The authors below (
http://www.medscape.com/viewarticle/726456_2) argued in 2010 that there is no absolute contraindication to IM epinephrine in anaphylaxis.
Keith J. Simonsa
Faculty of Pharmacy and Department of Pediatrics & Child Health, Faculty of Medicine, University of Manitoba, Manitoba, Canada
F. Estelle R. Simonsb
Department of Pediatrics & Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
They do remark that there may be relative contraindications to IM epi but no absolute contraindications.
Interestingly, I did a quick lit search and could only find an article from 1999 which referenced the 1993 article that PedOncoDoc referenced about this topic. There are several articles which discuss IV epinephrine and MI, but even these usually were related to an overdose of epinephrine (did find two cases where the right dose of IV epinephrine was given and a patient with a known cardiac history and multiple underlying co-morbidities developed an MI).
Thanks for the interesting question. I'll keep looking as well to see what else there may be out there in some obscure references.
I can tell you of two cases where I've been present in the prehospital setting (civilian) where someone inadvertantly had the epi-pen facing the wrong way and gave themself a digital injection. It was the same person who did it to himself both times (and wasn't me
). He got sweaty and tachycardic, but did fine (at that time I think he was in his mid to late 40s). He did not lose his finger and we did not give phentolamine. We did give him alot of flak about it, though.
Wook