Digital EpiPen injection

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Background

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

Clinical Features

  • Puncture wound with delayed capillary refill (vasoconstriction)

Differential Diagnosis

Evaluation

  • Typically a clinical diagnosis (no testing required)

Management

  • Observation for 2 hours after injection[1]
    • If continued ischemia symptoms after 2 hrs, inject phentolamine into the ischemic area (see procedure below)

Digital Phentolamine Injection Procedure[2]

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

References

  1. "Six Years of Epinephrine Digital injections: Absence of Significant Local or Systemic Effects." Annals of EM. Sept. 2010. 56(3):p270-274.
  2. http://emj.bmj.com/content/21/3/387/