---> Have seen 3 such cases in past.
One (my 1st) I treated with Phentolamine and had good resolution. Another, I
could not find Phentolamine for, but self-resolved anyway while I was
looking. The last (about 2years ago) was treated with Nitrate paste within a
glove and the hand then immersed in warm water. Resolved well.
Have looked into it in past and also dound no evidence of actual harm in
literature (and found enough cases documented not to try to publish mine -
which was the reason behind the search at that time).
As a medical student I was called over to see a case, treated by a fellow
med student, who had been given a local with epi, through "ignorance". We
were all shown it as the "this is why not to do it". That finger ended up
falling off eventually - I have no idea how or why nor was I alert enough at
the time (very useless student, I regret to admit) tyo find out any more
about the case, e.g. Hx of vascular disease or not.
So I still, to this day, believe in using epi-free locals on
end-vasculature. The reason is that epi is unnecessary, as they don't bleed
much, nor take long to do.
Should I get my next case of accidental injection, until the RCT is
published, I shall probably start searching for Phentolamine again.
>I recently treated an 8 yr. old girl who had inadvertently injected one of
>her fingers with an Epipen. Although the treatment (with phentolamine)
>resulted in symptomatic relief, it caused me to wonder if there was any
>basis
>to the dogmatic injunction against using vasoconstrictors along with
>anesthetics for digital blocks. I have been unable to turn up any such
>evidence in the literature or on the internet. Does anybody know of any
>instance of the use of a vasoconstrictor with a digital block having
>actually
>resulted in any harmful long-term sequelae in a human being. I would like
>to
>use any such information I receive as part of the discussion in a case
>report
>to be published and would therefore appreciate full details. Thank you.
>A.J. Shankar, MD
>York Hospital
>York, PA
>USA
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