Acute onset, seizure with placement of intraosseous cannulation


• En Route- IO attempt, IO successful, IV attempt, EKG, Versed. 4 doses (see below) totaling 6.2mg, MRH consult.
• Hospital- Vitals, IV attempt, fluid bolus via IO, Labs, Urine, planned for 1mg Ativan IV if patient starts seizing again.
• Response to treatment- IM and first IO Versed had little to no effect on patient, third dose of versed 1.5mg IO did stop seizures for a short while, 2.5mg IO versed stopped seizures upon arrival at hospital and provided for patient improvement.
• Oxygen and airway positioning moved oxygen saturation from 82% RA to 100%.
• IO attempt on Left Proximal Tibia failed, we think because the pediatric IO did not fully penetrate and failed to seat correctly. The decision was made very quickly to do a second IO attempt despite our first failure.
• The second IO required more force to get past the soft tissue to get the IO to seat but functioned very well after that.
• The patient’s airway was very positional so after stabilizing the patient, I would manually hold his head upright for most of the ride in.


• Pediatric ICU


Elliot Williams, Paramedic Woodburn Ambulance
Mark Shelton Paramedic Woodburn Ambulance


Merlin Curry, MD Paramedic University of Arizona
David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Febrile seizure
• Complex febrile seizure
• Status epilepticus
• Intraosseous Cannulation
• Critically ill

Differential Diagnosis

• Seizure disorder (non-febrile)
• Febrile Seizure
• Status epilepticus
• Non-accidental trauma
• Closed head injury (intracranial bleed)
• CNS neoplastic disease (tumor)
• Ingestion

Patient Workup

• EKG – Sinus tachycardia
• CBG – 125
• Patient had seizure activity, was drooling with some emesis near mouth initially when found on his side. patient had some grunting respirations, clear lung sounds.
• Eyes did not track movement, patient did withdraw from pain but was not alert.
• Left leg was noticed to be moving significantly more than right leg, even before IO’s.
• No head trauma noted, normal bumps and scrapes noted.

Editor’s Notes

This is continuation from case 817. The first attempt to obtain IO access was unsuccessful, likely because the pediatric IO catheter was too short. Oftentimes it takes a second attempt to obtain definitive access. The paramedics did a great job in quickly determining first attempt was not successful and moving on to the second attempt

– David Spiro, MD ReelDx Editor

Suggested References

Intraosseous Cannulation


• Gender: Male
• Age: 19 months
• Height: Not Available
• Weight: Not Available


• Temperature: 101 F/38.3
• Blood Pressure: 80/66
• Heart Rate: 129
• Respiratory Rate: 30
• Pulse Oximetry: 83% RA

Signs and Symptoms

Mom states fever today, gave acetaminophen before coming to Mall. Mom said that based on past seizures, PCP said to wait 5 minutes and then call 911

History Medical

• Two previous febrile seizures
• NKDA Social
• Lives with mother


• None

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