Examples:
(1) extravasation of a dopamine infusion
(2) autoinjection of epinephrine
Severity of tissue reaction depends on:
(1) type and amount of drug released
(2) the location where the injection occurs: release into the finger or an enclosed compartment can be more serious than a similar amount on the arm or thigh
(3) the length of time the drug release is left untreated. Immediate therapy can reduce the severity of the syndrome, while a delay of more than 12 hours can result in irreversible injury.
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Clinical Findings
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Severity of Reaction
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pallor/blanching, hematoma, mild irritation, erythema, numbness
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mild
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tissue edema with a mild compartment syndrome, moderate pain
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moderate
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extensive skin necrosis and sloughing; severe compartment syndrome with myonecrosis; severe pain
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severe
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Treatment of moderate or severe reactions:
(1) Prepare a solution of 5-10 mg of phentolamine in 10-15 mL of normal saline. An alternative agent may be terbutaline.
(2) Using a very small hypodermic needle, inject the solution into the entire area involved. DO NOT inject the phentolamine into a blood vessel, which can result in hypotension and tachycardia.
(3) Phentolamine exerts a sympatholytic effect, with dilatation of small blood vessels and hyperemia of the overlying skin.
(4) If severe pain is present, then a digital block with 1% lidocaine can be used.
Less severe reactions may respond to:
(1) warm soaks or compresses
(2) transdermal nitroglycerin
