Digital Epipen® Injection: A Case of Conservative Management

Sherman, Scott C.

doi:10.1016/j.jemermed.2009.07.027

Cited by 7 publications

(2 citation statements)

References 12 publications

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“…Accidental digital injection with epinephrine has multiple case studies and case series demonstrating minimal long-term adverse effects [3,4]. This is found both in the emergency medicine literature and has been long accepted and known within the plastic surgery community [5,6].…”

Section: Discussionmentioning

confidence: 96%

Pediatric Epinephrine Auto-injector Accident Without Digital Ischemia

Shapiro¹,

Ziehl²

2019

Cureus

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Accidental finger sticks with EpiPens and EpiPen Jr (epinephrine auto-injectors) are a very real hazard in those who carry them and their families. The most feared complications are digital ischemia and necrosis; however, long-term adverse effects are extremely rare. Treatment for a finger stick is controversial, ranging from intra-arterial injections of vasodilating agents to topical vasodilators to conservative management. We report a pediatric patient suffering from an EpiPen Jr accidental stick to the distal first digit who was successfully managed in a conservative fashion.

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Section: Discussionmentioning

confidence: 96%

Pediatric Epinephrine Auto-injector Accident Without Digital Ischemia

Shapiro¹,

Ziehl²

2019

Cureus

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“…Furthermore, a minimal dose of local anesthetic is conceptually valid for solutions with epinephrine and without [ 14 ]. From multiple case studies and case series, few long-term adverse effects of accidental epinephrine digital injection have been reported [ 15 , 16 ]. This is accepted by the plastic surgery community and identified in the emergency medicine literature [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection

2020

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Patient: Female, 26-year-old Final Diagnosis: Digital ischemia secondary to accidental epinephrine injection Symptoms: Pain Medication: — Clinical Procedure: Local injection of phentolamine to reverse ischemia Specialty: Plastic Surgery Objective: Management of emergency care Background: Accidental finger-stick injuries have been reported with epinephrine autoinjectors, such as EpiPen and EpiPen Jr, and can result in necrosis and digital ischemia. However, long-term adverse effects are very rare. The treatment for accidental finger-stick injuries is controversial and includes intra-arterial injections of vasodilating agents, topical vasodilators, and supportive management as needed. Case Report: Here, we report a case of a 26-year-old pharmacist who injected herself accidentally with an EpiPen on the tip of her index finger. Warm water and nitroglycerine gel did not alleviate her symptoms. After three hours, phentolamine was injected around the necrotic area, and the skin normalized. Conclusions: All health professionals should be trained in how to handle epinephrine autoinjectors safely. Phentolamine may be efficacious in treating accidental finger-stick injuries from epinephrine autoinjectors.

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