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Not one to blow mine or my co-authors trumpets' but there is an excellent (?) review article about this very subject Trauma 1999;1:291-299 I Greaves, GA Evans, AA Boyle Intraosseous infusions in the adult Adrian Boyle ----- Original Message ----- From: "Black, John" <[log in to unmask]> To: <[log in to unmask]> Sent: Friday, May 02, 2003 5:07 PM Subject: Adult I_O > I may have missed the initial thread, but does any one else have experience > of the use of these (Adult I/O) devices at other anatomical sites? > > John Black > Oxford > > -----Original Message----- > From: [log in to unmask] [mailto:[log in to unmask]] > Sent: 02 May 2003 16:46 > To: [log in to unmask] > Subject: sternal I_O > > I wonder if the sternal route is best here - the greater tuberosity of the > humerus may be more accessible from the side of the car, and ovoids the > risk of penetrating both sternal bone tables which may be already > fractured. When we used sternum for marrow sampling patients were rather > concerned too!! > > >Thank you to everyone who contributed to this. Your comments of support > >were welcome. > > > >For those who don't know Fire Speak a dash(board) roll is where the roof > >is removed, the front doors are opened and the bottom of the A post (the > >one with the front door hinges on) is cut parallel with and adjacent to > >the door sill. A ram from the bottom of the B post (the one the front > >door lock fits into) to the A post at steering wheel height then > >literally rolls the dash forwards, lifting the steering wheel etc away > >from the patient. > > > >Lessons I have learned are that I could have used more Ketamine. I was > >cautious because of the long held distrust of i.m. opiates in shock. The > >key idea is the sternal i/o. I had the kit, and in the back of my mind > >knew of the work the Israeli's did on it. Marten kindly let me know this > >chap is doing fine so far, I just hope he will remember this e-mail > >sequence when I come in with a similar case and an i.v. in the > >breastbone! It will after all give the Paramedics and Fire Crew > >something to talk about. I hear them now.... > > > >"There was this poor sod crippled in the crash, and the bloody doc just > >stabbed him through the heart he did!" > > > >Thanks again guys (and girls) > > > >Vic Calland > > > >-----Original Message----- > >From: [log in to unmask] > >[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham > >Sent: 30 April 2003 23:26 > >To: [log in to unmask] > >Subject: Re: Ideas please.... > > > > > >> This is a multi-part message in MIME format. > >> > >> ------=_NextPart_000_0010_01C30F51.90A1DB40 > >> Content-Type: text/plain; > >> charset="us-ascii" > >> Content-Transfer-Encoding: 7bit > >> > >> Perhaps some did not appreciate the fact we had nowhere for i.v. > >access, > >> or was there somewhere else I could have gone (no reminders about an > >old > >> line of argument with dog's corpora cavernosa please). What about > >> intranasal with the skull fracture? > >> > >> Vic Calland > >> Eventmed UK Ltd > >> Training & Development beyond First-Aid > >> Visit the website: http://www.eventmed.co.uk > >> > >Yes, no problem. However, ketamine needs to be given at a much higher > >dose im; around 10mg/kg - > >yes, ten! The patient is then asleep for about 20 minutes. Did you > >consider a sternal IO? There > >are several papers on this, with this Israeli one being one of the > >first: > > > >J Trauma 1997 Feb;42(2):288-93 > > > >Bone marrow infusion in adults. > > > >Waisman M, Waisman D. > > > >Department of Orthopedic Surgery, Carmel Medical Center, Haifa, Israel. > > > >OBJECTIVE: To asses the feasibility and success rate of vascular access > >through intraosseous > >infusions in adults, in elective and emergency situations using a novel, > >automatic device, the bone > >injection gun. DESIGN: A prospective, nonrandomized trial. MATERIALS AND > >METHODS: Two > >groups of patients were prospectively selected over an 11-month period. > >Group 1: Adult patients with > >recent closed long bone fractures, who underwent orthopedic surgery to > >upper and lower limbs and > >needed regional anesthesia. Group 2: Adult patients who required > >emergency or semiemergency > >vascular access, in whom intravenous central or peripheral cannulation > >could not be established > >within a reasonable period of time. MAIN RESULTS: Fifty adult patients, > >aged 27 through 78 years, > >underwent the procedure, which was universally successful. In group 1, n > >= 31 patients; in group 2 (n > >= 19), 12 patients had multiple injuries, and seven underwent emergency > >resuscitation. In 76% of the > >cases, the needle was inserted into the area of the tibial tuberosity; > >in the reminder of the cases, the > >needle was inserted at the distal end of the radial bone and into the > >lateral or the medial malleolus. > >The success rate for an adequate insertion was 100% in this group of > >patients. No complications from > >the procedure were observed in this series. CONCLUSIONS: This study > >emphasizes the importance > >and feasibility of the intraosseous route for infusion of fluids and > >medications in emergency > >situations in adults. The use of an impact, high speed automatic needle > >insertion device provides a > >higher success rate of vascular access via the intraosseal route in > >adult patients. > > > > Resuscitation 2003 Feb;56(2):183-6 > > > >Successful intraosseous infusion in the critically ill patient does not > >require a medullary cavity. > > > >McCarthy G, O'Donnell C, O'Brien M. > > > >Department of Emergency Medicine, Cork University Hospital, Wilton, > >Cork, Ireland > > > >OBJECTIVES: To demonstrate that successful intraosseous infusion in > >critically ill patients does not > >require bone that contains a medullary cavity. DESIGN: Infusion of > >methyl green dye via standard > >intraosseous needles into bones without medullary cavity-in this case > >calcaneus and radial styloid-in > >cadaveric specimens. SETTING: University department of anatomy. > >PARTICIPANTS: Two adult > >cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green > >dye in peripheral > >veins of the limb in which the intraosseous infusion was performed. > >RESULTS: Methyl green dye was > >observed in peripheral veins of the chosen limb in five out of eight > >intraosseous infusions into bones > >without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: > >Successful intraosseous > >infusion does not always require injection into a bone with a medullary > >cavity. Practitioners > >attempting intraosseous access on critically ill patients in the > >emergency department or prehospital > >setting need not restrict themselves to such bones. Calcaneus and radial > >styloid are both an > >acceptable alternative to traditional recommended sites. > > > > Ann Emerg Med 1993 Jul;22(7):1119-24 > > > >Five-year experience in prehospital intraosseous infusions in children > >and adults. > > > >Glaeser PW, Hellmich TR, Szewczuga D, Losek JD, Smith DS. > > > >Medical College of Wisconsin, Milwaukee. > > > >STUDY OBJECTIVE: To evaluate the ability of emergency medical > >technician-paramedic (EMT-P) > >units to become and remain proficient in the performance of the > >intraosseous infusion procedure. > >DESIGN AND SETTING: Descriptive nonrandomized trial open to all patients > >meeting protocol > >criteria over a five-year period; prehospital urban and suburban area > >with a population of 951,000. > >PARTICIPANTS: One hundred fifty-two consecutive patients (age range, > >newborn to 102 years) who > >had intraosseous infusion line placement attempted by EMT-Ps. > >INTERVENTION: Jamshidi sternal > >intraosseous infusion needle placed in the proximal tibia bone marrow in > >patients requiring > >emergency vascular access for fluid and/or medication administration. > >RESULTS: EMT-Ps performed > >165 attempts on 152 patients with a five-year success rate of 76% per > >patient and 70% per attempt. > >Success rates per patient age group were 78%, 0 to 11 months; 85%, 1 to > >2 years; 67%, 3 to 9 years; > >and 50%, 10 years or older. Success rates were significantly higher in > >children 3 years old compared > >with children and adults 3 or more years old (P = .04). Proficiency was > >maintained over the five-year > >study period. Infiltration was the most common complication, occurring > >in 14 patients (12%). Errors in > >landmark identification and needle bending were the most frequent > >identifiable causes for > >unsuccessful attempts. Evidence of clinical response to fluid or > >medication infused was noted in 28 > >patients (24%). CONCLUSION: EMT-P units can successfully perform the > >intraosseous infusion line > >procedure in patients of all ages. Proficiency is maintained over time > >despite its infrequent use by > >individual EMT-Ps. > > > > > > > >Best wishes, > > > > > >Rowley Cottingham > > > >[log in to unmask] > >http://www.emergencyunit.com > > > >________________________________________________________________________ > >This email has been scanned using the CleanPort MEF antivirus > >system. Funded for members by the Doctors.net.uk Bulletin service > >How does this protect me? http://www.Doctors.net.uk/qualityemail > >________________________________________________________________________ > > > > > > > > > > > Dr.Marten C. Howes MRCP(UK) FFAEM > Specialist Registrar > Accident and Emergency Medicine > Royal Preston Hospital > Preston > PR2 9HT > Lancashire, UK > > > ________________________________________________________________________ > All email and attachments sent from http://www.Doctors.net.uk have been > scanned by the MessageLabs SkyScan antivirus system > ________________________________________________________________________ > > ________________________________________________________________________ > This email has been scanned using the CleanPort MEF antivirus > system. 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