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Intraosseous access

Mats Eriksson, Gunnar Strandberg, Miklós Lipcsey, Anders Larsson
BACKGROUND: Intraosseous (IO) access can be established faster than a venous or arterial access when there is an urgent need for rapid initiation of treatment. The access can also be used to draw marrow samples. The aim of the present study was to evaluate the potential use of IO samples for enzyme determinations using a porcine model. MATERIALS AND METHODS: Bilateral tibial intraosseous cannulae and an arterial catheter were used for blood sampling from five healthy anesthetized pigs...
September 29, 2016: Scandinavian Journal of Clinical and Laboratory Investigation
Paul T Engels, Mete Erdogan, Sandy L Widder, Michael B Butler, Nelofar Kureshi, Kate Martin, Robert S Green
BACKGROUND: Although used primarily in the pediatric population for decades, the use of intraosseous (IO) devices in the resuscitation of severely injured adult trauma patients has recently become more commonplace. The objective of this study was to determine the experience level, beliefs and attitudes of trauma practitioners in Canada, Australia and New Zealand regarding the use of IO devices in adult trauma patients. METHODS: We administered a web-based survey to all members of 4 national trauma and emergency medicine organizations in Canada, Australia and New Zealand...
October 1, 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Benjamin Azan, Felipe Teran, Bret P Nelson, Phillip Andrus
BACKGROUND: Vascular air embolism is a rare but potentially deadly phenomenon. Early diagnosis allows providers to initiate measures aimed at preventing further air entry, preventing the migration of air to the lungs, and mitigating the hemodynamic effects of pulmonary air embolism. CASE REPORT: An emergency physician used point-of-care ultrasound to identify intravascular air before embolization to the pulmonary vasculature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Bedside ultrasound can be used as a tool for early diagnosis of intravascular air...
September 9, 2016: Journal of Emergency Medicine
Sergio Bustamante, Shravan Cheruku
No abstract text is available yet for this article.
August 29, 2016: Anesthesia and Analgesia
Nils Markus Budach, Stefan Markus Niehues
A 69-year-old woman was taken to our emergency department after having been found unconscious. An intraosseous catheter was placed in the head of the right humerus due to inaccessible peripheral veins. With the suspected diagnosis of shock, pulmonary embolism, and mesenteric ischemia, a CT scan of the chest and abdomen was initiated. Pulmonary embolism and mesenteric arterial embolism could be ruled out at excellent image quality.
August 29, 2016: Emergency Radiology
Merlin Pinto, Anne Lee Solevåg, Megan OʼReilly, Khalid Aziz, Po-Yin Cheung, Georg M Schmölzer
AIM: Guidelines for newborn resuscitation state that if the heart rate does not increase despite adequate ventilation and chest compressions, adrenaline administration should be considered. However, controversy exists around the safety and effectiveness of adrenaline in newborn resuscitation. The aim of this review was to summarise a selection of the current knowledge about adrenaline during resuscitation and evaluate its relevance to newborn infants. METHODS: A search in PubMed, Embase, and Google Scholar until September 1, 2015, using search terms including adrenaline/epinephrine, cardiopulmonary resuscitation, death, severe brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and adrenaline versus vasopressin/placebo...
August 13, 2016: Neonatology
Daniel L Wolfson, Margaret A Tandoh, Mohit Jindal, Patrick M Forgione, Valerie S Harder
OBJECTIVE: Intraosseous (IO) access is increasingly being used as an alternative to peripheral intravenous access, which is often difficult or impossible to establish in critically ill patients in the prehospital setting. Until recently, only Paramedics performed adult IO access. In 2014, Vermont Emergency Medical Services (EMS) expanded the Advanced Emergency Medical Technicians (AEMTs) scope of practice to include IO access in adult patients. This study compares successful IO access in adults performed by AEMTs compared to Paramedics in the prehospital setting...
August 5, 2016: Prehospital Emergency Care
Thorsten Hess, Roman Böhmer, Florian Arndt, Gernot Lorber, Jochen Herrmann, Klaus Püschel, Thoralf Kerner
On-scene invasive emergency procedures, such as intraosseous puncture, are often unavoidable, when indicated, and present a challenge for the emergency physician. Personal, temporal or local conditions are often unsuitable. Even with regular intervention by the emergency medical service, "last resort" measures occur very infrequently, particularly in pediatric emergencies. For the first time, this case report presents the use of intraosseous access at the humeral head with children, with reference to indication, implementation, problems and risks...
July 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Timo Wille, Katharina Neumaier, Marianne Koller, Christina Ehinger, Nidhi Aggarwal, Yacov Ashani, Moshe Goldsmith, Joel L Sussman, Dan S Tawfik, Horst Thiermann, Franz Worek
The recent attacks with the nerve agent sarin in Syria reveal the necessity of effective countermeasures against highly toxic organophosphorus compounds. Multiple studies provide evidence that a rapid onset of antidotal therapy might be life-saving but current standard antidotal protocols comprising reactivators and competitive muscarinic antagonists show a limited efficacy for several nerve agents. We here set out to test the newly developed phosphotriesterase (PTE) mutant C23AL by intravenous (i.v.), intramuscular (i...
September 6, 2016: Toxicology Letters
Thompson Kehrl, Brent A Becker, Dell E Simmons, Erin K Broderick, Robert A Jones
BACKGROUND: Intraosseous (IO) access can be complicated by obesity. Successful placement of a 25 mm IO needle is unlikely when soft tissue depth exceeds 20 mm. OBJECTIVES: The authors examined the relationship between body mass index (BMI), the ability to palpate the tibial tuberosity (TT), and soft tissue depth at recommended IO insertion sites. METHODS: Obese emergency department patients were assessed for a palpable TT and received ultrasound measurement of the soft tissue depth at recommended IO insertion sites...
September 2016: American Journal of Emergency Medicine
Bryn E Mumma, Temur Umarov
BACKGROUND: Sex differences exist in the diagnosis and treatment of several cardiovascular diseases. Our objective was to determine whether sex differences exist in the use of guideline-recommended treatments in out-of-hospital cardiac arrest (OHCA). METHODS: We included adult patients with non-traumatic OHCA treated by emergency medical services (EMS) in the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) database during 2007-2009...
August 2016: Resuscitation
Piotr Zasko, Lukasz Szarpak, Andrzej Kurowski, Zenon Truszewski, Lukasz Czyzewski
No abstract text is available yet for this article.
June 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Sandeep Singh, Praveen Aggarwal, Rakesh Lodha, Ramesh Agarwal, Arun Kr Gupta, Renu Dhingra, Jayant Sitaram Karve, Srinivas Kiran Jaggu, Balram Bhargava
BACKGROUND & OBJECTIVES: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers. METHODS: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers...
March 2016: Indian Journal of Medical Research
Peter Hallas
No abstract text is available yet for this article.
March 2016: Indian Journal of Medical Research
Stacy L Muir, Lance B Sheppard, Anne Maika-Wilson, James M Burgert, Jose Garcia-Blanco, Arthur D Johnson, Jennifer L Coyner
UNLABELLED: Introduction Obtaining intravenous (IV) access in patients in hemorrhagic shock is often difficult and prolonged. Failed IV attempts delay life-saving treatment. Intraosseous (IO) access may often be obtained faster than IV access. Albumin (5%) is an option for prehospital volume expansion because of the absence of interference with coagulation and platelet function. Hypothesis/Problem There are limited data comparing the performance of IO and IV administered 5% albumin. The aims of this study were to compare the effects of tibial IO (TIO) and IV administration of 500 mL of 5% albumin on infusion time and hemodynamic measurements of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) in a swine model of hemorrhagic shock...
August 2016: Prehospital and Disaster Medicine
Lukasz Szarpak, Zenon Truszewski, Jacek Smereka, Paweł Krajewski, Marcin Fudalej, Piotr Adamczyk, Lukasz Czyzewski
UNLABELLED: Medical personnel may encounter difficulties in obtaining intravenous (IV) access during cardiac arrest. The 2015 American Heart Association guidelines and the 2015 European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) suggest that rescuers establish intraosseous (IO) access if an IV line is not easily obtainable.The aim of the study was to compare the success rates of the IO proximal tibia and proximal humerus head access performed by paramedics using the New Intraosseous access device (NIO; Persys Medical, Houston, TX, USA) in an adult cadaver model during simulated CPR...
May 2016: Medicine (Baltimore)
Amanjit S Baadh, Ayushi Singh, Andrew Choi, Palvir K Baadh, Douglas S Katz, Howard T Harcke
OBJECTIVE: Paramedics and hospital-based providers occasionally need to place intraosseous devices to obtain vascular access in critically ill patients. Diagnostic radiologists must be prepared for the emergent administration of iodinated contrast media via the intraosseous route, and interventional radiologists should be familiar with the potential clinical uses of such access. CONCLUSION: We present a protocol for the administration of iodinated contrast media through the intraosseous route...
August 2016: AJR. American Journal of Roentgenology
Tigran Garabekyan, Vivek Chadayammuri, Cecilia Pascual-Garrido, Omer Mei-Dan
Acetabular intraosseous cysts are frequently encountered in patients with dysplasia or femoroacetabular impingement. Small cysts are typically addressed by removing the cyst lining and stimulating healing via microfracture or abrasion chondroplasty. In contrast, larger cysts involving 1-3 cm(3) frequently require additional fortification with bone graft material to facilitate osseous ingrowth and cyst healing. Previous arthroscopic reports have described the use of rim trimming to access the extra-articular side of the cyst, with subsequent use of straight metal cannulas for delivery of bone graft material...
February 2016: Arthroscopy Techniques
Yonatan Y Greenstein, Seth J Koenig, Paul H Mayo, Mangala Narasimhan
OBJECTIVE: Current guidelines recommend the use of intraosseous access when IV access is not readily attainable. The pediatric literature reports an excellent safety profile, whereas only small prospective studies exist in the adult literature. We report a case of vasopressor extravasation and threatened limb perfusion related to intraosseous access use and our management of the complication. We further report our subsequent systematic review of intraosseous access in the adult population...
September 2016: Critical Care Medicine
Marc R Wong, Matt J Reggio, Freddy R Morocho, Monica M Holloway, Jose C Garcia-Blanco, Constance Jenkins, Arthur D Johnson
BACKGROUND: Interruptions in cardiopulmonary resuscitation (CPR) to obtain vascular access reduces blood flow to vital organs. Tibial intraosseous (TIO) access may be a faster alternative to intravenous (IV) access for delivery of vasoactive medications. The purpose of this study was to examine the differences in pharmacokinetics and pharmacodynamics of TIO- and IV-delivered epinephrine. MATERIALS AND METHODS: A prospective, between subjects, experimental design comparing Cmax, Tmax, return of spontaneous circulation (ROSC), and time to ROSC...
April 2016: Journal of Surgical Research
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