‘The needle and the damage done’: Intra‐arterial temazepam

Abstract

Abstract Intra‐arterial temazepam injection by intravenous drug abusers may be associated with vascular and metabolic complications. Patients generally present with severe pain, mottling and swelling of the limb. This can progress to tissue loss. The pathophysiology is not clearly defined, but may include direct vascular injury, as well as rhabdomyolysis. This is illustrated by two cases that presented to The Geelong and St Vincent's Hospitals, Victoria, Australia, resulting in compartment syndromes, limb ischaemia and rhabdomyolysis. Treatment consists of reducing intracompartmental pressure, attempts to re‐establish blood flow by either pharmacological or surgical methods and supportive care. Compartment syndromes and ischaemia may take hours to develop, so that prolonged observation is indicated. Evidence of raised intracompartmental pressure or limb ischaemia warrants early and aggressive intervention in order to prevent or minimize the limb‐ and life‐threatening consequences of intra‐arterial injection of temazepam.