special subjects
High Pressure Injection Injuries
Treatment of HPI Injuries
IV antibiotics Prompt surgical exploration In the acute setting, the injured part is gently cleansed, dressed loosely with a sterile dressing, and elevated. Patients are given broad-spectrum IV antibiotics and, if necessary, Prevention . There is no evidence that the use of corticosteroids improves outcomes, and their use remains controversial. Clinicians (and patients) should not try to express the injected material out of the entrance wound by applying lateral pressure . Doing so is ineffective and simply spreads the injected fluid farther into the injured tissue. Ice should not be applied to the injured area. In high-pressure injection injuries, do not try to express injected fluid (eg, using lateral pressure on the wound) or apply ice. All high-pressure injection injuries require prompt exploration by a knowledgeable surgeon in an operating room; general anesthesia is required. The injured part is widely incised and explored. Dead and devitalized tissue is debrided, and as much foreign material as possible is irrigated and/or sharply debrided from the wound. In most cases, the surgical wound is left open and allowed to heal by secondary intention (ie, without being repaired), or closure is delayed. Amputation (eg, of digits or limbs) may be required. 