Desai Kishan K, Mann Adam J, Azar Faris, Lottenberg Lawrence, Borrego Robert
Department of Surgery, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA.
Department of Surgery, St. Mary's Medical Center, West Palm Beach, USA.
Cureus. 2023 Dec 9;15(12):e50248. doi: 10.7759/cureus.50248. eCollection 2023 Dec.
Obtaining adequate vascular access is imperative for effective resuscitative, therapeutic, and diagnostic interventions. The intraosseous (IO) route is indicated when immediate vascular access is needed, and standard central or peripheral intravenous (IV) access is unattainable or would delay therapy in a critical patient. We present a rare case of improper IO line placement in the right proximal tibia of a 30-year-old female involved in a motor vehicle collision, resulting in extravasation of blood products into the surrounding tissue and development of acute compartment syndrome. Emergency Medical Services was unable to obtain IV access in a timely manner, thus a right proximal tibia 45mm IO line was placed, and a unit of whole blood was given with a high-pressure infusor in the field. At the trauma center, the patient's right lower extremity was severely tense and edematous with no palpable right lower extremity pulses and no Doppler signals. Computed tomography revealed the IO catheter extending through both the proximal and distal cortices of the right tibia. Medial and lateral fasciotomy of the right lower extremity was performed in which all four compartments of the right lower leg were released and a significant hematoma was evacuated from the superficial posterior compartment. This case highlights the importance of IO access as a life-saving intervention while also underscoring the need to educate and familiarize pre-hospital and hospital healthcare personnel in delivering IO access so as to mitigate risks and improve outcomes for critically ill patients.
获得足够的血管通路对于有效的复苏、治疗和诊断干预至关重要。当需要立即建立血管通路，而标准的中心静脉或外周静脉通路无法实现或会延误对危重症患者的治疗时，可采用骨内（IO）途径。我们报告了一例罕见病例，一名30岁女性在机动车碰撞事故中，右胫骨近端骨内输液管放置不当，导致血液制品渗入周围组织并引发急性骨筋膜室综合征。紧急医疗服务人员未能及时建立静脉通路，因此在现场放置了一根45毫米的右胫骨近端骨内输液管，并使用高压输液器输注了一单位全血。在创伤中心，患者右下肢严重紧张、水肿，右下肢无脉搏可触及，多普勒信号消失。计算机断层扫描显示骨内导管穿过右胫骨的近端和远端皮质。对右下肢进行了内侧和外侧筋膜切开术，切开了右小腿的所有四个筋膜室，并从浅后筋膜室清除了大量血肿。该病例突出了骨内通路作为一种挽救生命的干预措施的重要性，同时也强调了对院前和医院医护人员进行骨内通路操作培训并使其熟悉该操作的必要性，以便降低风险并改善危重症患者的治疗效果。
