High Pressure Injection Injuries

We are often asked about injuries and illnesses that happen and we just wanted to tell you about a case in a factory, where hydraulic equipment was being used. A gentleman there, one of the workers, maintenance workers there, felt as though he had his hand stung whilst reaching inside a machine. And as a result of this, he sucked his finger and did nothing about it.

That gentleman, later, lost his finger; in fact, he lost two fingers.  “What could we have done?” And in that situation, the answer is recognising that something had happened, and not ignoring something that appeared very, very minor, because actually that stinging sensation that that chap felt, was the injection of a very high-pressure hydraulic fluid through his skin and into the inside of his hand. What are the consequences of that? Well, the consequences were, he lost two fingers; this will have a dramatic effect on how he lives his life from now on. In fact, he is no longer a maintenance engineer.

We have got to imagine that the skin, which is the largest organ of the body, is actually very porous, it is very soft, it is very vascular, it is very fluid. So, for anything that is injected towards the skin at high pressure, will immediately penetrate through the skin, destroying the soft tissues, the blood vessels and the nervous control over those blood vessels very, very easily. It is almost like a liquid bullet; an invisible, liquid bullet in fact. You cannot see immediately, other than maybe a tiny red spot, what has happened, but when that fluid enters into the inside of the skin, beyond the dermis, into the subcutaneous fat, we have got two problems here. The first problem is that it is space-occupying, and the second problem is that it is a poisonous substance to the body, it would not naturally be inside the body. And in the case of hydraulic fluid, it is very hygroscopic. Now that means it attracts water, it draws fluid towards itself. Now this has the effect of further increasing the space-occupying lesion. Couple this with the body’s natural inflammatory response, you can see how very quickly that the swelling inside the internal structures will start to crush nerves and blood vessels and muscles inside there.

And because the hand and the forearm are very compartmentalised in terms of fascia and muscle tissue, it is very easy for the pressure inside these compartments to build up, so that blood flow in and out of those is affected. Now this can happen in the space of a few minutes to a few hours after the initial injury. And the first thing that you will notice, or the patient will notice, is that it is starting to become hot, inflamed and painful, and perhaps, as in this case that I am talking about, the chap took a few… Two Paracetamol and a couple of Nurofen and hoping that the pain would go away. Now all the time that you are in pain is a sign that the tissue is actually dying. This patient should have immediately been taken to the local A&E department with a full description of what had happened because at that time, something could have been done about it. And that something would have been surgical intervention to debride the wound, to remove the poisonous substance, and to allow the swelling to swell without causing a compartment syndrome. Had that happened to this chap, the outcome would have been very different. As it stands, he is now without two fingers and unable to do his normal job.

The moral of the story is to be aware of the hazards that are around us when we are working in an industrial environment. It is impossible to know every day and during every situation, but when you are repetitively working with high-pressure fluids, hot fluids, chemicals, you should be fully aware of the potential hazards that can occur and know what to do with them when they do occur.

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