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What you should know about injection injuries and compartment syndrome

Nursing advocacy saved a man's hand

I can’t get out of my mind the case report that I recently read and want to share it with you so it can occupy your thoughts as well.

A young man in the Humble, Texas area worked for an auto body shop. One day he was using a high- pressure wand to spray blue latex paint on the car. The wand must have been unwieldy and his middle finger touched the tip of the wand while it was spraying paint.

I can relate to this because I’ve done something similar using a pressure washer, although washer equipment doesn’t operate anywhere near high pressures of an automobile paint wand. The young man wasn’t too worried about it but casually mentioned it to his supervisor, who told him to immediately go to the hospital emergency room (ER).

The employee was a little confused but did as he was told. When he got to the ER, a physician evaluated him and examined his hand. The doctor looked at every finger, but didn’t notice any swelling, abnormal pulse, diminished strength, or any evidence of a penetrating injury. Plus, the patient said that he wasn’t experiencing any pain.

When the ER spoke to the experienced registered nurse who was on duty about discharging the patient, the nurse spoke up and advocated for an orthopedic surgery consultation. This is the part of the story that I love.

On that date, this nurse perfectly exercised the unique responsibility of all nurses to advocate for care that he felt the patient needed. The physician showed no pride or arrogancy, accepted the nursing recommendation, and called an orthopedic surgeon. To the ER doctor’s surprise, after sharing the details, the orthopedic surgeon said he’d be right there.

When the surgeon did his own evaluation of the patient, everything still looked normal. Nevertheless, he admitted the patient to the hospital for close observation.

Sure enough, overnight the patient’s finger began to swell and got very painful. The orthopedic surgeon took him to the operating room (OR) for immediate surgery for suspected compartment syndrome.

What is compartment syndrome?

Over the years, I represented several clients with compartment syndrome medical malpractice cases. This is a painful medical condition where swelling or bleeding occurs within the tissues of a compartment of the body because compression within the compartment cuts off blood flow and oxygenation to muscles and nerves. In severe cases, emergency surgery is necessary.

Many cases of compartment syndrome arise after sports or athletic events and injuries, crush injuries, excessively tight bandaging, surgery of the arm or leg, or blood clots in the same area.

Medical and nursing experts look for signs and symptoms of compartment syndrome, including intense pain, numbness/paresthesia, weak or absent pulse, and weak motor strength or paralysis. Compartment syndrome can affect the lower or upper extremities.

When the surgeon took the patient to the OR, he made an incision on the palm side of his hand to decompress or release the compartment. The surgeon immediately saw blue latex paint—the same paint that the young man had been spraying when his middle finger accidentally touched the tip of the paint wand. The surgeon continued the incision of his hand and into the forearm. He had to keep cutting almost to the elbow before he found clean tissue that wasn’t affected by the blue latex paint.

Fortunately, because a registered nurse spoke up and advocated for the patient, and the ER doctor listened, the patient fully recovered.

Absent this type of attentive, competent multidisciplinary care, needless injuries can occur.

Believe it or not, another case in Houston was reported where there was a similar injury involving red paint. The major difference in that case, though, was that the patient was discharged from the emergency room because he had no symptoms or signs any problem. He developed severe compartment syndrome overnight and was taken to surgery. By then, though, it was too late for a full recovery. The surgeon had to cut out or reset a good chunk of muscle in his right hand and amputate two fingers.

Injection injuries

These injuries are common enough that there is a special name for them: Injection injuries. When a patient reports a finger or hand interrupting the high-pressure flow of paint or another fluid, the ER physician or other provider should have injection injury at the top of the differential diagnosis. Failure to admit the patient and give orders to work up this potentially devastating injury would violate the standard care in place the patient in needless risk.

If you’ve been seriously injured because of injection injury or other emergency medical condition in Texas, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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