Digital EpiPen injection
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- Accidental digital self-injection of epinephrine from an EpiPen.
- Puncture wound with delayed capillary refill (vasoconstriction)
- Typically a clinical diagnosis (no testing required)
- Observation for 2 hours after injection
- If continued ischemia symptoms after 2 hrs, inject phentolamine into the ischemic area (see procedure below)
Digital Phentolamine Injection Procedure
- 10cc syringe
- Phentolamine mesylate
- 1-2% lidocaine (WITHOUT epinephrine)
- 25g needle
- 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.
- Generally may be discharged
- "Six Years of Epinephrine Digital injections: Absence of Significant Local or Systemic Effects." Annals of EM. Sept. 2010. 56(3):p270-274.