Introduction: We present a rare case of digital ischemia secondary to accidental self-administration of an epinephrine auto-injector, in a caregivers attempt to treat his wife’s anaphylaxis. Aim: We hope to improve the awareness of digital ischemia management, and provide guidelines in the emergent management. Methods: Our proposal was consistent with NHMRC National Statement on Ethical Conduct in Human Research (2023) guidelines. Case: A 33 year old male patient accidentally injected his left thumb with his wife’s EpiPen® in an attempt to treat her anaphylaxis. He suffered digital ischemia to his thumb pulp, refractory to warm water immersion and topical nitroglycerine. After consultation between plastic surgeons, emergency physicians and pharmacists, local phentolamine infiltration was administered and significantly improve the patient’s outcome. Discussion: Various methods of treating digital ischemia have been described in the literature, from watchful waiting to active bedside treatments including topical nitroglycerine or local infiltration with α-antagonists, namely phentolamine. However, a lack of robust studies means practitioners must rely on their own judgement if and when this rare presentation arises. Conclusion: Rare presenting pathologies often require the collaboration of multiple specialities to improve patient outcomes. This is particularly pertinent in emergency situations, and in the absence of established guidelines or protocols. Teamwork, clinical judgement and medical expertise are required to provide the most relevant evidence-based medicine to the scenario at hand.