Digital EpiPen injection: Difference between revisions
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==Background== | ==Background== | ||
Accidental digital self-injection of epinephrine from an EpiPen. | *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<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 | |||
====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== | ||
[[Epinephrine]] | *[[Epinephrine]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[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/