7/15/09: Either septic tank water or hydraulic fluid…

“I’ve had these white bumps on my hands for 1.5 weeks and I can’t figure out if it was the septic tank water I had my hands in, the hydraulic fluid on my hands, or the new gloves I was wearing.”

“I’m not sure either, but I’ll go out on a limb and say the gloves are the least of your worries,” is what I wanted to say.

Turns out this gentleman was working on fixing the septic system at his cabin when the hydraulics broke on his back-hoe. That explains the hydraulic fluid, the septic tank water, takes a little more explaining I didn’t bother to ask about.

Since the white papules were responsive to over-the-counter hydrocortisone, my treatment plan included a higher potency topical steroid and careful monitoring. I presented the case to my preceptor and I watched his eyes lite up when I mentioned the word hydraulic fluid. We go into the room and my preceptor commences a repetitive interrogation of whether the hydraulic fluid was under pressure and was injected under his skin or was a simply soaked his skin. I stand there pretending like I know where this line of questioning is going surprised at the intensity of the interrogation.

I have always intuitively known that hydraulic fluid is probably not good for the body. What I didn’t know (and my preceptor has seen before), is that someone can actually lose their hands if the hydraulic fluid is injected into the hands. The quintessential story is that the someone grabs a hold of the hydraulic fluid line to either connect or disconnect the hose about 4” from the end of the hose, right where it usually bends, the hose cracks and sends a thin line of high pressure hydraulic fluid right into the person’s hand. The person my look at their hand and see a tiny little hole on their palm and think it is very inconsequential, though this little hole allowed a very necrotic substance into their body.

The treatment for this (and only treatment) is immediate surgery. Immediate as in this minute, not let me call the wife/husband/kids first then I’ll go to the emergency room; this is get yourself to a surgical table NOW!! The surgeon would slice open your hand and start doing mass irrigation of the immediate involved tissues and continue doing this until the cows come home, then do it for another 4 hours.

Moral of the story: don’t mess with pressurized hydraulic fluid lines!!

Our patient was lucky enough to avoid having the hydraulic fluid injected into his body, but my preceptor was nervous enough (even 1.5 weeks post incident) that he made the patient return in 1 week to see how he is doing.