EPIPEN® in the finger…

January 3, 2013

Hand XR, Orthopedics, Trauma, XR

I can think of only a couple worse places for an Epipen® to accidently be stuck:

EPIPEN finger 1

This is a pediatric patient that one of my colleagues saw.  Fortunately as you can see from the xray the tip of the needle went right through the bone and exited out the other side and the digit was not ischemic.

Accidental injection of epinephrine into a digit actually occurs somewhat frequently.  There are case reports and articles written on management if the digit is ischemic.  I’ll refer you to one that was published in the UK in 2004:

Velissariou I, Cottrell S, Berry K, Wilson B: Management of adrenaline (epinephrine) induced digital ischaemia in children after accidental injection from an EpiPen. Emerg Med J 2004, 21:387-388.

The article was a summary of three case reports out of the United Kingdom.  They used warm water immersion, topical nitroglycerin, and in one case local injection of 1.5 mg of phentolamine in 1ml of Lidocaine 2% was used with good effect.  Phentolamine is a short acting α blocker and can counteract the α mediated vasoconstriction epinephrine provides.  If you are practicing in the U.S., keep in mind that local Poison Control Centers can be good references if you have questions on management.

Author:  Russell Jones, MD

Image Contributor:  Mary Bing, MD

About emrems411

EMREMS: Radiology in Emergency Medicine

View all posts by emrems411

Subscribe to EMREMS

Subscribe to our RSS feed and social profiles to receive updates.


  1. The LITFL Review 090 - Life in the Fast Lane medical education blog - October 2, 2013

    […] EPIPEN® in the finger… – Awesome X-ray! […]

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: