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An 11 year old left-hand dominant boy is brought in after accidentally sustaining an injury from a paint injection gun while helping his father on a project at home. The injury occurred 2 hours ago. On exam, he has a barely perceptible entrance puncture wound at the tip of his right index finger, no deformity or swelling, and a normal neurovascular exam. Radiographs are negative for fracture and his tetanus is up to date.
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September 24, 2019 at 11:21 am
E) Broad-spectrum IV antibiotics and emergent consultation with a hand surgeon
High pressure injection injuries are considered surgical emergencies, and require emergent consultation with a hand surgeon, who will often need to perform intraoperative irrigation and debridement. Injection devices can inject paint, oil, grease, solvents, and other substances. The innocuous appearance of the wound can lull the practitioner into falsely believing that the wound is minor. Despite the benign appearance, there is a high risk of tissue damage and compartment syndrome, which may lead to necrosis and a need for amputation. Digital block should not be performed due to increasing the risk of compartment syndrome. The emergency physician should provide analgesia, obtain radiographs, update tetanus as needed, give broad-spectrum IV antibiotics, splint and elevate the affected part, and most importantly, consult a hand surgeon ASAP. Read more at http://www.emdocs.net/em3am-high-pressure-injection-injury/