Digital EpiPen injection: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Injection of other medication | |||
*Retained [[foreign body]] | |||
*[[Allergic reaction]] | |||
*[[Cellulitis]] | |||
==Evaluation== | ==Evaluation== | ||
*Typically a clinical diagnosis (no testing required) | *Typically a clinical diagnosis (no testing required) | ||
== | ==Management== | ||
*Observation for 2 hours after injection<ref>"Six Years of Epinephrine Digital injections: Absence of Significant Local or Systemic Effects." Annals of EM. Sept. 2010. 56(3):p270-274. | *Observation for 2 hours after injection<ref>"Six Years of Epinephrine Digital injections: Absence of Significant Local or Systemic Effects." Annals of EM. Sept. 2010. 56(3):p270-274. | ||
</ref> | </ref> | ||
*If continued ischemia symptoms after 2 hrs | **If continued ischemia symptoms after 2 hrs, inject [[phentolamine]] into the ischemic area (see procedure below) | ||
===Digital [[Phentolamine]] Injection Procedure<ref>http://emj.bmj.com/content/21/3/387/</ref>=== | |||
====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== | ==Disposition== | ||
* | *Generally may be discharged | ||
==See Also== | ==See Also== | ||
| Line 26: | Line 40: | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | [[Category:Toxicology]] | ||
Latest revision as of 10:53, 12 December 2017
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[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
- ↑ "Six Years of Epinephrine Digital injections: Absence of Significant Local or Systemic Effects." Annals of EM. Sept. 2010. 56(3):p270-274.
- ↑ http://emj.bmj.com/content/21/3/387/