Mistaking an Auto-injector for a Ballpoint Pen

Abstract

A 9-year-old boy was brought to the emergency department after accidentally injecting himself with an epinephrine auto-injector. He had failed to correctly place it in a carrying case. Mistaking the auto-injector for a ballpoint pen, he stowed it in his bag and blindly triggered it by touching the tip. A physical examination revealed a needle tip penetrating his right thumb and cyanosis distal to the thumb. His heart rate was 89 beats per minute and blood pressure 100/78 mm Hg at approximately hour after the accident. He felt pain but experienced no loss of sensation (Picture 1). A needle penetrating the distal phalanx appeared on radiography (Picture 2). After a physician removed the needle from the boy's skin, the cyanosis disappeared. Instructors introducing the epinephrine auto-injector to parents and educators of pediatric patients should alert them to the risk of accidental injection due to not placing the injector in a proper carrying case. Picture 1. Picture 2. The authors state that they have no Conflict of Interest (COI).