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The EpiPen and the ischaemic finger
Talvinder Singh1, Susheelwant Randhawa, Rakesh Khanna
1Department of Accident and Emergency Medicine, New Cross Hospital, Wolverhampton, UK. talvinder13@hotmail.com
Summary
Accidental EpiPen injection caused digital ischemia. Topical phentolamine reversed this adrenaline-induced complication, offering a novel treatment for finger ischemia.
Area of Science:
- Emergency Medicine
- Pharmacology
- Hand Surgery
Background:
- Accidental epinephrine (adrenaline) injection can cause digital ischemia.
- Epinephrine's vasoconstrictive properties pose a risk for tissue damage.
- Limited effective treatments exist for epinephrine-induced digital ischemia.
Observation:
- A 24-year-old patient experienced digital ischemia in her left index finger after accidental EpiPen injection.
- Various conventional treatments for ischemia were ineffective.
- The patient presented with signs of compromised blood flow to the finger.
Findings:
- Topical infiltration of phentolamine (an alpha-adrenergic blocker) mixed with lignocaine (a local anesthetic) was administered at the injection site.
- Immediate resolution of digital ischemia was observed following phentolamine administration.
- Phentolamine effectively counteracted the vasoconstrictive effects of epinephrine.
Implications:
- Topical phentolamine represents a promising and effective treatment for accidental epinephrine injection-induced digital ischemia.
- This case highlights the importance of recognizing and promptly treating this rare complication.
- Phentolamine infiltration may be a valuable addition to the emergency management of digital ischemia from epinephrine exposure.
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