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Intraosseous infusion of muscle relaxants
B S Katan1, J S Olshaker, S E Dickerson
1Department of Emergency Medicine, Naval Hospital, San Diego, California 92134-5000.
Insights
This case report details using an intraosseous line for emergency medication delivery in a critically ill infant with shaken child syndrome. This method facilitated atraumatic intubation, offering a novel approach for pediatric resuscitation.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Critical Care
Background:
- Shaken child syndrome presents with elevated intracranial pressure and seizure activity.
- Intubation in head-injured pediatric patients requires careful, atraumatic techniques.
- Intraosseous (IO) lines are typically used for fluid and emergency drug resuscitation.
Observation:
- A 6 1/2-month-old infant with suspected shaken child syndrome required resuscitation.
- The infant exhibited elevated intracranial pressure and seizure activity.
- An intraosseous infusion line was utilized for medication administration.
Findings:
- The intraosseous line was successfully used to administer muscle relaxants (succinylcholine chloride, atracurium besylate) and anesthetic agents (thiopental sodium).
- This novel application of an IO line facilitated an atraumatic intubation in a severely head-injured infant.
- This represents an original report of using an IO line for advanced airway management medications.
Implications:
- Intraosseous infusion is a viable route for administering neuromuscular blocking agents and anesthetics in pediatric emergencies.
- This technique may improve the safety and success rate of intubation in critically ill, head-injured children.
- This case highlights the versatility of intraosseous access in pediatric resuscitation beyond traditional uses.
Abstract:
This case report presents the resuscitation of a 6 1/2-month-old child with elevated intracranial pressure, seizure activity, and a presumptive diagnosis of shaken child syndrome. It is unique in the usage of an intraosseous infusion line for the administration of muscle relaxants and anesthetic agents to aid in an atraumatic intubation in this head-injured child. This is an original report of the usage of the intraosseous line for the administration of succinylcholine chloride, atracurium besylate, and thiopental sodium.