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High Pressure Injection Wound

Aka: High Pressure Injection Wound, 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, much higher than rated 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: Agent injected has risk of hepatotoxicity and nephrotoxicity
    1. Liver Function Tests
    2. Blood Urea Nitrogen (BUN)
    3. Serum Creatinine
  5. Management
    1. High risk injury
    2. Tetanus prophylaxis
    3. Immediate surgical consultation
  6. Complications
    1. Suppurative Tenosyovitis
      1. Staphylococcus aureus is most common
  7. Course
    1. Precaution
      1. Most high pressure washers provide >2000 psi at the nozzle (which may be >10x higher than rated psi)
    2. Amputation Incidence
      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 18:820-4

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