Case report of thigh laceration caused by EpiPen^® use that current guidance could not prevent

Abstract

There have been several reports of traumatic adverse events caused by insufficient restraint during the use of an EpiPen^®. While many of these reports discuss proper restraint posture, few emphasize the importance of maintaining restraint until the EpiPen^® is completely removed from the body. We herein present a case involving a 4-year-old boy who was prescribed an EpiPen^® because of allergies to walnuts and cashews. The boy developed an allergic reaction after inadvertently consuming baked sweets containing walnuts. His mother administered the EpiPen^® by holding his legs and pressing it against his thigh. Believing that the needle retracted automatically, she released her hold before the EpiPen^® was fully removed. As a result, the child moved his legs, causing a laceration on his right thigh. Although the mother was familiar with the importance of firm restraint as outlined in the current educational materials and guidance, the injury could have been prevented if she had been clearly instructed not to release the restraint until the EpiPen^® was completely withdrawn. This case highlights the need to enhance guidance on EpiPen^® usage to emphasize maintaining restraint until the device is fully removed.