perfusion causes pain and paresthesia, and the finger becomes bloated, pale, edematous, tense, and cold.[4]

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.[5][6] 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 vaccines have also been made.[7][8]

The majority of high-pressure guns and injectors reach pressures of 2000 to 12000 pounds per square inch (psi),[6] but the ejection pressure must be at least 100 psi to penetrate human skin.[9]

Treatment

Analgesia, systemic prophylactic antibiotics, elevation of the affected limb, and tetanus prophylaxis if necessary are all part of the initial management. Avoiding digital blocks is advised because they could exacerbate 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.[3] Ice is also discouraged because the goal is to maximize the hand's perfusion after injection.[1]

Only injections of the chicken, water, or air vaccine qualify for nonsurgical treatment; expectant management of these injuries is an option.[10] Surgical decompression is only necessary for high-pressure water injuries in cases where compartment syndrome symptoms are present.[11][12]

Epidemiology

With an estimated frequency of one in 600 injuries presenting to a hospital, these injuries are rare.[13] These injuries mostly affect young men and are related to the workplace.[6]

See also

References

  1. ↑ 1.0 1.1 1.2 Verhoeven, N; Hierner, R (April 2008). "High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature.". Strategies in Trauma and Limb Reconstruction (Online) 3 (1): 27–33. doi:10.1007/s11751-008-0029-9. PMID 18427921. 
  2. ↑ Kalsi, JS; Arya, M; Peters, J; Minhas, S; Ralph, DJ (May 2002). "Grease-gun injury to the penis.". Journal of the Royal Society of Medicine 95 (5): 254. doi:10.1177/014107680209500512. PMID 11983770. 
  3. ↑ 3.0 3.1 Rosenwasser, Melvin P.; Wei, David H. (2014). "High-pressure Injection Injuries to the Hand". Journal of the American Academy of Orthopaedic Surgeons (Ovid Technologies (Wolters Kluwer Health)) 22 (1): 38–45. doi:10.5435/jaaos-22-01-38. ISSN 1067-151X. 
  4. ↑ Wieder, Anat; Lapid, Oren; Plakht, Ygal; Sagi, Amiram (2006). "Long-Term Follow-Up of High-Pressure Injection Injuries to the Hand". Plastic and Reconstructive Surgery (Ovid Technologies (Wolters Kluwer Health)) 117 (1): 186–189. doi:10.1097/01.prs.0000185668.67855.63. ISSN 0032-1052. PMID 16404265. 
  5. ↑ Valentino, Matteo; Rapisarda, Venerando; Fenga, Concettina (April 14, 2003). "Hand injuries due to high-pressure injection devices for painting in shipyards: Circumstances, management, and outcome in twelve patients". American Journal of Industrial Medicine (Wiley) 43 (5): 539–542. doi:10.1002/ajim.10218. ISSN 0271-3586. 
  6. ↑ 6.0 6.1 6.2 Hart, Raymond G.; Smith, Gillian D.; Haq, Adeel (2006). "Prevention of high-pressure injection injuries to the hand". The American Journal of Emergency Medicine (Elsevier BV) 24 (1): 73–76. doi:10.1016/j.ajem.2005.08.001. ISSN 0735-6757. 
  7. ↑ LEWIS, H. G.; CLARKE, P.; KNEAFSEY, B.; BRENNEN, M. D. (1998). "A 10-Year Review of High-Pressure Injection Injuries to the Hand". Journal of Hand Surgery (SAGE Publications) 23 (4): 479–481. doi:10.1016/s0266-7681(98)80126-5. ISSN 0266-7681. PMID 9726548. 
  8. ↑ WONG, T. C.; IP, F. K.; WU, W. C. (2005). "High-Pressure Injection Injuries of the Hand in a Chinese Population". Journal of Hand Surgery (SAGE Publications) 30 (6): 588–592. doi:10.1016/j.jhsb.2005.07.009. ISSN 0266-7681. 
  9. ↑ Neal, N.C.; Burke, F.D. (1991). "High-pressure injection injuries". Injury (Elsevier BV) 22 (6): 467–470. doi:10.1016/0020-1383(91)90131-w. ISSN 0020-1383. 
  10. ↑ COUZENS, G.; BURKE, F. D. (1995). "Veterinary High Pressure Injection Injuries with Inoculations for Larger Animals". Journal of Hand Surgery (SAGE Publications) 20 (4): 497–499. doi:10.1016/s0266-7681(05)80162-7. ISSN 0266-7681. PMID 7594992. 
  11. ↑ Curka, Peter A.; Chisholm, Carey D. (1989). "High-pressure water injection injury to the hand". The American Journal of Emergency Medicine (Elsevier BV) 7 (2): 165–167. doi:10.1016/0735-6757(89)90130-7. ISSN 0735-6757. PMID 2920077. 
  12. ↑ JB, Weltmer; LL, Pack (1988). "High-pressure water-gun injection injuries to the extremities. A report of six cases". The Journal of Bone and Joint Surgery. American Volume (J Bone Joint Surg Am) 70 (8): 1221–1223. doi:10.2106/00004623-198870080-00014. ISSN 0021-9355. PMID 2901420. https://pubmed.ncbi.nlm.nih.gov/2901420/. Retrieved January 8, 2024. 
  13. ↑ SCHOO, MICHAEL J.; SCOTT, FRANK A.; BOSWICK, JOHN A. (1980). "High-pressure Injection Injuries of the Hand". The Journal of Trauma: Injury, Infection, and Critical Care (Ovid Technologies (Wolters Kluwer Health)) 20 (3): 229–238. doi:10.1097/00005373-198003000-00007. ISSN 0022-5282. 

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