Monday. Hubby was washing out a fabric-like sleeve when either the water pressure either blew it out of his hand or the wand came out of the end and sliced his finger open when his finger went in front of a 4000psi pressure washer.
Where it blew open his finger was not the main problem. It forced air and dirty water into his finger and it instantly his finger blew up in size and then turned blue.
We were at the emergency room within 10 minutes. We sat in the waiting room for over SIX hours. They did say they broke a record with 17 ER check-ins within an hour. The swelling went down a bit then when it started to come back we finally made it to a room to find out that high-pressure water injuries can cause compartment syndrome and are often worse than they look. We read to seek immediate medical attention, and that almost 30% of these high-pressure water injuries end in amputation and that it is indeed worse than it appears. While sitting so long in the waiting room he was wishing he’d squeezed it right when it happened and poured some peroxide over it. That, or wore gloves or bought a new sleeve. Although his pressure washer will write works in concrete so I’m not sure gloves would’ve totally helped.
After several hours, they did xrays and said he had subcutaneous air and water trapped inside. Yep, bet that is why his finger was instantly so big it felt like it’d just split the skin wide open and bust. I have no photos within the first hour after the accident. We left without the right shoes, phones, purse etc. After an hour when they finally brought him an icepack, I went home to get the stuff I needed and a dry shirt for him since he was shivering. After we saw the packed waiting room at Pardee, I went up and asked if Urgent Care would be quicker but they said they would send him right back there. There was hardly enough chairs and we overheard several people who’d been sent from Urgent Care with barf bags. Not like we really wanted to get sick from sitting there for so long. We tried to touch nothing and use sanitizer. When he fell off the roof and broke ribs and vertebra his butt hardly hit the chair seat before they saw him. I told him we should go back up and say he fell off a roof and on the way down his finger went in front of the pressure washer to see if they’d look at it sooner. Urgent Care handled the dirty nail puncture would through a finger in 2017 without a problem so I don’t know what they can and can’t do. I know the date because they wanted to know when his last tetanus shot was. Like everyone needs them at some point in their lives?
The ER doctor, Lloyd said she was calling in a hand surgeon. They called in an orthopedic surgeon Dr. Lavigne. The doctor pressed on it and decided to leave the cut open. He said if it had not started to go down in size or if he had been using a cleaner in the pressure washer they would’ve splayed it open right then to release the pressure and clean it out without waiting and watching.
Doc told him to try to bend it and work the fluid and air out, they never did clean it with anything other than saline, wrapped it and sent him home. Dr. Lavigne did call until he got us and said he needed to be on antibiotics and called some in. Hubby has celiac so wasn’t thrilled about tearing up his gut but he also didn’t want to lose his finger. We also know there are lot of doctors and people that overuse and abuse antibiotics, taking them often, for viruses, colds and as a precaution only when they are not needed. Overuse and misuse can cause superbugs, resistance, C-Dif, colitis, and lots of other side effects.
Then Tuesday he had a fever, the meat was coming out of the hole and had white on it, the redness moved down the top of his hand and he had shooting pains in it— but then again he did go to work that morning but quit when it felt and looked worse. The doctor said to come by and let him look. Said it was still okay to just watch. Made an appointment for Wednesday morning.
The camera club meeting fell on Tuesday. I wasn’t going to go, but he went to work that morning and the doc said it looked okay. Somehow I locked my keys in the car when I put the prints in and had to call him at 9pm to come with our other set of keys. I didn’t think my car would let you do that, but I was proven wrong. What timing I have.
Wednesday morning he had a red line with a bump at the end on the back of his finger, more redness, pain and swelling into his palm. Dr. Lavigne said he needed to surgery that afternoon and to be at the hospital at noon. The doctor said it’d be an overnight stay to manage the pain.
Well, when we got home, his bullheaded self put the tire back on the tractor just before his surgery Wednesday even though he had two friends offer to do the stuff he didn’t think I couldn’t do. He said I couldn’t lift the tire but then never let me try. I was wrapping up the water hose and pressure washer that was still out, and looked over and he’d done it. Stubborn man!
We got there at noon, shortly after they took us back to pre-op. Just before 3pm, they took him back to the OR. Just before 4pm and said he has a hole where the skin was torn open and more of his finger dead tissue had to be removed leaving a hole at that joint that he said would have to be packed and irrigated by home health. The doctor cut a zig zag pattern and flushed with antibiotic, dead necrotic tissue and grit like debris removed.
He had a pocket full, about 2″ long but the compartment syndrome threat has passed. Now it’s nerve, infection, pain management and healing correctly with complete use that tops our prayers. He did well under anesthesia. They sent a culture off to make sure he’s on the best antibiotic for the specific bacteria. We hope his celiac gut can recover from all the antibiotic especially since his finger got infected even though he was on them.
The nurse in recovery said it was up to us if he stayed for up to 23 hours or went home. He chose to go home.
The 4-6 hour digit nerve block wore off before 7pm and he was in more pain than on Monday until around 1am. All his fingers are hurting and cold. We are guessing it was from having a tourniquet on his arm during surgery or handling of the nerves. It sounds like a long recovery of packing, flushing, limited use, keeping it raised and iced for the next several weeks.
When we left recovery we stopped on the way home to get the prescriptions. They were not ready. Said it’d be another 30 mintues. I took hubby home and went right back. It hurt so bad even though he took a pain med the minute I got back home with it and we went to bed early. Rough night! We at least got a little sleep (between every 4 hour pain pill) when our neighbor quit mowing and his dogs stopped barking after 10pm.
Now we normally put our phones on auto DND but we wanted to use the easier alarm on hubbies phone to tell Siri to wake us up. All of our friends know we go to bed early even when nothing is wrong. After a few news alerts then a text after 9pm from his chiropractor wanted to know if he got his email when we were trying to sleep and let his pain meds work he put it back on DND and I set the old fashioned clock alarm.
He told me Thursday morning that between 7pm and 1am he actually wished they’d just amputated his finger or he’d stayed in the hospital so they could manage the pain better. It was offered. He said he wanted to go home, but when she asked his nerve block was still working.
By the 2nd pain pill, he started itching all over. The pain med was supposedly changed to one he tolerated better. When I got back home with the Rx and realized they’d filled it with the wrong original one but he was already in pain so he took it instead of waiting on me to go back to Walgreens. I should’ve checked before paying. He had a few pain pills left over he can take from his fall off the roof (apx 9 yrs ago) where he broke vertebra and ribs, that he knew did not make him itch. I called the hospital at 2am to ask how long one had to be out of his system before he could change to the other and they were NO help at all! I hope we can do getting and staying better ahead of the pain. The doctors assistant called me back and told him just to take Benadryl with the pain pill.
Two more things. When I called our insurance for a preapproval at 11am Wednesday for the noon surgery, they said it can take 7 days for approval. To top off this week, our fridge started humming loudly again with the “repaired” ice maker frozen up again. I think naps are on the schedule along with a decent dinner.
Friday he went for the follow-up. The pocket was all the way to the bone. He has to irrigate daily with Dakin which is a bleach solution. Doc originally said he had to pack the hole but said he could *just* irrigate.
Unpacking the gauze was worse than he thought it would be but the bleach irrigation was not as bad as he expected. Surprising it doesn’t burn (he says) like you’d think putting a diluted bleach solution into a finger hole that goes to the bone.
Saturday morning, the end of his finger is still partially numb, he can tell if it’s being pressed on but feels more like pressure than touch. The doc said the pocket was under the nerve and tendons all the way to the bone so we are hoping it is just nerves that have been traumatized and he gets feeling back. I hope even though he didn’t really want packing done, that not packing it was the right call. The hole is smaller so the access to irrigate into the large pocket is smaller. He had a large cyst removed as a teen that had to be reopened when it was surgically closed and healed on the outside first, instead of inside out, then packed, buying lots more healing time. This doctor didn’t close the hole so it could continue draining and the irrigation is to keep the infection out and I think he said it was to help heal the right way. He can’t even wash his hands with water. Soap then either peroxide or sterile saline of his entire hand, not just the finger.
It’s amazing with two sets of ears, really trying to pay attention, listen and retrain, and what we can’t remember. I had to take the darn syringe with the needle back and get them to show me how to get the needle out to attach the fine end to the large syringe sans needle. They gave us a different kind so maybe it wasn’t just us. Then again I hate needles and was not real comfortable fiddling with the first one trying to figure it out. The new kind is better. You just push a button and the needle part goes back in the handle part so you can easily get the end off we needed.
He’s down to just acetaminophen most of the time. Can’t take NSAIDs with the antibiotic. Still icing, still checking his cap fill on his nail, still keeping it elevated and dry and still praying. Irrigating 1- 2x per day. His system is feeling the effects of the antibiotic.
His finger aches and gets a heartbeat throb in it but he mostly only has sharp shooting pains now if it gets bumped or if he inadvertently tries to straighten it. He is having some shooting pains into the knuckle at his hand though today. Sadly I’ve hurt him more than once tending to it even though I’m trying my hardest not to.
Good news is he has no increased red on the top or the palm of his hand. The doc said it would probably still turn some color just from how much he had to do to clean out everywhere the high pressure put stuff in and caused damage. The doctor used something that could look in his finger as it helped splayed it back and said he got to a line (I think on the side) that the water pressure had not damaged and he said it did not extend into the knuckle, whatever they call the one that’s in your hand at the base of your finger.
Tyler is being ever so helpful. He tries to get to the bleach smell, reminds us we have a cat every time we get up, even in the middle of the night by escorting us between our legs and meeping to be held and petted. Most importantly he wants to in a lap and feels that his presence, really, really close presence, is just what the doctor ordered.
So no more updates for a while. We are just praying that infection or healing from the outside in doesn’t happen, and that there is no lasting nerve damage or change to his grip. I ordered a pack of silicone rings to see if those are any better than his gold band.
Even though the ER didn’t seem to know how important quick attention is, this is a more common injury that you’d think. Hubby knows better but the wand was supposed to stay IN the sleeve he was washing. We read about two boys that one pulled the trigger and hit his brother in the mouth. I hope it was not a commercial grade 4000psi pressure washer. I can’t even imagine that recovery. I’m surprised more kids, pets, and workers are not damaged by pressure washers.
Here is some of what we’ve learned:
- We have friends and family that have stepped in and asked what they can do and a whole lotta praying going on which means so much. Offers to help included everything from putting the tractor back together, mowing, gardening, running errands or just open-ended offers of help. We appreciate each of you!
- We are loving Amazon Prime for getting us stuff the next day after it was discovered it was needed without having to drive around hunting it. (Thanks mom)
- Umbrella bags make pretty good hand covers if you combine them with an ace bandage and a hair band, but the print on the outside comes off so watch your towels. I may try grocery store veggies bags.
- Dental floss does indeed help get a stuck wedding ring off and the silicone ones are probably a better choice for people in hubbies line of work.
- The finger-shaped ice packs are a joke. He’ll be healed before his finger will go through the large one and even my pinkie can’t fit through the small set.
- Cutting the wrapped injured finger out of a glove keeps you from freezing them ubwrapped fingers quite so much while you wait for the ice pack to make it through the bandages.
- No one around here stocks Dakin or Adaptic or the same quality Coban they use in the ER
- Before holding a syringe containing a Dakin upright and trying to get the air out… protective eyewear should be worn for when it squirts the liquid out before it gets to the air bubble.
- Walmart has WAY better prices on prescriptions than Walgreens and everyone regardless of insurance can use GoodRx.
- Someone should really make a pain med that lasts through the night.
- If you have a nerve block, don’t decide you’re okay to go home before it wears off.
- Take a pain pill before they unpack the gauze from a deep hole that just keeps coming out so long it makes you wonder just how big that pocket was and how they got it all stuffed in there.
- Dr. Levign goes above the normal call of care.
- They consider itching to be an adverse reaction not an allergic one.
- and most importantly, buy a new tractor sleeve or at least put on leather gloves just in case the wand slips out of the sleeve and whips across a body part.
Lot of help I am in the yard. Got just the front mowed before the belt broke on the mower. Hoping the push mower will still start this afternoon so I can at least knock down the side yard after some other errands and it’s dry.
He has follow up tomorrow. The hole did indeed close up on the outside the day after the packing was removed. Hope the inside hole heals too. He has shooting pains in his hand and arm, his stomach is a mess from the antibiotic. There has been no more redness or swelling in his finger or hand. The hole has a little bit of white edge to it but doesn’t look like puss or infection to us. He’s let up on the ice a bit but is still keeping it elevated and dry. He is trying to bend and straighten it but it just doesn’t want to, plus it makes it hurt and sends a heartbeat back into it.
We are hoping it doesn’t have to be reopened and packed to heal from the inside out, and I’m sure he’ll be glad when he can take a shower and get water on his hand instead of just sterile saline, peroxide, soap and Dakin bleach solution.
On Wednesday the 5th they took out the stitches. Said it may be a while before the shooting nerve pains stop going up finger, hand and arm, and the feeling comes back in the end of his middle finger. Said to flex and straighten it as much as he can even if he needs his other hand to do make it… which he does. He has to keep it dry (no water at all) bandaged and continue Dakin cleaning until it has healed over completely. Said to come back in a week and they’d start physical therapy to get movement back in his finger. I know he’ll try his best to get movement back and not do PT.
To all how have offered to help. He seems to have the inability to delegate. He can’t put the belt or pulley back on the mower but he took over the push mower and wouldn’t let me do it. He didn’t care for the way I pulled out the hose or watered in the garden either. That saying about, if you want something done right you gotta do it yourself, seems ingrained in him. He is out at his garden now as I type, supposedly just picking anything ready. Mowing he kept it elevated by hooking it in his shirt pocket. #StubbornMan
He has really been trying to straighten and bend his finger, but it does require him using his other hand. He can do the praying pose with elbows up without difficulty. His finger is actually more bruised looking this morning. Still has pain and drainage. Still has numbness of the tip.
7-6-19 his finger looks like someone overweight who’s lost a ton of weight. From being stretched out swollen for so long today when he makes it bend, there are skin fold wrinkles. He has finished one of the two antibiotics 🙂 but at the rate the hole is (not) closing up it’s going to be forever until he can get his hand wet and switch to a smaller covering. Guess because it’s right in the bend but it’s still open.
His finger was right at the nozzle when it came out of the greasy sleeve and sliced it open and injected air, fluid, and debris into his finger. While looking for either a surgery video or a Kalabasi sausage that had been 4000 psi pressure washered, I found videos of pressure washer tattoos… and I thought eating Tide Pods was stupid enough. Looks like most injuries are painters or mechanics. Some come from where there is a leak in a hose instead of the wand end going across a hand.
I never found either video I was looking for, or one on what PT for this would be, but I did find these:
With paint but his ER had him treated within 6 minutes.
Shows a photo during surgery but goes to a bunch of selfies toward end
Seems 4000 psi = bar 276. Yes the end is stupid.
Ultra high pressure cut log notice the water coming out through the rings in the log before they get it cut
Yep sitting for 6 hours in the ER couldn’t have helped matters any.
“The diagnosis is usually delayed secondary to the benign initial appearance combined with a lack of appropriate clinical knowledge among physicians. Surgical intervention including aggressive debridement and decompression must be undertaken in the first 6 hours to decrease the risk of amputation” https://parjournal.net/article/view/1243
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