Digital EpiPen injection

Background

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

Clinical Features

• Puncture wound with delayed capillary refill (vasoconstriction)

Evaluation

• Typically a clinical diagnosis (no testing required)

Treatment

• Observation for 2 hours after injection
• If continued ischemia symptoms after 2 hrs
  • give phentolamine mesylate 1.5mg in 1 mL of lidocaine into the ischemic area

Injection Procedure

Epinephrine induced digital vasospasm using Phentolamine

Indications

For use when epinephrine is accidentally or inappropriately injected

Contraindications

Drug class allergy or non-ischemia.

Equipment Needed

10cc syringe, phentolamine, 1-2% lidocaine, 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

• Outpatient

See Also

• Epinephrine