Epinephrine
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Whole hand ischaemia following extravasation: case report A 63-year-old woman developed whole hand ischaemia following extravasation of epinephrine [adrenaline]. The woman, who had congestive cardiac failure secondary to severe aortic stenosis, had an in-hospital cardiac arrest. She received epinephrine [dosage not stated] as part of CPR via an IV cannula on the dorsum of her left hand. An unknown quantity extravasated into the soft tissue on the dorsum of her hand. CPR was successful after 7 minutes, and she was transferred to an ICU, where she started norepinephrine [noradrenaline] and dobutamine for inotropic support. Six hours post-arrest, the dorsal aspect of her left hand was grossly oedematous, with an area of epidermolysis surrounding the injection site. Her hand appeared dusky and congested with delayed capillary refill at 6 seconds. The woman received the standard treatment for extravasation injuries: the line was removed, and radial puncture holes were made on her hand to allow removal of the extravasated solution. Normal sodium chloride was used to flush out the subcutaneous tissue. Her hand returned to a pink colour, with bright red blood upon pinprick, and her capillary refill improved to 3 seconds within minutes. Her hand was observed hourly. Her circulation gradually deteriorated 4 hours after washout, and 2 hours later, washout was repeated, returning her hand to the normal state of perfusion. At 12 hours, the cycle recurred and perfusion was restored after a third washout. Her hand remained well-perfused, but the area of epidermolysis demarcated leaving a necrotic patch on the dorsum of her hand. Subsequently, she developed systemic sepsis due to a respiratory infection, and died in the ICU 4 days later [cause of death not stated]. Author comment: "We report a case of extravasated [epinephrine] causing whole hand ischaemia." van der Rijt R, et al. Reversal of hand peripheral ischaemia due to extravasation of adrenaline during cardiopulmonary resuscitation. Journal of Plastic, Reconstructive and Aesthetic Surgery: JPRAS 66: e260-3, No. 9, Sep 2013. Available from: URL: 803095871 http://dx.doi.org/10.1016/j.bjps.2013.03.047 - Ireland
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Reactions 23 Nov 2013 No. 1479
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