Digital EpiPen injection: Difference between revisions

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==Background==
==Background==
*Accidental digital self-injection of epinephrine from an EpiPen.


==Clinical Features==
*Puncture wound with delayed capillary refill (vasoconstriction)


Accidental digital self-injection of epinephrine from an EpiPen.
==Differential Diagnosis==
*Injection of other medication
*Retained [[foreign body]]
*[[Allergic reaction]]
*[[Cellulitis]]


==Evaluation==
*Typically a clinical diagnosis (no testing required)


==Diagnosis==
==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.
</ref>
**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


Clinical ==Work-Up==
====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==
None ====
*Generally may be discharged
 
 
Treatment1) Observation for 2 hours after injection2) If continued ischemia sx after 2 hrs, give phentolamine mesylate 1.5mg in 1 mL of lidocaine into the ischemic area ==Disposition==
 
 
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==See Also==
==See Also==
*[[Epinephrine]]


==References==
<references/>


Tox: Epinephrine
[[Category:Toxicology]]
 
 
==Source==
 
 
"Six Years of Epinephrine Digital injections: Absence of Significant Local or Systemic Effects." Annals of EM.  Sept. 2010.  56(3):p270-274.
 
 
 
 
[[Category:Tox]]

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

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/
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