Abstract
BackgroundIntra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible. Despite recent improvement in IO devices and increasing indications, it remains rarely used in practice. Various complications have been reported but are uncommon.Case presentationWe report a case of massive acute tibial osteomyelitis in an adult male three months after an IO catheter insertion for emergency drug infusion. We review the literature on association between IO access and acute osteomyelitis in children and adults.ConclusionsEmergency-care givers and radiologists should be informed about this infrequent complication in order to make early diagnosis and initiate adequate antibiotic therapy.
Highlights
Intra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible
Intraosseous (IO) access is considered as an effective route in adults requiring emergency administration of fluids or medication for initial resuscitation [1]
The European Resuscitation Council Guidelines for Resuscitation established in 2015 that IO route is required in emergency situations whenever peripheral access cannot be achieved: it can be used for infusion, drug administration and blood samples [11]
Summary
Intraosseous (IO) access is considered as an effective route in adults requiring emergency administration of fluids or medication for initial resuscitation [1]. Case presentation A forty-year-old psychotic and intravenous-drug-addicted Caucasian male was cared by prehospital service for coma due to drugs overdose. In this emergency situation, without any intravenous access available, an IO device (EZ-IOTM; Teleflex Medical, Research Triangle Park, NC, USA.) was promptly inserted by the emergency medical technician (EMS) on scene in the upper portion of the left tibia to administer therapeutics and initiate mechanical ventilation. The patient reported psychiatric problems with schizophrenia, multiple intravenous-drug intoxications with coma, and regular cocaine and heroin use He left the hospital against medical advice three days after IO device removal. Warmth, point tenderness and swelling on the site of the IO access were present (Fig. 1a, arrow).
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