Rosen's Emergency medicine: concepts and clinical practice. In: Marx JA, Hockberger RS, Walls RM, Adams J. Successful treatment protocol for canine fang injuries. Ultrasound versus radiography in the detection of soft-tissue foreign bodies. Manthey DE, Storrow AB, Milbourn JM, Wagner BJ. An in vitro comparison of computed tomography, xeroradiography, and radiography in the detection of soft-tissue foreign bodies. Kjhns LR, Borlaza GS, Seigel RS, Paramagul C, Berger PE. Management of lacerations in the emergency department. Retained glass foreign bodies in wounds: predictive value of wound characteristics, patient perception, and wound exploration. Steele MT, Tran LV, Watson WA, Muelleman RL. Surgical infections of the hand and upper extremity: a county hospital experience. Emergency department evaluation and treatment of hand injuries. Orthopedic pitfalls in the ED: fight bite. Vascular trauma and compartment syndromes. The compartments of the hand: an anatomic study. Orthopedic pitfalls in the ED: acute compartment syndrome. The anatomy of experimentally produced high-pressure injection injuries of the hand. High-pressure injection injuries of the hand. Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Stengel D, Bauwens K, Sehouli J, Ekkernkamp A, Porzsolt F. 2000 18:820-4.Īmerican College of Emergency Physicians: Clinical policy for the initial approach to patients presenting with penetrating extremity trauma. High-pressure injection injuries to the hand. Vasilevski D, Noorbergen M, Depierreux M, Lafontaine M. Occupational hand and upper extremity injuries and diseases. Pressure gun injection injuries of the hand. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures: recommendations of the Immunization Practices Advisory Committee (ACIP). 2001 26:572-81.Ĭenters for Disease Control and Prevention. Indications and selection for digital amputation and replantation. Hand elevation: a simple effective method. Edinburgh, N.Y.: Churchill Livingstone, 1983:3–10. Edinburgh, N.Y.: Churchill Livingstone, 1990.Īmerican Society for Surgery of the Hand. The hand: primary care of common problems. In: American Society for Surgery of the Hand. Biomechanics of wrist injuries in sports. 17 A swollen hand, tense on palpation, in an intrinsic minimus position (i.e., extension of the metacarpophalangeal joints and flexion of the IP joints) strongly indicates this condition. Hence, compartment syndrome is diagnosed on the basis of a high degree of clinical suspicion. Dorsal and mobile wad compartment syndrome may not present with the classic signs. Paresis and pallor appear very late, and pulselessness, usually the last sign to appear, may be present early in patients with injury to major arteries 17 By the time all six symptoms manifest, the patient has been irreparably harmed. Paresthesia is an important early sensitive sign but lacks specificity. 15 Pressure refers to increased tension on palpation of the extremity. The “6 Ps” (i.e., pain, pressure, paresthesia, paresis, pallor, and pulselessness) should be assessed. 16 Paresthesia and pain disproportionate to the injury or increasing levels of pain following treatment are initial indicators that should alert the physician to the possibility of compartment syndrome. Anatomic variations of the hand, multiple compartment involvement, the presence of other injuries, or an obtunded patient make it difficult to predict physical findings of compartment syndrome.
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