I was recently informed of a case from an another institution in which a patient was started on a vasopressor medication via a peripheral IV while attempts at central access where attempted. The patient unfortunately suffered permanent extremity ischemia due to significant extravasation of the vasopressor medication into the soft tissue.
Phentolamine is reportedly the antidote for vasopressor extravasation into the skin and soft tissues (the evidence is not robust and limited primarily to case reports and animal data)
Phentolamine is a non-specific alpha-blocking agent that inhibits vasoconstriction and theoretically improves blood flow through the affected area
Take 5-15 mg of phentolamine and mix in 10 mL of normal saline - inject this into the affected area as soon as possible
Give the patient concurrent IVFs in the event of some systemic absorption
