Abstract Introduction Intraosseous access is lifesaving intervention in emergent resuscitation when intravenous access is challenging. Although generally safe , it can rarely result in devastating complication such as compartment syndrome and subsequent limb ischemia. we present a unique case of IO access-associated compartment syndrome leading to below knee amputation following resuscitation for massive GI bleed. Case Presentation 46 year old female with history of decompensated cirrhosis and portal HTN, with prior episode of GI bleed, was transferred to our facility for evaluation of progressive worsening of right lower extremity wound. she was initially admitted to an outside facility for upper GI bleed requiring endoscopic intervention. during the procedure, patient experience massive hemorrhage necessitating activation of massive transfusion protocol and emergent resuscitation. due to poor peripheral venous access, IO was established in the proximal tibia for fluid and blood product transfusion. later patient developed progressive swelling ,tense compartment and mottling of affected limb requiring fasciotomy. Despite decompression and IV antibiotics, patient developed worsening ischemic necrosis. Vascular-surgery team confirmed irreversible ischemia, and she underwent a right below-knee amputation. post-operatively she was gradually stabilized with multidisciplinary management. Discussion while Intraosseous access is often a critical component of resuscitation when intravenous access is unobtainable or difficult. , extra-vasation of fluids can cause compartmental pressure and ischemic injury. Early recognition of compartment syndrome in critically ill patient.patient is often delayed due to sedation and critical illness myopathy, further increasing morbidity.This case highlights the importance of vigilant monitoring in patients with IO access. Conclusion Intraosseous access can be life saving but carries risk of catastrophic complication such as compartment syndrome and limb loss. awareness, early detection , and timely surgical intervention are essential to prevent irreversible ischemic injury in post resuscitation patients. This abstract is funded by: NONE
Lama et al. (Fri,) studied this question.