Epinephrine in digit
1. Digital block c lidocaine to cause sympathectomy
2. Phentolamine .5-5 mg infiltrated or .5-2.5 mg block. Can give interarterial in radial
3. Terbutaline 1:1 dilution .5 mg/cc use 1 cc
But there is actually no data to support the potential of epi used in anesthetic concentrations to do any damage what-so-ever (Can J Emerg Med 5(4) 245 2003) refutes the dogma
High Pressure Injection Injuries
Initial sx can be minimal, maybe mild swelling. Hours later signifigant swelling which can progress to compartment syndrome.
dT and ABX
Surgical exploration and washout
HF is a gas at standard conditions
If bubbled through water, becomes hydrofluoric acid
Used in glass etching, masonry cleaning, rust removal (Naval jelly)
Weak acid, pathology not from acid burn
The F+ binds to Ca and Mg. Hypocalcemia results in cell death and altered membrane potential leading to severe neuropathic pain.
Get ekg and serum Ca and Mg to check for systemic toxicity
Irrigate for up to 30 minutes
if skin is red or blanched more than topical therapy will probably be needed.
In concentrations less than 50%, pain can be delayed for hours
Intense pain with paucity of physical findings is the hallmark
If only skin, try topical calcium gel (add 3.5 gm CaGluc powder or solution with 5 oz. (150 cc) KY Jelly or surgilube
Cover the area with the gel (can use gloves for hands) and reapply in one hour then apply Q4 hours.
If the pain persists >45 minutes after the application of the gel, try more aggressive measures.
Do not use local anesthetics, you need to know if the patient is still in pain
Use 5% CaGluc (Dilute 1:1 with NS) and inject .5 cc per centimeter square of skin SC
Infiltrate with a 5mm margin
Bier Block 10-15 cc 10% CaGluc diluted with 30-40 cc NS
Inhalation: 1.5 cc 10% CaGluc to 4.5 cc NS via neb
Eye: 50 cc 10% CaGluc in 500 cc NS used as an eye wash
If still in pain, use interarterial calcium. CaGluc 1 amp in 50 cc D5W, infuse over 4 hrs.
Place an a-line. If 4th or 5th finger effected, it will be necessary to advance the catheter to the brachial artery. Admit to the ICU for continuous pressure wave monitoring. Extravisation of Ca salts can be limb destructive, so must assure good tracing. Infuse 10 cc of 10% CaCL dilute c 40 cc NS over 4 hours (Adding 500 units of heparin will signifigantly cut down on catheter clots.) Stop each hour to flush the catheter with heparinized saline and check tracing. Flush with 10 cc of saline over 15 minutes after infusion is done. Can be repeated if pain returns.
Ocular Exposure: irrigate with saline, 1 liter only. More can exacerbate damage. Dilute MgSO4 as eye drops.
Ingestion, give calcium or mag salts
Inhalation nebulized MgSO4 or CaGluc, dilute to 2% before use
Irrigation with water
- Most acids and alkali
Topical or injectable calcium or magnesium salts
- Hydrofluoric acid
Cover burn with oil
- Sodium metal
- Lithium metal
- Sodium and lithium metals: brush away or excise pieces of metal
- Phenol: polyethylene glycol wipe
- White phosphorus: copper sulfate irrigation
- Alkyl mercury agents: debride and remove blister fluid
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