THERAPY IN INJURY
BY INDUSTRIAL VERY HIGH PRESSURE AIR JET
texte en français
Harms J-D., D’Andrea C., Hummel A.,
Unité de soins hyperbares
Groupe Hospitalier Sud Reunion
BP 350- 97448 Saint-Pierre cedex- Ile de la Réunion –France
We report the clinical observation of a wound made by very high pressure air jet and treated by hyperbaric oxygen therapy (HBOT).
CLINICAL ACCOUNT :
On the 31st of May 2005, a 25 year old man is victim of an accident in the workplace with a high pressure gun (2500 bar): a jet of air mixed with water issued from a crack of the pipe hit him at the left Scarpa’s triangle (femoral triangle).
He is in shock and a hematoma shows on his left Scarpa’s triangle as well as a complete anaesthesia of the area innervated by the left crural nerve. A medical emergency mobile unit carries him by helicopter to the Groupe Hospitalier Sud Reunion (GHSR). He is directly admitted in the operating room. Vascular filling in and blood transfusion (6 blood units and 2 plasma units) are necessary.
The surgical check-up is :
a wound of the left femoral triangle which sides are in shreds.
a long slit on the femoral vein.
destruction of the femoral junction with the femoral artery retracted.
ecchymosed contusion of the ilio-psoas muscle.
the crural nerve is affected.
The surgery consists of the suture of the vein, the reparation of the femoral junction, Redon’s drains and closing (Dr Testart J.).
The patient is hospitalized in intensive care unit.
The second day, a drop of haemoglobin at 6 g / dl is observed. The temperature is at 38.5 ° Centigrade and biological control shows 10 000 polynuclear cells /mm3 with an ascent of the CRP at 220 mg/L.
HBOT is started on the second day and followed by 2 sessions the next day and then by one daily session the next 2 days: a total of 5 sessions. Each session consists of 90 min at 2.5 ATA. Considering the favourable development, hyperbaric oxygen therapy is stopped.
The young man follows a 3 months physiotherapy. One year later, no after-effect persists.
High pressure injection injuries are rare (1). In this accident, HBOT is recommended (2,3) due to :
-the presence of air in the tissues, notably in the abdominal muscles, and visible through computerized axial tomography (scanning) made the day following the accident.
-the risk of anaerobic infection due to the gas and liquids injected: the second day after the surgery, a fever made us suspect an infection.
-important tissue lesions (crush injury) with considerable oedema all over the lower limb.
This serious accident due to a jet of air at a very high pressure and involving vascular damages at the Scarpa’s triangle with crush injury and infectious risks has profited from hyperbaric oxygen therapy and its long term development has been favourable.
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High pressure injection injuries to
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Annual Scientific Meeting of the European Underwater and Baromedical
Society on Diving and Hyperbaric Medicine
August 23rd - 26th, 2006 in Bergen, Norway
Organised by EUBS in collaboration with
Norwegian Baromedical Society and Centre for Hyperbaric Medical Research
mise en ligne : 24/09/2006
ASSOCIATION RÉUNIONNAISE DE MÉDECINE SUBAQUATIQUE ET HYPERBARE
Siège social : Groupe Hospitalier Sud Réunion, BP 350, 97448 Saint-Pierre cedex, Île de la Réunion
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