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BMJ 2009; 339 doi: (Published 08 July 2009) Cite this as: BMJ 2009;339:b2697
  1. Dan Markeson, ST1
  1. 1Department of plastic surgery, Stoke Mandeville Hospital, Aylesbury HP21 8AL
  1. danmarkeson{at}

    A 13 year old boy presented to the accident and emergency department having accidentally injected his right thumb with an adrenaline Epipen. On examination, despite application of warm water and use of a glyceryl trinitrate patch, the thumb was pale with a capillary refill of more than 5 seconds. A literature review indicated that accidental digital injection with high dose adrenaline is an increasing occurrence. Based on the advice I read, I injected 2 mg phentolamine (with normal saline and lidocaine) around the puncture site, leading to immediate restoration of normal blood flow to the digit.


    Cite this as: BMJ 2009;339:b2697


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