Morning Report: 6/25/2012

by Jay Khadpe MD • June 25, 2012 • Comments Off

We’re back with all new Morning Report’s this week. Today’s is a review of IO access courtesy of Dr. Guy, so check it out!

Intraosseous Vascular Access

History

Sweden 1922

World war II 1944

1980 used in India for cholera epidemic

1988 PALS

Anatomy

Nutrient artery-ascending and descending artery-arterioles- capillaries- central venous canal- medullary sinus accept fluids

Infusion

possible to infuse at a rate up to 45ml/min

sternum if elderly as long bone vascular system become fatty

Children less than 6- proximal tibia

Adults- distal tibia

Sternum advantaged- large, easy to penetrate, less fatty infiltration

Needle Insertion

Manual needle insertion

Perpendicular to surface

Twist with pressure

Penetration 1 cm or less

Aspiration of blood and secure

FAST 1- sternum

BIG

EZ-IO

Drill

15gauge 25mm needle for heavier than 40kg

15 gauge 15mm less than 39kg

Complications

Most commonly penetrating posterior cortex- pull back

Clogged catheter- flush

Infection- sugar infusion (0.6-3%)

Extravasations

Compartment syndrome

Thanks Dr. Guy! Leave any comments below.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

Bio
Latest Posts

Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital