How to stop zombie hand

You are examining a 15 year old who presents to the ED with his Mother after developing hand pain 2 hours prior. He is a proud member of the local paintball team “SLY Slytherins”. You observe an uninterested teenager texting on his phone and sweeping his long hair of his face every so often to see his text messages. Suddenly he starts waving his phone at you in sweeping motions -- when you ask him why, he states, “It’s for my SNAP story brah”. His Mother states she thinks he was cleaning his paintball gun a few hours earlier today. On exam there is full range of motion and local, exquisite pain in the palmar aspect of the hand near the hypothenar eminence. No swelling, warmth, or exudate is noted. Which of the following is true?

A. X-ray is very poor at showing foreign body material

B. Physical exam plays an integral role in identifying extent of injury

C. Amputation risk on average is less than 50% in these patients

D. QT prolongation is a useful marker in hydrofluoric acid exposure

——-References:

Hart, R. et.al. (2001). Emergency and Primary Care of The Hand. American College of Emergency Physicians.

Loveday, I. (2007). High-pressure injection injuries. Emergency Nurse. PMID: 18065043

Locker, J. & Carstens, A. (2010). High-pressure injection of silica-based paint into a finger. The New Zealand Medical Journal. PMID: 20648104

Kohli, N. (2009). High-pressure injection injury in a furniture repairman -an outwardly minor in jury with the potential for a devastating outcome. Journal of Occupational and Environmental Medicine. PMID: 19741372


Blake Briggs