Digital EpiPen injection

Background

• Accidental digital self-injection of epinephrine from an EpiPen.

Clinical Features

• Puncture wound with delayed capillary refill (vasoconstriction)

Differential Diagnosis

• Injection of other medication
• Retained foreign body
• Allergic reaction
• Cellulitis

Evaluation

• Typically a clinical diagnosis (no testing required)

Management

• Observation for 2 hours after injection
  • If continued ischemia symptoms after 2 hrs, inject phentolamine into the ischemic area (see procedure below)

Digital Phentolamine Injection Procedure

Equipment Needed

• 10cc syringe
• Phentolamine mesylate
• 1-2% lidocaine (WITHOUT epinephrine)
• 25g needle

Technique

• Dilute 1.5mg of phentolamine mesilate in 1mL of 2% lidocaine.
• Inject subQ into the site and stop when tissue turns pink again.
• Observe and repeat as necessary.

Disposition

• Generally may be discharged

See Also

• Epinephrine