Authored by Joseph Shiber*,
Introduction
A 41-year-old woman who was employed as a nurse complained of left-hand pain and discoloration for one day. She initially claimed that she had injected lidocaine into her arm in order to treat herself for carpal tunnel but later admitted to injecting six oxycodone tablets ground and dissolved in tap water into her left antecubital space. The injection site was visible over her brachial arterial pulsation. Her left hand was blue and cool to the touch with delayed capillary refill despite having palpable radial and ulnar arterial pulses (Image 1). Nitroglycerin paste was applied to her hand, an intravenous heparin infusion was initiated and she was admitted to vascular surgery. After three days, her hand was normal in color except for the nail beds which remained blue. She had normal motor function of the hand and was discharged home. She returned one month later with necrotic fingertips of all digits requiring amputation (Image 2 and 3).
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