Epi-pens are used by patients who have severe allergies (anaphylaxis) to food or bee-stings and can be life-saving. To use one, one only needs to take the cap off, and then forcefully stab into their thigh (it has a device to prevent it from going in too deep). It is a potent vaso-constrictor in addition to causing bronchodilation. Periodically, someone accidentally injects themselves somewhere besides the thigh. Most commonly, in the finger. EMS workers for some reason frequently do this to themselves on a more regular basis. Recently I treated a woman who was an EMT who had inadvertently injected herself in the thumb with a patient’s epi-pen while attempting to administer the drug. She came in with her thumb ashen-white and very painful. This is because the vasoconstriction of the drug causes the blood flow to be diminished to the tip of the finger. As bad as this sounds, it is rarely a serious problem (although people get very worked up about it). If often resolves with just warm soaks and tincture of time. In this case however, we soaked her thumb for about 2 hours with minimal improvement. The next thing to do is to use a injection of a very old anti-hypertensive drug called phentolamine. It is a very potent vaso-dilator (and rarely used any more for routine management of hyperstension) and when injected subcutaneously, will help reverse the effects of the epinephrine. I gave her several injections around the base of the thumb and like magic over the next few minutes, the thumb pinked up and her pain was better. Just like in the text books! Next time, be a little more careful!
[...] ERP wrote an interesting post today onBe Careful with Epi-PensHere’s a quick excerptEpi-pens are used by patients who have severe allergies (anaphylaxis) to food or bee-stings and can be life-saving. To use one, one only needs to take the cap off, and then forcefully stab into their thigh (it has a device to prevent it b…/b [...]
I’ve seen phentolamine used for priapism, and I was going to say this even before reading your other story.
Well, it is my understanding that priapism can be caused by phentolamine and drugs like it ( due to vasodilation and excessive inflow-see my previous post) but I guess if there was a situation where vasospasm prevented outflow of blood from the spongiosum, a phentolamine injection there might help.
Not too long ago I injected myself in the thigh in front of a whole class of EMTs that I was teaching. Someone had switched out our dummy trainer models (no needle/drug) for the real deal without telling me. Tachycardia ensued.
Anybody else ever make the mistake of doing a dig block using either marcaine with or lido with before? Been there once, and will not make that mistake again. More unnerving than anything else.
My son has a peanut allergy and I carry an epi pen with me. He is in preschool, so he has one there too. Being a nurse, I wanted to make sure that the teachers knew how to administer it if need be…. The actual injection part was not too bad, they had been through training and seemed to get it. But they told me that they would give it to him if he vomited, had hives, a fever or trouble breathing.
DUH. He is 3. You don’t give a dose of epi for vomiting. You don’t give it for anything short of swelling and airway compromise. With my luck, the kid will get a GI Virus at school and end up taken by an ALS squad to the hospital where I work.
Definite learning curve here.
K
Just came back from a conference where they talked about using it for reversal of local (phentolamine, not epi).
Hmm,I’ve heard of using nitro paste for this,I don’t know how well it works though.
Thank you for posting this! As an educator, I often work with students who have EPI-pens, but no one has
ever stated how to use one. (I have taken a few basic 1st aid courses.) Your weblog entry has provided me with additional knowledge to ensure that I can be successful in the event of an emergency.
I recently took a patient (via squad) from a doctor’s office who was given an epi-pen injection by the doc…..for a bee sting that had occurred 24 hours previous. The patient’s complaint was that it was “still swollen” when he went to the office….when I picked him up, the chief complaint was “tachycardia”. Imagine.
<<vows never to stab herself with an epi-pen accidently
Dude post epi-pen: “WHAT THE FUCK DID YOU STAB ME FOR?”
Me: “I guess you’re feeling better, sir.”
Dude: “I’mma sue your ass.”
Me: “I just saved your life, sir.”
Dude: “Oh.”
Yea.
I had a call at the local middle school for difficulty breathing. The kid looks like he is ready to stop breathing. The school nurse had just injected him with the EpiPen. Rather than have to intubate him, I had to keep him warm and keep an eye on his tachycardia – which is still better than intubating a kid.
Had a call one morning for a bee sting victim on a rugged trail section that used ladders to ascend rock facings. Typical location for hornet nests. Call came via satellite phone, second call for a woman w/ apparent panic attack. When we finally found them, both were in sad shape. The woman tried to explain, that she used the epi pens like they told her to. Press down till you feel the sharp sting, then count to ten. She did this twice, with no effect, and her husbands condition had her getting terribly upset.
Well, what she did was injected herself twice, none to her husband. She felt the sharp sting in her thumb, and counted to ten. We med-evaced them both from the trail. The husband came around quickly, after we administered benadryl PO and epi SubQ from our kit. Wasn’t much we could do for his wife.
I just stabbed myself with the epipen i was freaking out this morning i had to give my little brother the epipen shot and by accident i didnt use it right.i used the wrong side and i jabbed myself in the thumb it hirt i even stafted crying it was bleeding pale and my veins were blue i was scared no one was home And my brother still needed the pen so i injected him.good thing i got it right the second time
I stabbed my in the index finger, while I was trying to give my sister-in-law a shot for an allergic reaction. I was getting ready to go to the ER, when I noticed my finger was white with blue veins. I decided to look it up on line first. Thank God, I did that, now I don’t feel so stupid.
Hmmm, seeing a recurring theme here. Honestly, this sounds like a user interface design issue if everybody seems to be using them upside down!
Maybe putting a bunch of arrows on the side of the pen to indicate the “sharp end” might be a really good idea. Seriously!