Adrenaline Auto-injector injuries to digits; a systematic review and recommendations for emergency management

Walsh, Karl; Baker, Benjamin G.; Iyer, Srinivasan

doi:10.1016/j.surge.2020.01.005

Cited by 12 publications

(8 citation statements)

References 54 publications

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“…Warm soaks and massaging of the injection site should be systematically applied as a first-line treatment and vasodilator treatment should be discussed case-by-case. 7 Notably, in our survey, activation failures were reported in three patients, of whom two underwent worsening anaphylaxis symptoms. However, in these cases, the causal link between activation failure and poor outcome cannot be proven.…”

mentioning

confidence: 75%

“…Guillaume Pouessel 1,2 Nadine Petitpain 3 Luciana Kase Tanno 4,5,6 Sophie Gautier 7 Collaborators of the Anaphylaxis Working Group of the French Allergy Society †…”

Section: Data Ava I L a B I L I T Y S Tat E M E N Tmentioning

confidence: 99%

“…6 Different treatments may be administered after accidental digital injections, including heat, local injection of lidocaine or phentolamine, and nitroglycerine paste application. [2][3][4][5][6][7] However, there is a lack of consensus on the management of patients following such accidental digital adrenaline injections. Warm soaks and massaging of the injection site should be systematically applied as a first-line treatment and vasodilator treatment should be discussed case-by-case.…”

mentioning

confidence: 99%

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Adverse drug reactions from adrenaline auto‐injectors: Analysis of the French pharmacovigilance database

Pouessel

Petitpain²,

Tanno

et al. 2023

Clin Experimental Allergy

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mentioning

confidence: 75%

“…Guillaume Pouessel 1,2 Nadine Petitpain 3 Luciana Kase Tanno 4,5,6 Sophie Gautier 7 Collaborators of the Anaphylaxis Working Group of the French Allergy Society †…”

Section: Data Ava I L a B I L I T Y S Tat E M E N Tmentioning

confidence: 99%

mentioning

confidence: 99%

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Adverse drug reactions from adrenaline auto‐injectors: Analysis of the French pharmacovigilance database

Pouessel

Petitpain²,

Tanno

et al. 2023

Clin Experimental Allergy

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“…[9] A variety of methods have historically been trailed for adrenaline reversal. The most effective of these is local infiltration with the alpha blocker phentolamine (Walsh et al [7] ). It has been shown to be safe and effective at reversing the effects of adrenaline, restoring circulation almost immediately.…”

Section: Introductionmentioning

confidence: 99%

“…[6] At such concentrations there is a potential risk of digital ischemia progressing to necrosis should the device be injected into the hand or finger as well as severe pain and long term neuropraxia. [7,8] This is of particular relevance given the vast majority of auto-injector injuries involve the hand or fingers. [9] A variety of methods have historically been trailed for adrenaline reversal.…”

Section: Introductionmentioning

confidence: 99%

Adrenaline auto-injector injuries: Practical considerations in emergency management in a tertiary hand surgery unit

et al. 2023

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Adrenaline auto-injectors are the first line treatment for anaphylaxis in the community setting. Both anaphylaxis and auto-injector carriage are increasing in prevalence. Adrenaline auto-injector injuries are common and most often involve the hand or digits. Such injuries carry a risk of ischemic necrosis due to profound vasoconstriction, especially if there is undying vascular pathology such as Raynaud’s disease. The effects can be readily reversed with local infiltration of phentolamine. A survey was circulated to 40 clinicians working in the emergency and hand surgery departments of a major urban center. Knowledge of adrenaline duration of action and its reversal (agent, dose and location in the hospital) was assessed. All clinicians working within the two departments were eligible for participation. Only 25% of clinicians surveyed were aware of the duration of action of adrenaline. Half were aware of the correct reversal agent and only 20% knew the correct dose. Only one person was aware of phentolamine’s location within the hospital. There is relatively poor clinician knowledge surrounding adrenaline reversal and a lack of easily accessible information available about dosing and drug location within the hospital. Given the time dependent nature of adrenaline auto-injector injuries Emergency Departments should consider stocking phentolamine in an emergency drugs fridge within the department along with a dosing guide. This is likely to greatly reduce time from presentation to treatment and thus the chances of digital ischemia progressing to necrosis.

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Underuse of Epinephrine Autoinjectors in Anaphylaxis: Who Is to Blame?

Parikh

Cruickshank

Waserman

2022

Curr Treat Options Allergy

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Adrenaline Auto-injector injuries to digits; a systematic review and recommendations for emergency management

Cited by 12 publications

References 54 publications

Adverse drug reactions from adrenaline auto‐injectors: Analysis of the French pharmacovigilance database

Adverse drug reactions from adrenaline auto‐injectors: Analysis of the French pharmacovigilance database

Adrenaline auto-injector injuries: Practical considerations in emergency management in a tertiary hand surgery unit

Underuse of Epinephrine Autoinjectors in Anaphylaxis: Who Is to Blame?

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