oa Two cases of high-pressure injection injury – The importance of early, accurate, assessment and referral

Background: The emergency department physicians rarely see high-pressure injection injuries (HPI) to the hand. These work-related injuries can have a devastating effect on hand function, particularly if not treated early. These injuries are usually caused by the introduction of chemicals into the wound. Chemicals under high-pressure cause local tissue damage, ischemia, and acute and chronic inflammation. The initial assessment may suggest a trivial injury to the inexperienced physician. HPI should be considered as a surgical emergency. Wound exploration, cleansing, and decompression usually preserve the optimal functions. The prognosis of these HPI depends upon the time of presentation, the type of the fluid injected, the pressure, volume, site of injection and appropriate management.

Aim: We aim to highlight the importance of early recognition of HPI by the emergency physician.

Case presentations: We present two cases of HPI. Both of them presented with a small puncture wound on their hands within 1–2 hours of the injury. The first patient was treated with analgesia and antibiotics and was discharged home. He returned again to the Emergency Department after 24 hours with increased pain, swelling, and discoloration of the fingers. He was referred for surgical exploration but required amputation of the index finger. The second patient was immediately referred to the hand surgeon for surgical exploration. He was able to make a good functional recovery within 3 months of the accident.

Conclusion: These cases highlight the importance of early identification and referral by emergency physicians to ensure appropriate multidisciplinary treatment to prevent long-term disability.