The prevalence of epinephrine auto-injectors (EAI) use is on the rise. Our objective was to describes children with hooked EAI needles that were embedded in soft tissues. Results: Two children self-injected in their shins. The embedded EAIs required removal in the Emergency Department. Both needles were hooked and splayed at the tip. A boy in anaphylaxis kicked his leg during EAI injection and the hooked needle embedded under his skin and was difficult to dislodge. The exposed needle was curved. A girl had an EAI administered for anaphylaxis, which was also difficult to dislodge. On removal, the distal needle tip was hooked approximately 160 degrees. Images of the device revealed that the needle fired off-center from the device and the device components were cracked. We propose three different explanations for these hooked EAI needles. The first is that the needle could hit bone during injection and curve rather than penetrates further. Secondly, the needle could bend when the patient moves during injection. Thirdly, if a needle fires sufficiently off-center to hit the cartridge carrier, this could hook the needle prior to injection. Awareness of the reasons for needle hooking, damage observed, and challenges and successful approaches to their removal, can better prepare the provider for these uncommon events. Teaching parents, children and educators about safe EAI storage and appropriate restraint during use may prevent some of these accidental injuries. Reporting device failures may lead to improvements in device performance and design.

中文翻译：

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儿童钩状肾上腺素自动注射器：四例报告，提出了三种不同的机制

肾上腺素自动注射器 (EAI) 的使用率正在上升。我们的目标是描述嵌入软组织的钩状 EAI 针的儿童。结果：两个孩子在胫骨上自我注射。嵌入式 EAI 需要在急诊科移除。两根针都钩住并在尖端张开。一名患有过敏反应的男孩在注射 EAI 时踢了他的腿，钩针嵌入他的皮肤下，难以拔出。暴露的针是弯曲的。一名女孩因过敏反应而接受了 EAI，这也很难清除。在移除时，远端针尖被钩住大约 160 度。该设备的图像显示，针头偏离设备中心发射，设备组件破裂。我们对这些钩状 EAI 针提出了三种不同的解释。首先是针在注射和弯曲过程中可能会击中骨骼，而不是进一步穿透。其次，当患者在注射过程中移动时，针头可能会弯曲。第三，如果针头的发射偏离中心足够大以击中药筒载体，这可能会在注射前钩住针头。了解针钩的原因、观察到的损坏以及去除它们的挑战和成功方法，可以更好地为这些不常见事件的提供者做好准备。向父母、儿童和教育工作者介绍安全的 EAI 存储和使用过程中的适当约束可能会防止其中一些意外伤害。报告设备故障可能会导致设备性能和设计的改进。当患者在注射过程中移动时，针头可能会弯曲。第三，如果针头的发射偏离中心足够大以击中药筒载体，这可能会在注射前钩住针头。了解针钩的原因、观察到的损坏以及去除它们的挑战和成功方法，可以更好地为这些不常见事件的提供者做好准备。向父母、儿童和教育工作者介绍安全的 EAI 存储和使用过程中的适当约束可能会防止其中一些意外伤害。报告设备故障可能会导致设备性能和设计的改进。当患者在注射过程中移动时，针头可能会弯曲。第三，如果针头的发射偏离中心足够大以击中药筒载体，这可能会在注射前钩住针头。了解针钩的原因、观察到的损坏以及去除它们的挑战和成功方法，可以更好地为这些不常见事件的提供者做好准备。向父母、儿童和教育工作者介绍安全的 EAI 存储和使用过程中的适当约束可能会防止其中一些意外伤害。报告设备故障可能会导致设备性能和设计的改进。以及消除它们的挑战和成功方法，可以更好地为这些不常见事件的提供者做好准备。向父母、儿童和教育工作者介绍安全的 EAI 存储和使用过程中的适当约束可能会防止其中一些意外伤害。报告设备故障可能会导致设备性能和设计的改进。以及消除它们的挑战和成功方法，可以更好地为这些不常见事件的提供者做好准备。向父母、儿童和教育工作者介绍安全的 EAI 存储和使用过程中的适当约束可能会防止其中一些意外伤害。报告设备故障可能会导致设备性能和设计的改进。