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{
    "pk": 34874,
    "title": "A Case of Prehospital Magnesium Sulfate Extravasation",
    "subtitle": null,
    "abstract": "<p>Case Presentation</p>\n<p>A 73-year-old female with chronic obstructive pulmonary disease presents via emergency medical services for shortness of breath. She is found to be hypoxic, tachypneic, and in notable distress. She is treated with inhaled albuterol, oral dexamethasone, and intravenous magnesium sulfate. Upon arrival to the emergency department her had was noted to have significant bleeding, and on further investigation it was determined that the intravenous catheter has inadvertently become extravasated, and the magnesium had entered the subcutaneous space. The bleed with significant and pulsatile, a tourniquet was applied, and the vessel was ultimately tied off by the trauma surgery service. </p>\n<p>Discussion</p>\n<p>Intravenous medication administration is ubiquitous with emergency care in both the hospital and prehospital environments.  Medications use is paramount to treatment of a vast majority of emergent clinical conditions, furthermore, the route of administration is often intravenous in the patient with emergent illness.  The placement of intravenous catheters is a skill that nurses, paramedics, and advanced emergency medical technicians learn early in their training.  The care team is tasked with not only starting intravenous lines, but also in monitoring them and ensuring medication is delivered into the systemic circulation, and not elsewhere.  Certain medications, notably potassium preparations and vasoactive medications, are known vesicants.  We present a case of vascular extravasation of magnesium sulfate, not know for causing significant tissue damage, that led to significant venous and arterial injury.  This case highlights the need for prehospital clinicians as well members of the emergency department care team to be ever vigilant for medication extravasation. </p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "IV infiltration"
        },
        {
            "word": "extravasation"
        },
        {
            "word": "magnesium sulfate"
        },
        {
            "word": "prehospital IV access"
        }
    ],
    "section": "Images in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3zk9c1db",
    "frozenauthors": [
        {
            "first_name": "Sean",
            "middle_name": "",
            "last_name": "Bilodeau",
            "name_suffix": "",
            "institution": "Tufts University School of Medicine, MaineHealth Maine Medical Center, Department of Emergency Medicine, Portland, Maine",
            "department": ""
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Bohanske",
            "name_suffix": "",
            "institution": "Tufts University School of Medicine, MaineHealth Maine Medical Center, Department of Emergency Medicine, Portland, Maine",
            "department": ""
        },
        {
            "first_name": "Kate",
            "middle_name": "",
            "last_name": "Zimmerman",
            "name_suffix": "",
            "institution": "Tufts University School of Medicine, MaineHealth Maine Medical Center, Department of Emergency Medicine, Portland, Maine",
            "department": ""
        },
        {
            "first_name": "Eric",
            "middle_name": "",
            "last_name": "Wellman",
            "name_suffix": "",
            "institution": "Tufts University School of Medicine, MaineHealth Maine Medical Center, Department of Emergency Medicine, Portland, Maine",
            "department": ""
        },
        {
            "first_name": "Matthew",
            "middle_name": "",
            "last_name": "Sholl",
            "name_suffix": "",
            "institution": "Tufts University School of Medicine, MaineHealth Maine Medical Center, Department of Emergency Medicine, Portland, Maine",
            "department": ""
        }
    ],
    "date_submitted": "2024-08-28T18:03:02.732000-07:00",
    "date_accepted": "2024-12-19T17:03:34.980000-08:00",
    "date_published": "2025-03-20T15:30:00-07:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/34874/galley/35748/download/"
        }
    ]
}