A Case of Prehospital Magnesium Sulfate Extravasation

Intravenous medication administration is ubiquitous with emergency care in both the hospital and prehospital environments. Medication use is paramount to treatment of a vast majority of emergent clinical conditions; furthermore, the route of administration is often via IV in the patient with emergent illness. The placement of IV catheters is a skill that nurses, paramedics, and advanced emergency medical technicians learn early in their training. The care team is tasked with starting IV 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 known for causing tissue damage, which led to significant vascular injury. This case highlights the need for prehospital professionals as well as members of the emergency department care team to be ever vigilant for medication extravasation.