1/28. gangrene of the hand: a complication of radial artery cannulation.radial artery cannulation for constant monitoring of arterial pressure and blood gases has become commonplace in the care of the seriously ill. The radial artery is readily accessible and is often regarded as carrying a negligible complication risk, because there is extensive collateral arterial flow in the hand. To the rarely reported cases of gangrene of the hand secondary to cannulation of the radial artery, this publication adds two, both survivors. One, a 46-year-old female with a clinical picture suggestive of mild Raynaud's disease, was treated by closed mitral commissurotomy; the second, a 44-year-old female, was treated for drug overdose complicated by cardiac arrest and renal shutdown.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/28. Natural gas inflation injury of the upper extremity: a case report.High-pressure injection injury is well known to hand surgeons. We present a case of low-pressure inflation injury to the upper extremity. Our experience with this injury, its treatment, and the eventual outcome are discussed.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/28. zinc burns: a rare burn injury.A patient was presented with significant burns resulting from a workplace accident in a zinc production unit. This occurred as a result of the spontaneous combustion of zinc bleed under high pressure. The patient sustained burns to the face, body, and hands and suffered significant injury to the left cornea. Computed imaging revealed solid particles in the ethmoid sinus and also in the right nasal fossa, dissecting the right lacrimal duct. Photographic documentation is presented. This injury was potentially preventable and resulted from poor observance of safety procedures.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/28. Pneumomediastinum after injection injury to the hand.Pneumomediastinum as a consequence of injection injury to the hand has not been previously reported. We present a 22-year-old male who developed pneumomediastinum when a high pressure hose injected air into his hand. The anatomic continuity between peripheral ulnar neurovascular bundle and the hilar vessels provided the route for air entering the hypothenar eminence to penetrate the mediastinum. After ruling out life-threatening causes of pneumomediastinum such as esophageal perforation, his management included observation and serial radiographs. By one week there was complete resolution of the mediastinal air. This report demonstrates that pneumomediastinum may be associated with air injection injury of the hand, and that expectant management is appropriate.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/28. High-pressure injection injuries to the hand.High-pressure injection injury hides the true extent of the lesions behind an apparent small and harmless puncture of the finger or the hand. Through clinical description, we wish to point out the need for prompt treatment to avoid mutilating and function-threatening complications. We wish to outline the role of the emergency physician who must be aware of the incidence of high-pressure injection injury and become accustomed to early referral to a surgeon, experienced in extensive surgical exploration, removal of foreign bodies, and rehabilitation. The open-wound technique gives the best results. We also point out that failure to refer may become an increasing focus of negligence claims.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
6/28. High-pressure cement injection injury of the hand: a case report.Modern equipment allows injection of substances at much higher pressures than previously. We describe a high-pressure cement injection injury to the hand and how its management differs from other injection injuries. This injury was treated by the established standard for this surgical wound: immediate debridement. The wound had the same mechanism, pathology, bacteriology, and treatment as other similar wounds. prognosis after high-pressure injection injuries, however, also depends on the substance injected. Treatment for cement injection injuries differs because of the unique properties of cement. Immediate intervention is necessary for decompression and minimization of chemical burn. Removing the final few fragments of cement after they have hardened may decrease the number of debridements and soft tissue destruction. Serial x-rays can be used to guide debridements, but if serial x-ray films are not obtained, a final x-ray is mandatory to ensure removal of all cement.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
7/28. Compartment syndrome.Compartment syndrome is a limb-threatening and occasionally life-threatening injury. It occurs whenever the tissue pressure (referred to as interstitial pressure) within a closed anatomic space is greater than the perfusion pressure. Untreated, compartment syndrome leads to tissue necrosis, permanent functional impairment and, if severe in large compartments, renal failure and death. Compartment syndrome can occur within any muscle group located in a compartment. It is most common following an event that severely damages a muscle, like a crushing or twisting injury. Mechanisms of injury that involve circumferential burns, ischemia and tourniquets can cause compartment syndrome. Motorcyclists who suffer lower-extermity injuries in accidents are a high-risk group. A tough membrane referred to as a fascia covers muscle groups, forming a compartment for the muscle. In normal circumstances, this arrangement allows the muscle to function more efficiently, but if the muscle is injured in any way, the fascia limits the amount of swelling that can occur. This in turn restricts the flow of blood through the affected region. The first compromised function within the compartment is the flow of lymph and venous blood. If there are sensory nerves running through the compartment, they will not function correctly, causing the numbness, tingling and, later, the pain associated with compartment syndrome. With more swelling, arterial flow is compromised, pain worsens and motor function is impaired. An artificial way of producing a compartment syndrome is to place a cast or splint around a damaged extermity, compressing it. This is a way emergency personnel can compromise an injury and cause long-term consequences for the patient. Recovery is achieved by surgically opening the compartment involved (a fasciotomy) and releasing the pressure. The muscle at first will swell outside the compartment, but then it recovers, swelling is reduced and normal function can be recovered. Prehospital treatment of extremity injuries that will prevent or limit compartment syndrome is immobilization, elevation and cooling. Recognition of the syndrome later in its course, as in this case, requires the EMT to remove the patient to an appropriate emergency department. Prehospital providers need to recognize that many mechanisms of injury can produce this syndrome, even those that seem relatively minor. All injured patients should be educated to seek care should the symptoms of numbness, deep pain and coolness to the distal extremity occur. This case involved a patient who, from a relatively minor mechanism of trauma, experienced an internal disruption of the muscle group controlling the thumb (thenar mass). The early swelling in the thenar compartment resulted in the patient experiencing a tingling sensation in his left thumb. In many cases, such an injury would be referred to as a "stinger" (a temporary neurological deficit due to a sudden and excessive stimulation of a neurologic plexus or junction). But this patient had more swelling in the compartment, resulting in a lack of circulation manifested by a cool extremity, poor capillary refill and decreased pulse oximetry. Luckily, this officer recognized the need for medical evaluation of what appeared to be a minor injury and was returned to duty with no permanent impairment.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
8/28. High-pressure injection injuries of the hand.While often innocuous at presentation, high-pressure injection injuries can lead to devastating consequences. Stiffness, chronic pain, infection, and even amputation can occur, with amputation rates ranging between 16% and 48%. Early surgical decompression and debridement are the cornerstones of treatment.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
9/28. Non-infective subcutaneous emphysema of the hand secondary to a minor webspace injury.subcutaneous emphysema in the hand is commonly associated with infection or high-pressure injection injuries, with other non-infectious causes being reported as rarities in the literature. We describe an unusual case of minor injury to the first webspace resulting in significant subcutaneous emphysema.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/28. A new dressing method for free skin grafting in hands.Using adhesive drapes and a disposable suction drain, the grafted area is compressed by positive pressure that is equivalent to the negative pressure of a suction drain. With this dressing method, the graft can be observed throughout the postoperative course, and can be applied with uniform and constant pressure. Thin drapes accommodate well to various shapes, so this method is uniquely qualified in free skin grafting of hands.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
| | Next -> |