Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;6(1):93-95.
doi: 10.5811/cpcem.2021.11.54464.

Unintentional Epinephrine Auto-Injector Maxillofacial Injury in a Pediatric Patient

Jason David  1 , Jerad Eldred  2 , David Raper  1
Affiliations

Unintentional Epinephrine Auto-Injector Maxillofacial Injury in a Pediatric Patient

Jason David et al. Clin Pract Cases Emerg Med. 2022 Feb.

Abstract

Case presentation: A four-year-old female patient presented to the emergency department with an epinephrine auto-injector that had unintentionally discharged into her mandible. There was difficulty removing the auto-injector at bedside. Images we acquired noted needle curvature not present in an off-the-shelf model. She was sedated, and the auto-injector was removed by retracing the angle of discharge, with care taken not to inject epinephrine into the patient.

Discussion: Epinephrine auto-injector accidental discharges are an unusual injury pattern, but the incidence of such events is increasing in the United States. The emergency clinician should be cognizant of complicating factors with discharges, such as bent needles. Here we discuss a case of discharge into the maxillofacial region (lower jaw), with approaches to treatment.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none. The views expressed here are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government.

Figures

Image 1
Image 1
Cranial radiographs identifying foreign body (arrow).
Image 2
Image 2
Maxillofacial computed tomography with axial view reconstruction demonstrating hooked foreign body (arrow).
Image 3
Image 3
Removed epinephrine auto-injector and bent needle (arrow).
See this image and copyright information in PMC

References

    1. Anshien M, Rose SR, Wills BK. Unintentional epinephrine auto-injector injuries: A National Poison Center observational study. Am J Ther. 2019;26(1):e110–e4. - PubMed
    1. Campbell RL, Manivannan V, Hartz M, et al. Epinephrine auto-injector pandemic. Pediatric Emerg Care. 2021;28(9):938–42. - PubMed
    1. Koch G, Poulsen S. Mental Development of the Child. 1st ed. Vol. 35. Copenhagen: Munksgaard; 2001. Paediatric dentistry—a clinical approach; p. 41.
    1. Javadrashid R, Fouladi DF, Golamian M, et al. Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofac Radiol. 2015;44(4):20140229. - PMC - PubMed
    1. Goldman RD, Long KC, Brown JC. Hooked epinephrine auto-injector devices in children: four case reports with three different proposed mechanisms. Allergy Asthma Clin Immunol. 2020;16:19. - PMC - PubMed