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Title: Management options for accidental injection of epinephrine from an autoinjector:
Post by: SilverLining on February 17, 2015, 07:58:03 PM

http://www.jmedicalcasereports.com/content/3/1/7268

Quote

Abstract
Introduction
Epinephrine autoinjector devices are used with increasing frequency to treat severe anaphylactic reactions. Accidental injection, usually involving a finger, is a potential complication.

Case presentation
A physician in a Family Practice training program accidentally injected epinephrine into his left thumb while reading the operating instructions of an autoinjector (Epipen®). He developed swelling, pallor, and pain in the thumb. Treatment included topical nitroglycerin, oral vasodilators and warming of the thumb. As expected, none caused an immediate response; however, after 8 hours, the thumb was pink and warm. There was full recovery 2 months after the accident. We reviewed the treatment of accidental epinephrine injection, and found that the use of parenteral adrenergic alpha blocker phentolamine would have produced immediate recovery.

Conclusions
All health professionals concerned with the use of epinephrine autoinjectors should receive adequate instruction on their use. A regimen for management of accidental epinephrine injection, in particular the use of phentolamine, should be emphasized.

Title: Re: Management options for accidental injection of epinephrine from an autoinjector:
Post by: Macabre on February 17, 2015, 08:55:48 PM

DS injected himself in the finger at Middle School while training someone.  ~)

I was actually worried.  You can lose a finger that way.  His was a tip--so circulation was a concern. 

But he was fine. 

Title: Re: Management options for accidental injection of epinephrine from an autoinjector:
Post by: spacecanada on February 17, 2015, 09:06:41 PM

They should almost have this written in the 'what to do in case of overdose or misuse' section of the doctor and/or patient handouts that come with the medication.  I know at least two people who have accidentally injected epinephrine into their fingers and ended up in the emergency room with the 'wait and see' approach and then vasodilators.

Title: Re: Management options for accidental injection of epinephrine from an autoinjector:
Post by: SilverLining on February 17, 2015, 09:29:07 PM

I only know personally of one accidental injection.

Grade two student, epi-pen was kept in a backpack hanging at front of crass with big sign that it had <student name's> epi-pen.  A trouble-making kid (really, he was just a major trouble maker) took it out of the back pack, was playing with it at recess and jabbed himself in the fleshy part below the thumb.

(School decided epi-pens were to dangerous and would now be kept locked in the office. I helped the mom change their mind. It switched to student carrying it himself.)

~~~

It did prevent a school secretary from accidentally self injecting. She was trying to show someone how she knew all about epi-pens and how to use them. From across the room I said "that's not a trainer" and she said "yes, see, it said  generic".  She held it, ready to swing and jab. And I said louder "it has a needle and epinephrine". I went over and showed her there was an expired date. Then I dug through the drawer and took out the trainer and showed her the difference.

I then suggested the trainer not be kept with the real epi's.  What if a trainer was grabbed in an emergency?

Title: Re: Management options for accidental injection of epinephrine from an autoinjector:
Post by: Janelle205 on February 18, 2015, 12:04:02 AM

Our trainers at camp are kept in a special box just for teaching - there are a few expireds in there so that we can show them where to look to check the fluid and expiration date.  Staff don't check before using, but we have them check dates and the fluid when they check out their first aid kits before trips.  We always send camp epis on wilderness trips, mainly in case of an unknown insect sting allergy or an allergy that presents after a large number of stings.

At one of my old jobs, my supervisor's daughter accidentally epi-d herself in the hand.  She thought it was a trainer.  They ended up calling the town emergent care doc, who gave them permission to watch and wait at home.  Luckily, all turned out ok.

Title: Re: Management options for accidental injection of epinephrine from an autoinjector:
Post by: MomTo3 on February 19, 2015, 08:29:12 PM

Wow!  DD injected DS right into his thumbnail when he was about 3.  Dr. wasn't at all worried.

This is scary to look at in hindsight!