Drainage of an extradural haematoma by intraosseous needle in a remote hospital

We report the case of an intraosseous needle used to drain an acute extra-dural haematoma in a remote hospital. An 18 yr. old female attended the Emergency Department, after sustaining a closed head injury from a fall. After a CT scan, she was diagnosed with a large acute extradural haematoma (EDH). Prior to air ambulance transfer to the Neurosurgical Centre, she developed a fixed dilated pupil and hemodynamic instability. The Neurosurgeon advised that an intraosseous (IO) needle drainage would prevent brain stem herniation. An Emergency Medicine (EM) consultant drained 60 ml of blood and clot via an IO needle. The pupil and cardiovascular status normalised. The patient underwent neurosurgical drainage with full neurological recovery. We believe that this is the first IO drainage of an EDH at a remote hospital followed by full neurological recovery.