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High Pressure Injection WoundAka: Spray Gun Injection Injury

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  1. Background
    1. Associated with occupational paint or spray gun use
    2. Nozzle pressures are very high (up to 10,000 psi)
  2. Symptoms
    1. Non-dominant index finger most commonly affected
    2. Patient develops numbness, burning or pain over time
  3. Signs
    1. Deceptively small entry wound despite severe SQ damage
  4. Labs: Risk of Hepatotoxicity and nephrotoxicity
    1. Liver Function Tests
    2. Blood Urea Nitrogen (BUN)
    3. Serum Creatinine
  5. Management
    1. Tetanus prophylaxis
    2. Immediate surgical consultation
  6. Complications
    1. Suppurative Tenosyovitis (secondary Staph. aureus)
  7. Course
    1. Amputation rate: 50% if injection psi >2000
    2. Amputation rate: <40% if injection psi <2000
  8. References
    1. Vasilevski (2000) Am J Emerg Med 18:820

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