Gangrene of the leg following intraosseous infusion

According to Pediatric Advanced Life Support (PALS) guidelines, intraosseous (IO) infusion should be started without delay in a critically ill child with shock, cardiopulmonary failure or arrest if intravenous access is not rapidly secured»1 Starting an IO is considered an emergency procedure with a good success rate and a very low incidence of complications in trained hands* We present the case of a patient who developed gangrene following extravasation of fluid and irritant medication»