Providing the sternum is cannulated in the midline this procedure should not
cause a pnemothorax as the pleura does not reach the midline. It is much
more likely that the pleura was breached parasternally in the case below. A
pneumomediastinum is a potential complication but in itself is unlikely to
cause any significant morbidity.
Particular care will clearly be needed when using this technique in the
elderly with osteoporosis.
The uninjured skull sounds attractive as long as the temples are avoided!
Presumable it would be worth avoiding the frontal sites because of the
unpredictable extent of the sinuses. Anyone feeling brave?
Thanks for the calcaneal reference - I will bring it to my colleagues
attention for use in the ED/post extrication. I have certainly have
struggled to gain IO access in children over 5 years of age using the upper
tibia because of IO metal fatigue/failure.
John Black
Oxford, UK
-----Original Message-----
From: Rowley Cottingham [mailto:[log in to unmask]]
Sent: 08 May 2003 09:44
To: [log in to unmask]
Subject: Re: Adult I_O
> OK, those of you who have met me know I'm a big fella so the sternal and
> skull marrows are off the list of sites to stick i/o's in to. But does
> anyone know whether shoulder or iliac crest is easiest, and is shoulder
> an anterior approach?
>
> Vic Calland
> Eventmed UK Ltd
> Training & Development beyond First-Aid
> Visit the website: http://www.eventmed.co.uk
>
Panic not, Vic. Complications of sternal IO are rare. Look at the date on
this one. I an only find a
couple of other papers from a single centre in the French press, who clearly
employ Arnie
Schwartzenegger as their operative:
Minerva Med 1989 Jun;80(6):611-3
[1st reported case of pneumothorax caused by sternal puncture]
[Article in Italian]
Polverino M, Schiavo A, Fiorenzano G, Santoriello C, Di Domenico P, Musella
U.
Regione Campania, U.S.L. n. 48, Cava dei Tirreni-Vietri.
The case of a woman aged 65 who presented pneumothorax following sternal
marrow needle biopsy
after diagnosis of thrombocytosis is reported. The complication was
certainly attributable to the
biopsy because chest X-ray immediately prior had been perfectly normal. No
other cases of the kind
have been reported. It is probable that this complication occurred because
air passed into the pleural
cavity, probably through a fracture rim at the internal face of the sternal
bone trabeculae.
Best wishes,
Rowley Cottingham
[log in to unmask]
http://www.emergencyunit.com
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