Injection injuries

Gray, J.E. (1978). Pathological evaluation of injection injury. In Sustained and Controlled Release Drug Delivery Systems (Robinson, J., Ed.). Marcel Dekker, New York, pp. 351-405. 

High-pressure injection injuries (eg, from paint spray guns) are important not because of systemic toxicity due to absorption of an injected substance (eg, paint thinner) but because of extensive irritant-related tissue necrosis. Emergency surgical evaluation of such cases is mandatory. 

Pressurized gases and fluids can cause injury. Major hazards are air and gas injuries, injection injuries, and whipping of lines. 

Injection Injuries Injection injuries occur when a fine stream of gas or fluid enters the body. Fine streams of air, gas, or liquid can penetrate the skin. Medical inoculations with injection guns apply this principle. 

A fine stream may look safe because it is so small. It may seem harmless because of the famUiaiity with water or some other common liquids without pressure. However, line streams can cause serious injection injuries. Medical literature reports injection injuries resulting from fluids with line streams at 650 to more than 7000 Ib/in. Equipment operating at much lower pressures can create such pressures. 

High pressure streams of fluids can easily make incisions in skin and other tissue. Fluid injected through even a tiny hole in the skin can migrate quickly throughout several layers of tissue. Removal is extremely difricult because of the distribution among the tissue. If the fluid is toxic or contaminated with infectious microorganisms, amputation is often the only solution. Delays in onset of treatment can result in radical treatments for injection injuries. Injection injuries typically involve the lingers and hands. Such injuries also occur to arms, face and other parts of the body. 

South Dakota. The operator of a backhoe received severe injection injuries to his hand. A hydraulic line started to leak. A small, high-pressure stream of hydraulic fluid struck the operator s hand, penetrated the skin and filled a significant part of his hand with fluid. 

Training People who work around compressed air lines, hydraulic systems, and other pressurized fluid and gas equipment should leam about the hazards. They should learn not to place fingers or hands against a fluid stream and they should learn not to place the stream near anyone else. Protective gloves and clothing may help reduce injection injuries. 

Lewis, H.G., Clarke, P., and Kneapsey, B., A 10-Year Review of High-Pressure Injection Injuries to the Hand, The Journal of Hand Surgery British European Volume, 23 (4) 479-481 (August 1998). 

Injection Some materials may become injected purposely or accidentally. Accidental injection is more important for occupational settings. Refer to the discussion of injection injuries in Chapter 19. 

Macaulay JC (1986) Occupational high-pressure injection injury. Br J Dermatol 115 379-381... 

Nervous system A series of 28 cases of post-injection injuries after intragluteal injections recorded over 8 years in an electroneuromyography laboratory has been reported [24 ]. A complete history was available in 26 cases. They all had sudden pain and subsequent radiation of pain and numbness in the distribution of the sciatic nerve. In 23 cases the injected drug was known it was metamizole (dipyrone) in 11. 

Sevim S, Kaleagasi H. Sciatic injection injuries in adults is dipyrone a foe to nerve Acta Neurol Belg 2009 109(3) 210-3. 

Drug administration route The authors compared a new and old adrenaline autoinjector with respect to correct autoinjector use. The new adrenaline autoinjector is more effective in unintentional injection injuries than the old one however, it still does not fulfil the criteria of an ideal adrenaline autoinjector [24 ]. 

Physical Injury - High-pressure Injection Injuries... 

N. C. Neal and F. D. Burke, High-pressure injection injuries. Injury, 1991,... 

G. Couzens and F. D. Burke, Veterinary high pressure injection injuries with inoculations in larger animals, J. Hand Surg., 1995, 20, 497-499. 

G. Rappold and E. Rosenmayr, High-pressure injection injuries of the hand. Pathogenesis, problems and therapy, Handchir. Mikrochir. Blast. Chir., 2001, 33, 332-341. 

L. Christodoulou, E. Y. Melikyan, S. Woodbridge and F. D. Burke, Functional outcome of high-pressure injection injuries of the hand, J. Trauma, 2001, 50, 717-720. 

H. D. Kaufman, The clinicopathological correlation of high-pressure injection injuries, Br. J. Surg., 1968, 55, 214-218. 

R. H. Gelberman, J. L. Posch and J. M. Jurist, High-pressure injection injuries of the hand, J. Bone Joint Surg. (American Volume), 1975, 57, 935-937. 

J. V. LeBlanc, High pressure petroleum injection injuries, J. Occup. Med., 1977, 19, 276-277. 

E. V. Craig, A new high-pressure injection injury of the hand, J. Hand Surg., 1984, 9, 240-242. 

R. J. Maxwell and P. L. Dixon, High-pressure injection injuries of the hand A report of three cases, Aust. N. Z. J. Surg., 1988, 58, 344-346. 

K. A. Gutowski, J. Chu, M. Choi and D. W. Friedman, High-pressure hand injection injuries caused by dry cleaning solvents Case reports, review of the literature, and treatment guidelines, Plast. Reconstruct. Surg, 2003, 111, 174-177. 

R. Gonzales and M. L. Kasdan, High pressure injection injuries of the hand, Clin. Occup. Environ. Med., 2006, 5, 407-411. 

I. Utrobidc, Z. Pogorelic and N. Druzijanic, High-pressure injection injuries of the hand report of two cases, Acta Chir. Belg., 2011, 111, 46-50. 

B. T. Harter and K. C. Harter, High-pressure injection injuries. Hand... 

A. Karlbauer and F. Gasperschitz, High-pressure injection injury a hand-threatening emergency, J. Emerg. Med., 1987, 5, 375-379. 

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