Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection

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.