Contents:
1. Hyaluronidase(multiple vials)
• 1500units/vial – at least 3–5 vials
2. Syringesand Needles
• 1mL, 3 mL, and 10 mL syringes
• 30Gand 27G needles
3. NormalSaline (sterile)
• Forreconstitution of hyaluronidase and flushing
4. AlcoholPrep Pads
5. WarmCompress Packs
6. TopicalNitroglycerin Paste (e.g., 2%)
• Useonly if indicated and under guidance
7. Aspirin(325 mg)
• Forsuspected embolism or ischemia
8. SterileGloves
9. Sharpieor Skin Marker
• Tooutline ischemic area
10. EmergencyContact List
• LocalER, supervising physician, plastic surgeon/dermatologist consultant
11. PatientConsent & Incident Documentation Forms
12. InstructionManual (included below)
Instruction Manual: Emergency Vascular OcclusionProtocol
Step 1: Recognizethe Signs
• Blanchingor whitening of the skin
• Pain,often out of proportion
• Mottling,dusky discoloration
• Coolnessto touch
• Delayedcapillary refill
• Livedoreticularis pattern
Step 2: StopInjection Immediately
• Donot continue injecting in the area.
• Remaincalm and reassure the patient.
Step 3: Mark theArea
• Usea skin marker to outline the affected region.
• Documenttime and description of symptoms.
Step 4:Administer Hyaluronidase
Reconstitution:
• Mix1500 units of hyaluronidase with 1–3 mL of saline per vial (based on injectorpreference and area of concern).
InjectionTechnique:
• Injectliberally across the entire ischemic area and into surrounding tissue.
• Usemultiple entry points and fan technique.
• Startwithin 60 minutes of symptom onset if possible.
Dosage:
• Use450–1500 units or more depending on severity and size of area.
• Mayrepeat every 30–60 minutes if symptoms persist.
Step 5: ApplyWarm Compress
• Encouragesvasodilation and blood flow.
• Avoidcold compresses.
Step 6: Massagethe Area Gently
• Promoteperfusion and product dispersion.
Step 7: ConsiderAdditional Measures
• TopicalNitroglycerin Paste: Apply a thin layer over affected area (underguidance).
• Aspirin325 mg PO: Give unless contraindicated.
• Oxygen:If available, administer 100% O2 by mask or nasal cannula.
Step 8: EscalateCare
• Ifno improvement within 60–90 minutes:
• Contactsupervising MD
• Referto emergency department or specialist
• Providea detailed report with products used and steps taken.
Step 9: DocumentThoroughly
• Completeincident report and patient consent.
• Takebefore-and-after photos if possible.